Hello!
CDC regulations as well as INS standards (44.3) state that VAD "placed in an emergency situation", should be replaced as soon as possible no longer than 48 hours .
To be sure I am understanding this correctly, if a patient arrives in the EOR and has an IV placed , when the "emergency " is resolved, and the patient is transported ( or before) this VAD should be replaced?
Have you ever heard of a similar standard ( replace within 48 hours) for pre-hospital peripheral IV placement ( ex transported from a nursiing home) or antecubital IV placed in an emergency situation?
Thanks for your comments.
Mary
The issue is not the location of the patient when the IV was placed. The issue is the criticallity of the patient and whether the first responders had the time to perform aseptic technique. If the patient is crashing and there is no time for appropriate skin antisepsis, no adequate stabilization and dressing, then it should be changed ASAP and no later than 48 hours. BTW, this would apply to those cardiac arrest within the hospital as well and CVADs in the field, ER, or hospital. The information appropriate for subsequent caregivers to make the right decision has never been included in the hand-off communiucation. So changing the catheter falls through the cracks. I would strongly recommend focusing including the appropriate information in this hand-off communication rather than where the patient was located when the insertion took place. A crash on the interstate in the pooring rain in a comatose patient with decreasing BP - change it. A patient in their home complaingin of abd pain but vital signs are stable - EMS should have time to use appropriate aseptic technique. I have seen this be an issue in a couple of legal cases. Also, the catheter should be changed as soon as the patient is stable and not later than 48 hours. So it should not be allowed to remain in situ for 48 h if the patient is stablized. This standard does not address an IV catheter in the antecubital, however I would always change those to a more reasonable and comfortable site in the opposite arm, giving that antecubital site time to heal before making another stick below that ACF site. ACF sites have more complications and it is never comfortable for the patient, so it should be changed also. This may or may not be an infection prevent issue but would easily prevent phlebitis and infiltration/extravasation occurring in the ACF. 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