Debate has arisen at my workplace over the best "last resort" for placing peripheral IVs for home infusion of antibiotics. Patients are sent home with pumps that administer antibiotics at regular intervals (q8h, q12h etc). Usually we try to place IVs in the forearm (not hand, not wrist, not ac). There is no workplace policy for or against hand placement, however policy does state that AC should be reserved for emergencies only. What practices or policies are followed elsewhere? Thanks.
Why doesn't the patient get a PICC?
Under some circumstances they might. However I am hoping to gather information, policy, practice, fact or opinion on which placement location is better or at a mininum least hazardous.
The goal should be proper planning for vascular access so you do not reach the "vein of last resort". You should plan vascular access from the very first encounter with the healthcare system and you should be choosing the type of vascular access device that has the greatest likelihood of reaching end of therapy with the minimal number of devices used. Use of short peripheral catheters until all veins are exhausted is far below the current standard of practice and should not be allowed for any patient. Both CDC and INS documents state that if therapy is to be needed longer than a week, you should consider a PICC or midline catheter. Then you must consider the final osmolarity and pH of the therapy to determine if it is appropriate for infusion therapy peripheral veins - See INS Standards of Practice for more info. This document also states that all areas of joint flexion should be avoided and that site selection should begin low and work upward. So if you are practicing according to these standards, there will never be a chance to reach the point you have described. For home care hand veins are often avoided due to patient activity. But you should start low in the forearm, always avoiding the wrist and the AC. There are more nerves located in those areas and you have a much greater chance of damage to those nerves with venipuncture in the wrist and AC. So for home care patients, never hand nor the AC would be the best or safest choice. Only forearm veins should be used for peripheral catheters. If therapy is needed for longer than a week you must be more proactive about getting a PICC or midline (depending on pH and osmolarity) before the patient is accepted by the home care company. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861