In 2011 paramedics in NH have been able to access a port in the field. I am wondering if other states allow this and what is the protocol for changing the needle? Is it considered prehospital? Does it need to be changed in 24 hours?
In 2011 paramedics in NH have been able to access a port in the field. I am wondering if other states allow this and what is the protocol for changing the needle? Is it considered prehospital? Does it need to be changed in 24 hours?
Pre-hospital or where an IV site was inserted is not the criteria for changing within a specific period. The criteria is what the conditions were under which the site was accessed or the IV catheter inserted. The CDC and INS statements both focus on those conditions. If the EMS people had time to do proper aseptic technique, the catheter does not need to be changed within the designated 48 hours or as soon as the patient is stable. On the other hand, any time the device is not inserted under the recommended aseptic conditions, that device must be changed asap or no longer than 48 hours. This applies to any location inside or outside the hospital and to all catheters, including CVADs. Most implanted ports are the patient's lifeline for critical therapies. If the conditions of the patient and situation do not allow for aseptic technique, then I would not want anyone touching an implanted port and would prefer that they start another peripheral site which can be more easily removed. Lack of aseptic technique would contaminate the implanted port, a surgically inserted CVAD, much more costly and difficult to remove and replace. The flip side of this is that the patient with an implanted port may not have veins that can easily be found and cannulated in an emergent situation. So it is a catch-22 situation, but I would have a hard time with EMS accessing ports without strict aseptic technique. Eager to know what is being done in other states. 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
Lynn,
In Ohio the paramedics are starting to be taught to access ports. They must have education first. I am working on a program now to teach about central lines and port access. I think it should be trained IV specialist to teach that way aseptic technique could be stressed.
Lisa
Lisa- Would you share this once it is complete? [email protected]
What will you be teaching about a situation where it is a true emergency and their is no time to do aseptic technique for fear of loosing the patient totally? I am curious about what critical thinking will be stressed for these situations. 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
I used to have to travel in the ambulances a lot as I worked in a small rural ER, we would stabilise the patient then transfer to a tertiary hospital. so a hospital to hospital transfer. Often on the way back home we would be diverted to an emergency and it was our bad luck and have to stay with the ambulance.
I am guessing that the system is similar, but realise I am not USA.. there are different levels of ambos, and those who had climbed the ladder slightly would take any vein, and stab it often if the patient didnt even need a PIV, when questioned it was well I have to keep my experience up for when the real emergency arises. and absolutely no cleaning of the area at all, asepsis is left back in the ambulance bay.
Also it was an area where a lot of extreme sports were played, so many fractures or sprains, in they would come, and yes a huge 16 g needle insitu, for a sprained wrist.. once again when asked why since the hospital was just 10mins away.. we need the practice.
As being one with a port, Id be horrified at these gunho cowboys being allowed to access my port. I found those I worked with that they felt if they didnt have to clean for a real emergency then they didnt need to for an accident attendance.
I do not mean to be generalising, but I did attend the ambo lectures held, so that I could learn to be better for these return trip diversions.. and despite hearing them[ ambo attendees] being taught the need to be clean when inserting PIV, it was all forgotten at the roadside/sports arena.
I guess not seeing the patient suffer sepsis later or blaming the original injury for that, makes the need for asepsis less important than the chance to have a go..
So agree training would have to be really rigid and well maintained..