I am interested in sharing your feedback with the Emergency Nurses listserv that I subscribe to. They have an interesting discussion thread regarding placement of PIV in the mammary vein. A couple of users have mentioned an interest in what infusion experts would say or recommend regarding the practice - here are a couple of the comments and I will share your responses with them. I am not a CRNI, but an RN and I represent a new SPIV catheter and am often asked questions about this practice. Of course I do not believe this practice should be commended but I frequently hear that there is not an IV team available in these hospitals and in the ER they do "what needs to be done"...below are the comments on this discussion.
Thanks in advance!
Melissa
As the Educator of a large Emergency Department, I received several calls over the past couple of years where this occurred. I was notified by the Nurse Manager of the Vascular Access team, and generally dressed down for having this happen. She reported this is not a site endorsed by the Infusion Nurses Society. While I am not a member of that organization, I would like to know what their position truly is on this, as well as ENA's position, since it does seem to happen. While not ideal, if utilized for the short term and watching closely for complications, perhaps it is an alternative. Or...people may have to insert IO instead!
. We do this in my ED as a LAST RESORT
Ok…here is a doozy. Don’t shoot the messenger, ok? J
A colleague and I were discussing the following question and I said I would post for a reply. Can a nurse insert a peripheral IV catheter into a vein in the patient’s breast?
There has been lots of previous discussion about this issue on this forum. My response is NEVER, not anyway, not any day for any patient. There is too much risk and we now have better alternatives. First the nurse must ask, why is there such prominent veins in the breast or chest area? This could easily be from some type of collateral circulation build up because of previous trauma or thrombus. These veins would be very small and tortuous. How would you distend them to make the puncture? These venous sites are NOT mentioned in the INS Standards of Practice or the INS textbook. On the other hand, we now have ultrasound and infrared light devices to increase the success of finding veins of the upper extremity. And as was mentioned, there is IO which should be employed on a rapid basis. Why should you waste time in searching for a peripheral vein if the patient needs meds fast? Insert the IO, give the needed meds, and then use the next 24 hours of the IO dwell time to obtain a consult with an infusion/vascular access nurse specialist. In a malpractice case, I would bring all of these issues into my expert witness testimony. There would also be no studies supporting this as a safe and acceptable site because those studies have not been done. So no evidence to support this decision. Finally, I have seen some horrible extravasation injuries from implanted ports that resulted in complete mastectomy. This could easily occur with a peripehral catheter in a breast or chest vein. So the bottom line is, in my opinion, use of these veins falls below the standard of care and the nurse could easily be held liable for this practice. Of course, no one can predict the outcome of a legal case but this is far too much risk for the nurse and/or hospital to accept. 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
Thanks Lynn for your quick response. I have shared that with the ENA Listserv, it is a very busy group so I hope today we have gotten them to consider other options. Have a great weekend!
Melissa Smith RN, BSN
Lynn,
I completely agree with what you are saying and have repeated this over and over to ED staff. Is there a position paper or standard that addresses this per INS? I looked at standards and it says where you should place peripheral lines but it doesn't address to not place it in the mammary vein. Staff are asking for evidence or standard.
Thanks,
Kimberly BSN, VA-BC
I just wrote an posted a blog message on this issue - www.hadawayassociates/blog. A standard can not be written when there is absolutely no evidence upon which to base that standard. Standards are no written based on professional experience or opinion. I have never found anything pro or con about chest/breast veins for insertion of a peripheral catheter, but in my opinion, it would be extremely bad practice. And in a court of law, an expert's opinion would be the basis for the jury's decision - whichever expert (plaintiff or defense) is the most believable to the jury. Do you want it to go that far? If reason and the information I wrote in my blog post will not change their practice, then it may come down to a lawsuit. Hope not. 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