Why are we starting IVs again?
EMS seems to have a “technological imperative” when it comes to our allotted “monkey skills”. The day they put a new toy on your rig is the day you suddenly find a need for it. Venous access is no exception. Now granted, starting IVs is not a new addition to the EMS scope of practice, we’ve been doing that for years. And the ability to start them isn’t the only driving factor. Crews that I’ve spoken to often reference the appreciation of the hospital staff for starting an IV. Other crews reference complaints by the hospital staff that an IV wasn’t started. Call it a healthy mix of availability and peer pressure.
In a 2011 article published in the Journal of Vascular Access (did you know there was one of those?) authors review a cohort of patients transported to a single emergency room and evaluate whether IVs were actually used after they were placed. Here’s the abstract:
J Vasc Access. 2011 Jul-Sep;12(3):193-9. doi: 10.5301/JVA.2010.5967.
Indication and usage of peripheral venous catheters inserted in adult patients during emergency care.
Göransson KE, Johansson E.
Department of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden. firstname.lastname@example.org
PURPOSE: The aim of this study was to identify the underlying decisions taken regarding the insertion of prehospital peripheral venous catheters in adult patients and, additionally, to ascertain peripheral venous catheter insertion rate and explore prehospital and hospital (within 24 hours of insertion) pharmaceutical treatment via peripheral venous catheters.
METHOD: This cross-sectional study gathered data through a study-specific questionnaire and patient record auditing. We distributed a study-specific questionnaire to be completed by ambulance crews, and carried out patient record auditing for 345 patients (median age 64 years, range 18-97 years) arriving at the emergency department at a Swedish level-1 trauma center in October 2008.
RESULTS: Of 135 patients (39%) arriving at the emergency department with a peripheral venous catheter, 94 (70%) had received the device because the ambulance crews intended to use it for intravenous therapeutics (of which analgesics, intravenous fluids, and psycholeptics were most frequently used). In 30 patients (22%), the prehospital inserted device was not used by the ambulance crews or at hospital within 24 hours. The corresponding rate of unused peripheral venous catheters inserted in patients after arrival at the hospital was 35%.
CONCLUSIONS: We found that the main reason for the ambulance staff to insert a peripheral venous catheter in a prehospital setting was that they intended to use the device. Further, the rate of unused peripheral venous catheters was lower among prehospital peripheral venous catheters than hospital.
The results pretty well speak for themselves. It should be noted that this analysis only took place at one hospital. I also know that compared to my system, 39% of patients receiving an IV is relatively low. The important thing to remember is that an IV is an invasive procedure. Simply starting one because you can or because “someone might use it later” may not be the best thing for your patient. Every IV increases the risk for healthcare-acquired infections.
What about you? Do you routinely start prophylactic IVs? Why or why not? Let me know in the comments.