Does this make you crazy too?? It does make me crazy. It is a rarity, but really......how long do they think this will last? The only time I see this is from the ED.
This practice is danger and has absolutely no evidence to support its safety. Extravasation in this area could easily mean a mastectomy for the patient. This can and has happened with extravasation from central venous catheters. In fact, I have a legal case of this nature right now. So insertion of short peripheral catheters in the chest or abdominal wall has no scientific basis, and can be excessively risky. You must educate the nurses about this and do whatever it takes to get them to change their practice. But I would also listen to them about why they think it is necessary to use these sites. Is it truly a case of a crashing patient and there are no veins of any extremity to find? Is this a dehyrated patient and the peripheral veins do not easily distend? Is this a case where the nurses have never been taught the correct skills for locating and palpating peripheral veins? I see this as the primary issue in most cases. Nurses do not know how to palpate properly, so if there are no easily visible veins in the hands, wrist or antecubital fossa, they think there are no veins at all. This is simply not correct. If they do have a valid need for some patients, I think they should be trained in use of US for PIV or insertion into the EJ for temporary access. Lynn
I would agree totally with Lynn on this and would add that intraosseous infusion should be thought of and used WAYY before you'd ever look at a breast vein.
The terms "emergency and "chronic" (frequent hospitalizations) indicate two different plans of care to solve the problem of iv access. As I have posted before, I have placed peripheral lines in non-traditional areas (never a breast though) in emergent situations for specific reasons based on the risk/benefit to that particular patient in that particular scenario. To "routinely" do that by definition increases the risk of having a complication. A"chronic" scenario as you describe requires medical management based on a team approach, perhaps an infusaport for example. I do not know if other avenues were explored with this particular patient PRIOR to her return to the ER with her LAST hospitalization. If not, they should have been. Is the patient aware of the risks of having an IV in her breast? Just because she insists and the fact that it was done before does not make it right nor safe.
Therefore, you then need to find a temporary solution in the ER before you can treat the chronic issue of poor vascular access. If the ER physician elected not to place a central line, I can assume then that the risks outweighed the benefits. Therefore I assume the patients condition was not seriously life threatening. Consequently, for the nurse to assume that risk by placing a "risky" PIV in the breast ("because the patient insists") in this situation is to walk a legal tightrope, especially (as Lynn indicated) if things do go wrong. IV fluids by themselves if infiltrated pose a risk for injury. IV pain meds & IV antibiotics increase that risk exponentially!! As a nurse, and as an "IV Specialist" I would ask: were other avenues explored? Can the antibiotics can be given PO or IM? Can the pain meds can be given PO or IM? Could the patient tolerate PO fluids? If not, and her conditon is NOT life threatening, can she do without fluids until a vascular surgeon is consulted? Is clysis appropriate in this case? I personally feel intra-osseous is a bit extreme in the awake, alert, and non-emergent patient, but was this also discussed by the members of the ER team with the patient?
I'm not even going to discuss the problems inherent in sending this patient to a regular medical floor with a PIV in her breast!
In conclusion, I personally feel "routine" PIV starts in "non-traditional" veins is not appropriate by definition of the word "routine". These situations need to be handled on a case by case basis based on risks/benefits to the patient. In the scenario as you describe & based on the info provided, I personally would NOT have placed a PIV in the breast.
Does this make you crazy too?? It does make me crazy. It is a rarity, but really......how long do they think this will last? The only time I see this is from the ED.
Gwen Irwin
Austin, Texas
This practice is danger and has absolutely no evidence to support its safety. Extravasation in this area could easily mean a mastectomy for the patient. This can and has happened with extravasation from central venous catheters. In fact, I have a legal case of this nature right now. So insertion of short peripheral catheters in the chest or abdominal wall has no scientific basis, and can be excessively risky. You must educate the nurses about this and do whatever it takes to get them to change their practice. But I would also listen to them about why they think it is necessary to use these sites. Is it truly a case of a crashing patient and there are no veins of any extremity to find? Is this a dehyrated patient and the peripheral veins do not easily distend? Is this a case where the nurses have never been taught the correct skills for locating and palpating peripheral veins? I see this as the primary issue in most cases. Nurses do not know how to palpate properly, so if there are no easily visible veins in the hands, wrist or antecubital fossa, they think there are no veins at all. This is simply not correct. If they do have a valid need for some patients, I think they should be trained in use of US for PIV or insertion into the EJ for temporary access. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I would agree totally with Lynn on this and would add that intraosseous infusion should be thought of and used WAYY before you'd ever look at a breast vein.
Wendy Erickson RN
Eau Claire WI
PIV in chest, breast
The terms "emergency and "chronic" (frequent hospitalizations) indicate two different plans of care to solve the problem of iv access. As I have posted before, I have placed peripheral lines in non-traditional areas (never a breast though) in emergent situations for specific reasons based on the risk/benefit to that particular patient in that particular scenario. To "routinely" do that by definition increases the risk of having a complication. A"chronic" scenario as you describe requires medical management based on a team approach, perhaps an infusaport for example. I do not know if other avenues were explored with this particular patient PRIOR to her return to the ER with her LAST hospitalization. If not, they should have been. Is the patient aware of the risks of having an IV in her breast? Just because she insists and the fact that it was done before does not make it right nor safe.
Therefore, you then need to find a temporary solution in the ER before you can treat the chronic issue of poor vascular access. If the ER physician elected not to place a central line, I can assume then that the risks outweighed the benefits. Therefore I assume the patients condition was not seriously life threatening. Consequently, for the nurse to assume that risk by placing a "risky" PIV in the breast ("because the patient insists") in this situation is to walk a legal tightrope, especially (as Lynn indicated) if things do go wrong. IV fluids by themselves if infiltrated pose a risk for injury. IV pain meds & IV antibiotics increase that risk exponentially!! As a nurse, and as an "IV Specialist" I would ask: were other avenues explored? Can the antibiotics can be given PO or IM? Can the pain meds can be given PO or IM? Could the patient tolerate PO fluids? If not, and her conditon is NOT life threatening, can she do without fluids until a vascular surgeon is consulted? Is clysis appropriate in this case? I personally feel intra-osseous is a bit extreme in the awake, alert, and non-emergent patient, but was this also discussed by the members of the ER team with the patient?
I'm not even going to discuss the problems inherent in sending this patient to a regular medical floor with a PIV in her breast!
In conclusion, I personally feel "routine" PIV starts in "non-traditional" veins is not appropriate by definition of the word "routine". These situations need to be handled on a case by case basis based on risks/benefits to the patient. In the scenario as you describe & based on the info provided, I personally would NOT have placed a PIV in the breast.
IV GUY
IV GUY