I've been searching for evidence based data about starting peripheral IV's in uncommon areas, ie, breast, chest, etc. I found this same question asked in the past on the forum. I agree with the answers that were provided, but is their any evidence out their to support not using these veins routinely?
I would like to present this scenario to this group of experts: A female patient comes in to the ER that has a chronic condition and is frequently in and out of the hospital. Her condition is stable and not life threatening. She has had multiple central lines (IJ, SC, Femorals and PICCS) and has extinquished all veins appropriate for peripheral access even using ultrasound. She can no longer be accessed for a bedside PICC insertion by the IV Team. It is after hours and she needs access for fluids, antibiotics and pain meds. She insists that the ER nurse start an IV in her breast because that is all that can be obtained in her. The ER physicians do not want to attempt a central line. I'm not sure that an EJ IV was attempted. The IV is started in her R breast and she is admiited in to the hospital which of course after 2 days the R breast IV develops grade 4 phlebitis.
I agree this is dangerous practice and should not be done unless it is a life threatening emergency and used temporarily until the patient becomes stable and can be given better venous access. I also agree that the staff need education in order to change this practice but am unable to find anything to deter it. I would appreciate any help that can be given from this group of experts. I thank you in advance for your time and information.
Below is the posted past forum...
I would agree totally with
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
This practice is danger and
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, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Blog http://hadawayassociates.blogspot.com/
Office Phone 770
IVs 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