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Recently, an ICU RN "expanded" our PIV Therapy policy and placed an IV in a patients leg 2 inches above the ankle, inner aspect because the patient was septic requiring IV antibx and had already been "no peripheral access" by the IV Team.  What have other facilities done when there is a life threatening situation dependent on IV access when there are no other alternatives (PT/INR, co-morbidities, etc not consistent with central lines placement)?  I appreciate your feedback.
rivka livni
In 25 years as an ICU nurse,

In 25 years as an ICU nurse, when it's life threatening situation as you described, when we needed an IV we put it where ever we could find a vein, once the patient is more stable, you get a safer, better IV access.

With today's good Ultrasound venous imaging, I would say that someone with  good technique should be able to get a decent IV access despite abnormal labs.

I am not sure what you mean by co-mobidities, but if there is no documented complete occlusion of central veins or severe central venous stenosis, a CVAD should be able to be inserted with Ultrasound guide.

From a clinical standpoint,

From a clinical standpoint, Rivka is correct. In an emergency, you place a catheter whereever you can find a vein. But a better access must be found when the patient is stable. I would agree that veins of the feet and legs in adults and all children of walking age should not have the feet or legs used routinely. 

From an administrative standpoint, you used the phrase "expanded our PIV Therapy policy." This is a serious problem if it means what I think it means. A policy should be considered non-modifiable and nonnegotiable for all circumstances. The nobody can alter a policy for individual patient circumstances. This is the very reason that you must be extremely careful about what you write as a policy. You can write this as a practice guideline but it you have it written as a policy, you have taken away the ability of the nurse to use approrpriate judgment in caring for patients. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

 The site you describe

 The site you describe sounds like the saphenous vein,which while not anybody's first choice does at least offer a fairly straight path to the IVC and in dire situations it can be pretty handy. There are worse sites for IV's. When a patient is critically ill and you have 12 IV pumps running,any patent IV is a good IV. 


David Longseth,RN

Trauma Life Support Center

University of Wisconsin Hospital

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