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Pain and swelling with a nontraumatic peripheral IV start in the mid forearm

I started a peripheral IV saline lock in a relatively healthy patient in his mid forearm cephalic vein on the first attempt. I used a 20G, one inch BD Insyte catheter. Used 2ml of normal saline  to flush. During catheter insertion, the patient reported pain. Approximately four to five minutes later, the patient continued to report pain, though his pain level had decreased.  I removed the catheter and placed another in his left hand without incident. After the patient's procedure, I assessed the initial, troubling site and observed mild swelling. The patient reported mild pain to palpation adjacent to the insertion site. I applied an ice pack and the swelling diminished but did not disappear. The patient was discharged. The only infusate was the 2 ml flush. My rationale for the pain was nerve involvement. Would that explain the swelling?

Yes it could be nerve

Yes it could be nerve involvement with the swelling. You did not describe the type of pain. Nerve pain is usually tingling, electrical shock like pain, pins & needles or numbness. There is no way to make a venipuncture and avoid hitting nerves because they are so close together. To meet the standard of care and avoid litigation, the nurse should always remove the catheter when there is pain such as this. Lawsuits happen when the nurse ignores the complaints, does not remove the catheter and continues to use it. You did the right thing. Lynn

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

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