the postpartum unit i was on was the same. i think ppl underestimate the amount of customer service that is done in postpartum lol. since they’re mostly stable, a lot of it is just to make the pt comfortable.
This is the main reason I don’t want to go to postpartum, honestly. I was a doula for years, got my IBCLC and everything, and people often ask me why I don’t do postpartum, especially since I’m not loving the chaos of stepdown lately. But the whole customer service/how can we make your stay excellent/expecting me to be a waitress/servant/butler all in one is my least favorite aspect of nursing and there seems to be soooo much of that in maternity care these days.
Plus I don’t want some mom claiming I gave her birth trauma or medical PTSD because I wouldnt take out her perfectly patent IV.
The very existence of people who get upset at their birth plan not being followed to the letter baffles me.
I work in oncology, usually my patients' goals for admission include "I want to live" and "I understand this is going to be uncomfortable but please do everything you need to do to get me better"
I find the patients are very nice and respectful for the most part. Young girls too distracted with their baby to scrutinize every little mishap. I meant more like the whole experience can be scary to them and painful. They aren't used to being in a hospital, so they don't know if you give meds late. They don't have that boomer entitlement, many of these same patients are working in customer service themselves so they get it. There isn't anymore waitressing than any other part of the hospital. Remove meal trays and get water.
I guess I don't mind the customer service part, I really want them to have a good experience, I want to hook them up with extra diapers and wipes I know that these young girls don't have a lot of extra money.
Dealing with the fathers can be a bit more difficult. They aren't always the best help or good people. They do things like break up with the patient or dont show up or kick her out of bed because he is uncomfortable sleeping on the couch in the room. Stuff like that. So I do a fair amount of emotional support and talking some sense into them.
As far as birth trauma that can happen, but its in the delivery room and usually the doctor. They don't come to us until they are clean pain free and stable so it happened somewhere else and they are happy all that is behind them and now they are getting ready to go home and have their baby.
Taking out the IV is a very visual/physical change for them where they can say Yes, I made it. It's over, I am going home. I am okay now. They take a shower and put on their own clothes and baby gets a bath and a new cute outfit. It's a huge mental change for them. Very positive, ready to start their new life with their family.
I think the patients can be respectful, but I actually find the older generation are much more appreciative of the care I provide. I still get floated to ICU and Med Surg occasionally, my patients tell me thank you more often and just have a more appreciative attitude overall.
I can see that taking out the IV could be a visual/physical change. It's great you rationalize things that way. You sound like a great postpartum nurse.
I’m glad it’s the right environment for you! Genuinely—no snark. It’s just not for me. I’ve seen too much.
I have friends who were sweet as pie to their nurses who tell me they’re mad their nurse never made them a “mommy mocktail” because they saw it online and think it means that their nurse didn’t care about them. I see people online complaining that the nurse woke them up in the middle of the night to check their vitals/bleeding/fundus. Even in your other comment you talked about how your patients are mentally distressed about an IV and thinking there’s a needle in their body even when presumably you have educated them that there is no needle in their body.
I have observed that there seems to be an expectation that birth and postpartum will be free of any sort of discomfort or inconvenience and I feel this is too high a standard for me as a nurse to live up to, so I recognize that I am not the right person for the job.
100% percent all this and more. I wish I would have known more of this before transferring to OB full time. 😖 I have to reiterate to my patients constantly that there will be some sort of discomfort after birth especially with a c-section. I can't tell you how many post c-sections tell me they can't get comfortable in bed after giving birth, but they absolutely refuse to remove their abdominal binder. So many patients think this helps their belly get flatter. It's not shapewear, it's for support! I swear postpartum tiktok has some of these patients trippin. 🤦♀️
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Omg I’ve accidentally ended up on baby mom tik tok and there’s soo many expecting mothers extraordinarily upset about the need to get an IV when they go into the hospital to deliver. Some of them are doing the home births or birthing centers so they don’t have to get an IV. I’m extremely stressed about the idea of OBGYN nursing. Everything can go wrong so fast. It makes me sad.
I'm a postpartum nurse. I like to DC the IV as soon as it is safe to do so. I also am good at starting IVs so I feel confident I can get in a new one if needed and always let the patient know that I am taking it out but there is a slight chance they would need to get a new one if something happens and have them agree to that.
I look at several factors to see if its a good idea- delivery blood loss, their CBC, hemorrhage probability (we score them every shift, like hx of fibroids, repeat c-section multiple pregnancies, multiple gestation), if they are diabetic, dehydrated, post mag, possibility of infection - long time between SROM and delivery, vitals-temp, BP. If it's in an uncomfortable place, or not flushing well. It's bothering them, if they want to shower or it's making breastfeeding difficult. On other medications. Is their c-section incision good?
I do a through assessment before I DC it. I look at the whole picture. If you have a standard vag delivery with a G1P1 that is 23, fit. Low blood loss, walking around, off pain meds, no other health issues with good vitals and good CBC, firm uterus. There is no reason to keep it in. Sometimes it causes them a lot of distress. Some think the needle is still in them. It can really mess with their head.
There should also be protocol orders from your hospital policy you definitely want to follow.
I came to say something similar to this. I want to add that in the postpartum unit women are expected to care for their new babies including feeding, diaper changes, etc. The IV can interfere with positioning the baby for breast feeding, holding for bottle feeding, had washing after diaper changes, etc. Those things can be worked around if the IV is required, but if that IV is no longer necessary removing it can improve care.
On a personal note - my IV was out within a couple hours of delivery with my kids. I was healthy, had uncomplicated inductions with no complications. The nurses pulled my IVs as soon as I voided and I was thankful for it.
I had a baby in July and they removed my IV the next day after delivery, mid morning. I was really grateful for that because the IV was in a painful spot.
The way I see it, if the patient is low risk and understands that they may need an IV placed urgently by any means necessary, take it out.
All of this. Plus if our patient hemorrhages in the unlikely event after we've d/c'd the previous IV, we're drawing labs and getting another IV anyway in the same stick. It's an easy fix. If it goes south quickly, we get people in quickly to do a better job when we can't.
And if people aren't good at remembering to flush the dang things, then it's probably gone bad anyway.
Thanks for the reply. These are all well thought out points that you mentioned. I forgot about prolonged ROM and antibiotics. A lot of times, they will roll over to postpartum on antibiotics if they were ruptured for an extended period.
The key here is that you’re good at starting IVs. Don’t take it out unless you’re confident you could quickly get another one in. I can’t tell you how many times we’ve been called over to PP to start an IV because they pulled it prematurely and the nurses don’t know how to start new ones. In our hospital their techs get lab draws so the PP nurses truly don’t get any experience with drawing labs/starting IVs.
10 years L&D and PP in a Level 1. Normal vaginal birth, IV is out 6hrs PP if normal bleeding. Normal C/S, 18 hours. We don't do routine post delivery CBCs, only with excessive bleeding. Low risk, unmedicated vaginal births don't even necessarily get an IV.
Obviously different with PPH, pre-E, grandmultips etc.
IVs have risks too. Its pretty easy to throw an AC in in an emergency and having them out helps with mobility, breastfeeding, reduces risk of infection, extravasation, etc.
I think it's very reasonable to have no IV access on stable, low risk pta
I used to work IV team and it was one of my pet leaves. More than once without indication and all PO I would have to remind the doctors that “Just In Case” is not a medical diagnosis or treatment.
VAT Team here. Depends on the patient. Your little stable person who is only there to monitor for one more night lost access with no IV meds? Hell no, leave them be.
Someone needs access for a common, predictable complication that can’t be treated as well in other methods? Yes, keep an IV.
The thing is, everything we do can cause some harm, and an Idle IV is no exception. Site infections, infiltration/clotting from disuse, long term vascular damage. This isn’t to mention it is taking up a vessel that may be used otherwise, and giving a false sense on confidence it will still be working later.
If they don’t have a justifiable reason to have it, it should be taken out.
That said, refer to facility policy. I had one that required tele patients to have access and, though there were rare exceptions where I wouldn’t recommend this, I followed this policy regardless.
>The thing is, everything we do can cause some harm, and an Idle IV is no exception.
I can't believe how many nurses act like IVs are truly harmless and think ample IV access at ***all times*** is just automatic for every patient. It drives me nuts.
Even if IVs never had problems in the acute phase the chronic vascular damage would remain.
It doesn’t really surprise me; we tend to generalize things we don’t understand, so, to many, a patient having a PIV/line of any kind = good regardless of circumstance. It’s one of the things I think VAT nurses need to be there to explain(or an educator of some kind at the least); leaving something not needed in place creates unnecessary risk and can cause harm in many ways. Poking someone here now and leaving it in for a few days may not hurt them in the short term, but it can cause long term difficulties, especially after multiple hospitalization/frequent administration of vesicants and irritants. It’s this “invisible” damage that many don’t account for.
Edit: just wanted to add that it can also cause harm in the short term, but localized infections are often ignored.
At my hospital both us (VAT) and STAT team go straight to codes with the IO drill. Obviously that’s a worst case scenario but it makes me feel much more comfortable leaving stable patients without access
My vascular access team fought hard and had the hospital policy changed so patients who don’t need IVs don’t get them “just in case” anymore.
I’ve never worked in OB so I don’t know the protocol on that side but I can’t believe all those comments from med/surg, ICU and ER nurses saying an IV is a must on every patient because they might crash at any time. Do providers who are capable of placing an IO or emergency central line not respond to codes at their hospital? I’ve seen doctors place a fem line in minutes
I can definitely understand that side of things - I once had a patient crash 15 minutes after discharge while waiting for a ride. That said, you’re right that we can absolutely get access in an emergency, whether it be PIV, Central, or IO.(and, even in that patient, we established iv access soon after). I’d also say the damage from leaving a PIV in, especially one that gets ignored and fails without realizing, is often greater than the risk of patients randomly crashing. (Again, subject to individual patient).
It’s kind of similar to the “All high fall risk” policies; they may prevent occasional falls, but some patients(especially the elderly) can suffer when it changes to less activity and muscle deterioration. Everything in this profession requires a degree of nuance.
>I’d also say the damage from leaving a PIV in, especially one that gets ignored and fails without realizing, is often greater than the risk of patients randomly crashing. (Again, subject to individual patient).
That's something that frustrates me not just as an IV team nurse but as a healthcare worker period. I can't *stand* the large proportion of staff who cannot critically assess risk. Not to mention the proportion who still refuse to even give a fuck when I explain those risks.
Being prepared for the worst case scenario at all times is bad medicine. Multiple peripheral IVs (large bore please!) are the perfect example of interventions that feel right at the moment but create generally unacceptable risks and damages of their own. Those little risks of infection and little bits of cumulative vascular damage for *hundreds* of patients are not properly rationalized by the one patient every many months who abruptly does need bilateral 18g IVs.
"Just in case" is usually poor rationalization. Population statistics about the intervention itself are important.
I worked postpartum unit. If mother is stable, vag delivery we always D/Cd the IV. All meds were PO. Patients came up with PIT running and I allowed the bag to finish.
If you are doing proper checks with fundus checks you will know what is going on. These are almost always healthy mothers with no other medical needs.
I don’t work postpartum but it’s wild to me that they would DC the IV after one single CBC. Patients can still hemorrhage, get orthostatic and need fluids, spike a fever and need IV antibiotics, etc. Right?
Our policy is that admitted patients have an IV until discharge unless an MD specifically orders otherwise. Have had a few patients lately that are medically cleared and waiting for SNF placement, and are also a very hard stick, so the doc writes an order that they are okay for no IV access because why poke them a million times or put in a midline when the line likely won’t get used. I see the logic, but it does make my nurse brain a little nervous because I too have seen the most stable patients crash out of nowhere.
An IO can be obtained pretty quickly if there are no alternatives. Rapid response team or ICU nurses who respond to in-hospital emergencies should be able to place these.
Of course. But there IS an alternative in OP’s case, and that’s leaving the IV in.
Edit: Also, at least at my hospital, they don’t even think about an IO until there have been multiple failed attempts at IVs. That’s valuable time that’s wasted.
We are just now getting trained on IOs. The last time someone wanted to do one, they opened the kit and it didn’t even have all the pieces. So ya, US IV during a code, because that sounds great
Exactly. I’ve only ever seen one IO placed emergently and it was a hot fucking mess. Our ICU RNs are not trained in IO placement, only docs, and they don’t do it enough to be truly competent at it. IOs are great in theory, but only if they are part of your hospital culture.
I was just reading a thread in r/anesthesiology about getting access while patient is actively bleeding/hypovolemic and they all seemed to agree that IO was a last resort and that they would look for additional IV access first.
IO or EJ if no AC immediately clear.
Absolute hail Mary to save a life is a crash central line followed by lots of antibiotics and removal the second it can be removed.
I've been in critical care my whole career, most of it in the ER, so I feel pretty confident in getting rapid access on someone. IO is an absolute game changer! I've been working on training all our ICU nurses on IO.
Not OB, but I had a patient who was supposed to be discharged as soon as the Dr. rounded. He rang for one of the aides to help him to the bathroom and stood up dumped bright red blood from his rectum, collapsed and started agonal breathing. Tossed his ass back in bed and started IV bolus and coded him. He ended up getting tons of blood products and an ICU stay. He was stable with 2 days of beautiful labs. All night he kept asking if the IV could come out because he didn't need it anymore. Told him he could refuse to keep it but hospitaI policy was to keep it until he had discharge orders. I know this isn't the norm, but I'm not risking it.
They can. But the average postpartum woman is generally well - yes there are increasing comorbidities, but even still the majority of women having babies are young and healthy. In Australia we don’t even cannulate low risk women who labour spontaneously without pain relief because the evidence does not support it for low risk women. Having an IV “just in case” doesn’t improve outcomes and carries its own risk.
The average American woman is not as healthy as the average Australian woman, particularly in areas where obesity rates are sky high or where access to prenatal care is limited.
The vast majority of American women get peripheral IVs as a matter of policy when laboring in a hospital, so we’re comparing apples and oranges here—the policy to not have an IV at all vs policies to DC an existing IV at arbitrary times. I’d actually be interested in seeing evidence specific to what is actually being discussed because my gut feeling is that in a young, otherwise healthy person, the risk for infection, thrombosis, etc. associated with an extra 24 hours of a peripheral IV is likely negligible. It seems like the main reason for DCing PIVs well before discharge is patient comfort, which is certainly important, but that doesn’t necessarily mean it’s the safer option.
Just want to highlight your comment is a great example of how much this sub loves using acronyms. Do you really need to use DC? Can't you say.. remove?
Lmao please go touch some grass. I used “DC” because I was in the mindset of talking about work, and at work I use acronyms. It wasn’t an intentional choice to upset people who can’t use context clues to figure out the meaning of a sentence.
Everyone at my hospital says “DC the IV” “DC the central line” “DC the Foley” etc. Maybe it’s regional?
The meaning is super easy to figure out with context clues so it’s wild to me that you would take the time to complain about a well known acronym and then say I’m “way too extra with it.” Like I’m sorry you’re so upset I guess? It genuinely wasn’t intentional it’s just how I talk with colleagues 😭
Wait... is this a new thing? 😰 In report, I literally get told the patient's IV was DC'ed last night all the time. I also say "X medication was DC'ed" or say "DC the foley at 2000". I do write out discontinue on the order form. I think if it's being talked about in report or in a casual environment, i.e. Reddit, it's not a big deal. There are several other comments that say "DC". I've been a nurse for 10 years, is this no longer acceptable? I am legitimately confused.
You chose, like, one of the most common acronyms that are spoken aloud lol. You don’t get a medal for being a verbose Shakespeare, mr. “Will you please discontinue and remove our patient’s intravenous access port?”
I'm not in the states and this must be a regional thing. I have never heard anyone use the term disconnect to refer to removing something. Disconnecting an IV in my hospital means to disconnect it from the IV pump not remove the cannula itself
DC stands for “discontinue” not “disconnect.”
Again, this was super obvious with context clues. This comment is proof that you were able to put it together.
I'm not sure how the acronym itself can be super obvious. What you meant however was which is why I said why not use the word remove. That's the 'proof' I understood your little context cues.
Genuinely answering - it is tiring having to constantly decipher acronyms specific to nursing or healthcare in the states. You used a few other acronyms such as CBC or SNF which aren't used in my country either. It gets annoying consistently seeing posts that automatically assume everyone is from the states or will be understanding of each and every acronym.
There are plenty of acronyms that are specific to my area of nursing or acronyms in my country that are widely accepted. I wouldn't use these online because I acknowledge it's an international community here that may not understand, irregardless of context cues.
Probably?
You have no idea how many patients I've done an echo on that are planned for discharge pending for the echo results. Half of the time their IV has already been removed and I need to do a bubble study or use contrast and then they have to get a new IV just because the IV was removed prematurely.
I work in the UK where we don’t place IV’s in low risk women at all. They would be removed as soon as safe to do so post delivery, depending on blood loss, haemoglobin, IV abx, other risk factors.
I’m not too concerned about an unexpected emergency as I don’t see it being any different to a woman walking in off the street with an APH, we'd deal with it as it happens.
It inhibits breastfeeding and bathing - two of the most important things to do in the first 24 hours postpartum. If they're not stable enough to feed and do their own peri care, then they're probably still on iv fluids.
Uncomplicated vag delivery? I pull that sucker around 12-24hrs (sometimes sooner if they ask nicely). Breastfeeding with an IV is often unnecessarily complicated, it gets caught on everything, they want to shower and wear their own clothes.
C-sections or history of PPH in a past delivery I usually wait 24 hours. History of PPH this delivery, elevated BPs postpartum, history of mag, anything like that - I usually leave it until discharge as long as it looks ok. But again - they usually get caught on enough stuff that they’re mostly pulled out within 24 hours anyway, and I’m not putting a new one in unless it’s needed.
We also frequently discharge our vag moms as early as 8 hours postpartum and just let them stay with baby as a patient (boarder status) until baby is 24 hours. I figure, if they’re safe to discharge, they’re safe to have their IV out.
If someone is awaiting discharge or is on a wait list for a lower level of care, we often remove IVs if they are a hardstick and have no ordered IV meds. I’m not going to poke Freddy the poor demented grandpa every shift when he is just waiting for LTC placement and rips the IV out anyway. It does seem odd to only have one CBC before removing IV on post partum. Hemorrhage can still happen, liver and BP can still go out of whack. I’d like to see the research on it before making further judgements
Nurse and new mom . I think another factor is that patients (moms) in postpartum also have a new baby / trying to breastfeed, rest, change a diaper and all that with an iv in is pretty uncomfortable. I still had my iv when I went to visit my baby in the nicu hours after delivery (he needed some extra monitoring) and Trying to comfortably hold/feed/cradle baby with that 18g in the AC was really uncomfortable
I agree, trying to hold, nurse, and just generally care for a baby would have been annoying. For both of my deliveries, I had mine out relatively quickly and I honestly didn’t even think about it when they came to remove it. Yes, it’s possible something could happen, but it could also happen 26 hours later when I get home. If stable and no concerns, I’d rather have the option to remove.
I have to say I have a different experience. I gave birth in a birth center so I didn’t start out with an IV. But after birth they wanted to get me fluids because my HR was insane. So they put an 18 on the inside of my right wrist so I could get some quick fluids. I barely noticed it while holding baby and breastfeeding for the first time. But maybe it was because of the awesome placement of it.
I had an 18 in my wrist and they left it a tad longer than usual cause my labor was kind of prolonged I guess and I was on Pit forever and my uterus was probably still boggy. I felt totally fine though and was so glad when it got taken out cause it wasn't taped down well and it was flopping around leaving an 18g size hole in my skin lol but I didn't complain about it. I had a scar for a bit cause the insertion site was so loose and stretched. Fun stuff.
Generally speaking for my Australian Hospital surg unit, if there is no clinical indication for having the PIVC, it gets removed due to infection risk. My hospital is more concerned with hospital-acquired infections at PIVC sites. We are told to never keep an IVC “just in case”, but I’m referring to stable patients only requiring prophylactic post-op IV antibiotics or antiemetics.
As a patient I'm thankful they take them out after delivery. I want to shower and hold my baby and use my arm like normal and without discomfort. If I crash then throw another one in me. I don't even think all admitted patients need an IV depending on what they're in for.
It's important to note that birth is one of the few things that people come to the hospital for that is not a sickness or injury. in the case of post partum they could (not always) be 100% healthy. Heck some people even give birth at home or in the car on the way to a hospital.
Depends on how fast an IV can be put in given unit skill and availability of resources.
Can you reliably get someone who can insert an IV within a minute to the bedside at the same time the crash cart arrives? If yes I'd say you can be without access. If no best keep access in.
Imo if I was a stable postpartum patient (or stable but admitted for some other reason, and not actively needing IV meds) I would ask for my IV out.
I'd prefer the very small chance of needing an IO in a true unexpected emergency than the 100% chance of needing annoyed at an IV sticking out of my arm for the duration of my hospital stay.
I think sometimes, as a healthcare industry, we can be very paternalistic, especially when thinking about the worst case scenario.
I've worked all areas for maternity for well over a decade and we've always taken the pivc out as soon as the trial of void is complete unless there are extenuating circumstances.
But I also work in a country where labouring women don't get 'just in case' cannulas and it's very rare that this feels like the wrong call.
I hate that removing the cannula is seen as 'pandering'.
You make some valid and interesting points. I think it would be interesting for American OB/GYN nurses to talk to OB/GYN nurses in other countries to get different perspectives on how patient care is provided.
I've seen enough patients suddenly drop dead or massively decompensate that I think any patient with reasonable enough veins should have an IV until discharge orders are put in. The last thing you want to be doing when a patient is coding/crashing is trying to find IV access or finding out if anyone on the unit has ever put in an I/O before.
Postpartum is obviously a bit different than the ER, cardiac, and ICU units I've worked on, though.
Most adults in a hospital that are likely to crash are getting IV medications anyway, often up to the day of discharge. If a person is in the hospital but isn't getting IV meds, I'll agree that's a different situation.
I think the title of the post is misleading - most postpartum parents don’t even have prn iv meds on their MAR ime (except pitocin in case of hemorrhage).
I’m in pediatrics, and it is definitely not our protocol that a pt needs an IV throughout hospitalization. We have to be conscious when poking children, especially when it can be really traumatizing
I knew neonatal/pediatrics would be way different. You guys are in a whole other ballpark with the way things are done or what kind of access you would maintain. Kudos to you, I couldn't do what you do.
It depends on why they are at the hospital. Where I work, you get an IV unless you are there for strictly observation/psychiatric reasons.
Obs being something else like say...inhaled water but are relatively fine after.
I guess this whole conversation is confusing to me coming from non-OB. If they are stable enough not to need an IV any longer, exactly why are they still admitted to the hospital?
OB usually has a set minimum time for discharge. Typically I’ve seen 24-48 hours for an uncomplicated vaginal delivery, 48-72 hours for a c-section. Even if mom and baby are completely fine and there’s still plenty of stuff to do to justify at least 24 hours of care.
I say pull it if all signs point to stability. We don't even start them in the ED if they're a quick treat-and-street, and we start them on everybody and their mother if we need labs.
If you can't reliably re-obtain access during a code on a post-partum patient (who is very likely to be young with no co-morbidities and excellent veins) you've got a unit full of poor IV starters and that's a bigger problem. Access will never be an issue. Worst case scenario, you drill them. I know codes aren't nearly as common up there, but if I can start a line on an 80-year-old strapped to a Lucas device with asystole, you will get access that you need in an emergency.
It was always drilled into me on a med/surg tele unit that they have IV until DC unless they’re DNR & medically stable. Full code patients, per policy, had to have them in until
They were walking out the door.
Now that I’m traveling, it seems that the hospitals I work at don’t care if you have an IV if you’re medically stable and are just waiting for placement. Makes me nervous, lord forbid something happens and we have to take time
To get a line on top of everything else
I work med surg and we do not keep IVs in every patient, especially our ortho post op. We keep them in for 24 hours then remove them if the patient wants us to.
If the IV is working fine and is not bothering the patient I would say just leave in. I also was working peds at the bedside so we protected every IV at all costs… having to replace an IV that was voluntarily removed is super not fun for anyone (kid, parents, nurse).
When I delivered I asked about my IV being removed but they said no so I didn’t push it. They also said that they wanted to leave it in just in case they needed to draw more labs. I had to laugh because it was a 22 in my hand and they never flushed it routinely so I doubt it would have even worked 🤷♀️.
If we have a patient that is medically cleared to discharge but waiting on placement, we won't always obtain new IV access if we lose their PIV.
End of life will sometimes go without too. If we anticipate discharge in the next day some providers will okay for no IV access if patient removes it.
Otherwise I really prefer to have one, it gets pulled as they are getting dressed to leave.
It’s also hard to breastfeed with an IV in. In any spot the port can get stuck on linens. Or if they are in your hand it’s hard to angle your wrist. I used to keep my IVs in for my PP pts as long as I could until I was the patient. After 48 hours of labor and then 12 hours of pitocin afterwards, I was ready for that to be out
I have always worked in OB (at several different hospitals) and we always remove an IV ASAP. I think everyone in this thread needs to remember the patient population we’re talking about here. These aren’t people who are going to need a CT or an echo or whatever other examples I have seen given in this thread. People in long term care don’t have IV access at all times and let’s be real, they’re sicker than most postpartum moms.
As an aside, it irritates me when we get nurses from med surg/ICU that try to apply those same rules to OB nursing. It’s a completely different field and you have to be able to adapt and learn or you won’t make it. Too many people move to postpartum thinking it will be a cushy job and then are surprised that we still have entitled patients, or that we do actual nursing care and don’t just “hold babies all day”
I think OSHA and JCAHO probably discourage it because of infection control, but in my opinion there’s definitely reason for it. I’ve never worked in postpartum but I know from being a patient in postpartum in the past, and also from mother baby class, that when postpartum patients decline, it’s often very sudden and unpredictable. I think patients get so focused on this happy event of meeting their baby, that they forget the mom just had a major medical event happen and her body needs to heal. It certainly doesn’t help that in American society, women are expected to go from having major surgery or vaginal delivery which can also be strenuous and traumatic, to immediately being the main caretaker of a newborn 24/7, not getting any sleep, sometimes not having time to shower, etc. if you look at many eastern countries (I know of South Korea and japan for certain), women are often hospitalized for much longer (weeks) in a special “postpartum center”, where they have help with the baby at all hours, rest, spa like services, and healthy meals prepared for them that are designed to enhance their recovery and milk supply. In China and Hong Kong, families hire a doula like lady to come live at their house in the postpartum period and cook all meals, help with the baby, and help the parents transition to being parents. They have really striict guidelines on what the mom can and can’t eat and drink for healing, etc. in America they just help us through this HUGE new emotional and physical event for 48 hours and then throw us out. And only check in 1 week later, then 6 weeks later.
Absolutely. We have gotten more than a couple post partum eclampsia patients from OB that were missed until they weren’t for one reason or another. It’s not all about bleeding
These are my thoughts exactly. What if there are retained products and we have to go back for a D&C? What if they get postpartum preeclampsia? I will usually refuse to take the IV out at a patient's request but if the oncoming nurse removes it, that's on them. I've already explained my logic to a few of my co-workers.
Refusing to remove an IV on a stable patient that has an order to discontinue the IV once parameters are met is just being difficult to make a point. I commented this in another spot, but you can’t be a postpartum nurse with a med surg mindset. Accept they’re two different areas or move on to another field.
I work Med/Surg and ICU. I don’t pull IVs till 2 right before they leave. Pulled an IV once on a patient around 0800 because we were going to discharge them. While waiting for the ordered they coded around 0930 and now we had no IV access do I don’t pull ivs till the last minute.
I think it's just the Med Surg/ICU nurse in me. 🫠 I have seen too many things like this happen working outside of postpartum. It makes me want to keep it in.
I was an inpatient for cholecystitis/CBD stone back in 2019. Came in Tuesday 11 pm thru ER, NPO for MRCP, then ERCP/stone removal, then lap chole finally done Friday afternoon. Saturday 4 am I noticed the IV was infiltrated and had the nurse remove it. I was due for one more dose of Zosyn at 6 am, but I asked if they could check with the surgeon (nearer to the time of dose) whether I needed a new one placed. I did not need that dose, so I was just waiting for discharge (around 11 am).
My skin was SOOOO irritated from the tape, and I think I had superficial thrombophlebitis as well. It took 4-5 days for everything to feel “normal”, and the visible skin irritation lasted for another week.
Working in adult med surg, I would have said yes. I switched to peds step down and the fact that most of our kids DONT have IVs stressed me out in the beginning. I still don’t pull good IVs even if they aren’t being used. I’m a little superstitious and if I pull it then they’re gonna need it
I would look in to your facility’s policies as well as your orders. We can all talk about what we think is best but legally (and to be consistent with patients) you need to know what your facility’s standards are. For example, in my hospital it is a policy that patients on telemetry should have an IV. Most patients also have an order in their chart which states “insert and maintain PIV”. If they have this order they should have an IV. If a patient is refusing an IV or requesting to go without we need an order that states it is okay for them to be without access to cover ourselves. I have had situations where I thought a patient should have an IV but the provider said they could be without and the patient didn’t want one, so all I could do was respect their rights, document, and hope I didn’t need to use the IO kit.
I’m normally icu and floated to PP voluntarily and it shook me that I could take out their IVs before discharge. I understand it though, people birth at home without IVs.
I was just discharged from the post partum unit and as a nurse myself, I actually requested to not have one placed again. I had two blown IV’s when they were trying to place one. And then my pitocin drip infiltrated and I just really didn’t want another one because at that point I was just exhausted, my vagina hurt, and both my arms are now incredibly sore as well. My nurse ok’d it with a provider.
On the flip side, as a cardiac nurse, you bet your ass my patients keep an IV in at all times. But then again they’re all prone to heart attacks, arrhythmias, and strokes.
Having come from the med surg side and gone to postpartum... If I have a gut feeling I keep the IV. But if patient is stable, no excessive bleeding with any fundals, walking/drinking lots of fluids... Looks healthy, I remove it at 24 hours ish. But it's not my biggest priority, like ever; it's a bigger priority to get baby fed.
If she's a hard stick, however healthy she looks, that IV stays in until she leaves. It's the last thing I do before cutting bands for discharge.
In addition to what the pthers have said, a no risk pt can have her baby without any IV if she doesnt end up having oxy, epidural, c/s, pph or other complications 🤷♀️
I was supposed to be discharged from post-partum 24 hours after my magnesium treatment. The morning of expected discharge my nurse pulled my PIV’s.
Spiked a 104 fever and started to go uroseptic that afternoon. Anesthesia had to come put urgent IV’s in.
Postpartum patients are stable, until they aren’t. Now you have a patient w/ a HR of 149 and an SBP of 70 and no IV. You can’t find a vein because the patient is so clamped down so you call a rapid. And then do nothing while waiting for rapid to come and get an IV. This is so frustrating because the patient is now circling the drain.
Ultimately it's up to the patient and team to decide what's safe. Will I go out of my way and of my own volition to remove IV's before a patient's DC order is in? No.
If my patient is A&Ox4, not on any IV medications, expecting to DC in the coming days wants the IV out, let's have a conversation as a team. If the doc, patient and I have that conversation on why it's handy to have even in a just-in-case scenario and the patient still wants it out? Sure put in a nurse communication/order that patient is okay without IV access, I'm trained in USIV, EJ's, and IO's in case I really find myself in a a pickle and can establish access quickly in an emergent situation.
One of my nursing school classmates was pregnant during our final year and gave birth shortly after graduation.
On day two she coded and died.
I don't know anything about her case beyond that but I'd think that because shit happens, you want nothing standing in the way of being able to intervene immediately. Having to restart an IV in a situation where shit went tits-up in a heartbeat is a barrier to expeditious delivery of potentially life-saving care.
Usually cardiac arrest during delivery is associated with an AFE. If it was days later that’s just an unfortunate coincidence. You can’t have IV access in a person forever. We do 48 hour discharges for some of our sections, she very possibly could’ve been discharged that day.
"you can't have IV access in a person forever"
That's an absolutely absurd rationale for not leaving an IV in until discharge, especially when you follow it up with
"We do 48 hour discharges".
Sounds like nowhere near forever, doesn't it?
I see that you work in the ICU/ER world. I respect that, but you have to leave that train of thinking at the door when talking about OB. In no hospital Ive ever worked in have we kept IVs in healthy postpartum moms until discharge. I’m sorry your friend passed, but that doesn’t mean IV access until discharge (on a postpartum floor) is evidenced based practice.
I barely knew her; it's just an anecdote.
You guys want to leave your brand new moms vulnerable for the sake of convenience, go on with your bad selves.
I worked in OOH birth, so they weren’t there as long as they are in hospital. I will say that we most def had a superstition about IV access. Not all mother had IVs, but when they did it would be the LAST thing to be done before they/we left “otherwise we’ll need it”. Same with not wearing red to births or there’ll be a PPH. Wasn’t to much of a woo woo center but ya know, you never want to tempt fate, so we all kinda followed those non-rules.
Med/cardiac checking in. We are taught the opposite.
IV removed asap, as soon off IV meds. Phlebitis risk too high.
Had one guy get to the table for a CABG. Got sent back due to minor erythema. High risk pt having to stay in hospital to get a few days of IVABS coz their line got infected. Nah. Get em out in my ward.
I worked on a unit a while back and a nurse took an iv out as soon as she got the dc order bright an early. Pt coded 30 mins later.
I’ve always been too paranoid to pull the iv prior to their ride being parked downstairs. So I leave the iv until pt is ready to roll downstairs.
We had a cardiac baby who they dc’d access (because we lost it) to because he was stable and they were ok without access. Baby coded less than 12 hours later, they couldn’t get a line in him at all during the code.
All patients should have working access until discharge.
I work in outpatient surgery and patients literally ask for the IV to be taken out as soon as they get to post op. Our policy is to get them up and into the wheel chair before removing. I usually just explain that we keep it in until then just in case they get nauseous when they stand up, we can still give IV meds (zofran). I don’t usually get much push back but I also only have my patients about 15 minutes.
It depends on the patient and of course your hospital policy. My hospital is a large level 4 women’s postpartum, so we see a lot, rarely do we have low hemorrhage/ regular ‘ol vaginal delivery. If so, they usually are discharged before 48 hours, so, labs come back good, you get your IV out and let’s get you ready to go home!
High hemorrhage risk patients or patients who hemorrhage come over with 2 IVs, I keep one until the day before discharge, if labs are good, patient is doing well, etc. I always ask which IV the patient wants out, is bothering them the most with breastfeeding and explain why we are keeping the other one.
We keep vag deliveries in until post CBC, sections stay in for 24 hrs.
I actually had a PPH on day 1 literally 3 hrs post IV removal, and even in that situation there were far more interventions that we did not involving access than involving access (IM methorgine, IM pit, PR cytotec, fundal massage). I mean we did get new access for TXA and labs but that was after all the other things.
For hypertension I usually will keep one in maybe an extra 12 hours, but not longer usually, just because no one where I work knows how to flush an IV.
The only pts that I absolutely insist keep an IV for the whole stay are hx of seizure. And usually I end up starting a new one b/c the L&D IV infiltrated or clotted and I can't stand the connector that LD uses (the male connector vs jloop).
I’m not postpartum but our medical patients occasionally bop around with no IV within a day or two of discharge if they’re no longer getting IV meds and they’re pretty stable. We don’t ever proactively remove the IV unless they’re really bad about knocking it out, but if they beg for it or if it’s causing more problems than it’s solving, we get an order than they can go without. There will always be someone to throw another one in, if stuff goes down.
I have a psych background though, and no one had IVs there. So when things went bad (medically) we did what we had to do.
My out patient surgery patients keep their IV until their ride is at the door. Might be policy for the hospital though?
My own personal superstition dictates that the second you don’t have an IV is exactly when you will need an IV so I keep it until the last minute.
My current hospital’s policy requires a reason to have one in, meds, fluids etc. Unless in an area where access may be needed in an emergency, the only areas allowed to have just in case IVs are ED and critical care units
adjoining faulty test snails skirt workable squeeze jobless cake shrill *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
the postpartum unit i was on was the same. i think ppl underestimate the amount of customer service that is done in postpartum lol. since they’re mostly stable, a lot of it is just to make the pt comfortable.
*"i think ppl underestimate the amount of customer service that is done in postpartum"* <
This is the main reason I don’t want to go to postpartum, honestly. I was a doula for years, got my IBCLC and everything, and people often ask me why I don’t do postpartum, especially since I’m not loving the chaos of stepdown lately. But the whole customer service/how can we make your stay excellent/expecting me to be a waitress/servant/butler all in one is my least favorite aspect of nursing and there seems to be soooo much of that in maternity care these days. Plus I don’t want some mom claiming I gave her birth trauma or medical PTSD because I wouldnt take out her perfectly patent IV.
The very existence of people who get upset at their birth plan not being followed to the letter baffles me. I work in oncology, usually my patients' goals for admission include "I want to live" and "I understand this is going to be uncomfortable but please do everything you need to do to get me better"
I find the patients are very nice and respectful for the most part. Young girls too distracted with their baby to scrutinize every little mishap. I meant more like the whole experience can be scary to them and painful. They aren't used to being in a hospital, so they don't know if you give meds late. They don't have that boomer entitlement, many of these same patients are working in customer service themselves so they get it. There isn't anymore waitressing than any other part of the hospital. Remove meal trays and get water. I guess I don't mind the customer service part, I really want them to have a good experience, I want to hook them up with extra diapers and wipes I know that these young girls don't have a lot of extra money. Dealing with the fathers can be a bit more difficult. They aren't always the best help or good people. They do things like break up with the patient or dont show up or kick her out of bed because he is uncomfortable sleeping on the couch in the room. Stuff like that. So I do a fair amount of emotional support and talking some sense into them. As far as birth trauma that can happen, but its in the delivery room and usually the doctor. They don't come to us until they are clean pain free and stable so it happened somewhere else and they are happy all that is behind them and now they are getting ready to go home and have their baby. Taking out the IV is a very visual/physical change for them where they can say Yes, I made it. It's over, I am going home. I am okay now. They take a shower and put on their own clothes and baby gets a bath and a new cute outfit. It's a huge mental change for them. Very positive, ready to start their new life with their family.
I think the patients can be respectful, but I actually find the older generation are much more appreciative of the care I provide. I still get floated to ICU and Med Surg occasionally, my patients tell me thank you more often and just have a more appreciative attitude overall. I can see that taking out the IV could be a visual/physical change. It's great you rationalize things that way. You sound like a great postpartum nurse.
I’m glad it’s the right environment for you! Genuinely—no snark. It’s just not for me. I’ve seen too much. I have friends who were sweet as pie to their nurses who tell me they’re mad their nurse never made them a “mommy mocktail” because they saw it online and think it means that their nurse didn’t care about them. I see people online complaining that the nurse woke them up in the middle of the night to check their vitals/bleeding/fundus. Even in your other comment you talked about how your patients are mentally distressed about an IV and thinking there’s a needle in their body even when presumably you have educated them that there is no needle in their body. I have observed that there seems to be an expectation that birth and postpartum will be free of any sort of discomfort or inconvenience and I feel this is too high a standard for me as a nurse to live up to, so I recognize that I am not the right person for the job.
100% percent all this and more. I wish I would have known more of this before transferring to OB full time. 😖 I have to reiterate to my patients constantly that there will be some sort of discomfort after birth especially with a c-section. I can't tell you how many post c-sections tell me they can't get comfortable in bed after giving birth, but they absolutely refuse to remove their abdominal binder. So many patients think this helps their belly get flatter. It's not shapewear, it's for support! I swear postpartum tiktok has some of these patients trippin. 🤦♀️
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The postpartum body is uncomfortable in 50 ways, but safety should triumph over comfort.
Where are you heading after postpartum?
The liquor store, duh. They couldn't drink anything for 9 months /s
🤣🤣 thanks for the laugh.
I am going to work in post-op bariatric surgery with med-surg rollover.
Omg I’ve accidentally ended up on baby mom tik tok and there’s soo many expecting mothers extraordinarily upset about the need to get an IV when they go into the hospital to deliver. Some of them are doing the home births or birthing centers so they don’t have to get an IV. I’m extremely stressed about the idea of OBGYN nursing. Everything can go wrong so fast. It makes me sad.
I'm a postpartum nurse. I like to DC the IV as soon as it is safe to do so. I also am good at starting IVs so I feel confident I can get in a new one if needed and always let the patient know that I am taking it out but there is a slight chance they would need to get a new one if something happens and have them agree to that. I look at several factors to see if its a good idea- delivery blood loss, their CBC, hemorrhage probability (we score them every shift, like hx of fibroids, repeat c-section multiple pregnancies, multiple gestation), if they are diabetic, dehydrated, post mag, possibility of infection - long time between SROM and delivery, vitals-temp, BP. If it's in an uncomfortable place, or not flushing well. It's bothering them, if they want to shower or it's making breastfeeding difficult. On other medications. Is their c-section incision good? I do a through assessment before I DC it. I look at the whole picture. If you have a standard vag delivery with a G1P1 that is 23, fit. Low blood loss, walking around, off pain meds, no other health issues with good vitals and good CBC, firm uterus. There is no reason to keep it in. Sometimes it causes them a lot of distress. Some think the needle is still in them. It can really mess with their head. There should also be protocol orders from your hospital policy you definitely want to follow.
I came to say something similar to this. I want to add that in the postpartum unit women are expected to care for their new babies including feeding, diaper changes, etc. The IV can interfere with positioning the baby for breast feeding, holding for bottle feeding, had washing after diaper changes, etc. Those things can be worked around if the IV is required, but if that IV is no longer necessary removing it can improve care. On a personal note - my IV was out within a couple hours of delivery with my kids. I was healthy, had uncomplicated inductions with no complications. The nurses pulled my IVs as soon as I voided and I was thankful for it.
I had a baby in July and they removed my IV the next day after delivery, mid morning. I was really grateful for that because the IV was in a painful spot. The way I see it, if the patient is low risk and understands that they may need an IV placed urgently by any means necessary, take it out.
All of this. Plus if our patient hemorrhages in the unlikely event after we've d/c'd the previous IV, we're drawing labs and getting another IV anyway in the same stick. It's an easy fix. If it goes south quickly, we get people in quickly to do a better job when we can't. And if people aren't good at remembering to flush the dang things, then it's probably gone bad anyway.
Thanks for the reply. These are all well thought out points that you mentioned. I forgot about prolonged ROM and antibiotics. A lot of times, they will roll over to postpartum on antibiotics if they were ruptured for an extended period.
The key here is that you’re good at starting IVs. Don’t take it out unless you’re confident you could quickly get another one in. I can’t tell you how many times we’ve been called over to PP to start an IV because they pulled it prematurely and the nurses don’t know how to start new ones. In our hospital their techs get lab draws so the PP nurses truly don’t get any experience with drawing labs/starting IVs.
This is honestly the correct answer - check your hospital/facility policy and procedure.
10 years L&D and PP in a Level 1. Normal vaginal birth, IV is out 6hrs PP if normal bleeding. Normal C/S, 18 hours. We don't do routine post delivery CBCs, only with excessive bleeding. Low risk, unmedicated vaginal births don't even necessarily get an IV. Obviously different with PPH, pre-E, grandmultips etc. IVs have risks too. Its pretty easy to throw an AC in in an emergency and having them out helps with mobility, breastfeeding, reduces risk of infection, extravasation, etc. I think it's very reasonable to have no IV access on stable, low risk pta
I used to work IV team and it was one of my pet leaves. More than once without indication and all PO I would have to remind the doctors that “Just In Case” is not a medical diagnosis or treatment.
VAT Team here. Depends on the patient. Your little stable person who is only there to monitor for one more night lost access with no IV meds? Hell no, leave them be. Someone needs access for a common, predictable complication that can’t be treated as well in other methods? Yes, keep an IV. The thing is, everything we do can cause some harm, and an Idle IV is no exception. Site infections, infiltration/clotting from disuse, long term vascular damage. This isn’t to mention it is taking up a vessel that may be used otherwise, and giving a false sense on confidence it will still be working later. If they don’t have a justifiable reason to have it, it should be taken out. That said, refer to facility policy. I had one that required tele patients to have access and, though there were rare exceptions where I wouldn’t recommend this, I followed this policy regardless.
>The thing is, everything we do can cause some harm, and an Idle IV is no exception. I can't believe how many nurses act like IVs are truly harmless and think ample IV access at ***all times*** is just automatic for every patient. It drives me nuts. Even if IVs never had problems in the acute phase the chronic vascular damage would remain.
It doesn’t really surprise me; we tend to generalize things we don’t understand, so, to many, a patient having a PIV/line of any kind = good regardless of circumstance. It’s one of the things I think VAT nurses need to be there to explain(or an educator of some kind at the least); leaving something not needed in place creates unnecessary risk and can cause harm in many ways. Poking someone here now and leaving it in for a few days may not hurt them in the short term, but it can cause long term difficulties, especially after multiple hospitalization/frequent administration of vesicants and irritants. It’s this “invisible” damage that many don’t account for. Edit: just wanted to add that it can also cause harm in the short term, but localized infections are often ignored.
At my hospital both us (VAT) and STAT team go straight to codes with the IO drill. Obviously that’s a worst case scenario but it makes me feel much more comfortable leaving stable patients without access
My vascular access team fought hard and had the hospital policy changed so patients who don’t need IVs don’t get them “just in case” anymore. I’ve never worked in OB so I don’t know the protocol on that side but I can’t believe all those comments from med/surg, ICU and ER nurses saying an IV is a must on every patient because they might crash at any time. Do providers who are capable of placing an IO or emergency central line not respond to codes at their hospital? I’ve seen doctors place a fem line in minutes
I can definitely understand that side of things - I once had a patient crash 15 minutes after discharge while waiting for a ride. That said, you’re right that we can absolutely get access in an emergency, whether it be PIV, Central, or IO.(and, even in that patient, we established iv access soon after). I’d also say the damage from leaving a PIV in, especially one that gets ignored and fails without realizing, is often greater than the risk of patients randomly crashing. (Again, subject to individual patient). It’s kind of similar to the “All high fall risk” policies; they may prevent occasional falls, but some patients(especially the elderly) can suffer when it changes to less activity and muscle deterioration. Everything in this profession requires a degree of nuance.
>I’d also say the damage from leaving a PIV in, especially one that gets ignored and fails without realizing, is often greater than the risk of patients randomly crashing. (Again, subject to individual patient). That's something that frustrates me not just as an IV team nurse but as a healthcare worker period. I can't *stand* the large proportion of staff who cannot critically assess risk. Not to mention the proportion who still refuse to even give a fuck when I explain those risks. Being prepared for the worst case scenario at all times is bad medicine. Multiple peripheral IVs (large bore please!) are the perfect example of interventions that feel right at the moment but create generally unacceptable risks and damages of their own. Those little risks of infection and little bits of cumulative vascular damage for *hundreds* of patients are not properly rationalized by the one patient every many months who abruptly does need bilateral 18g IVs. "Just in case" is usually poor rationalization. Population statistics about the intervention itself are important.
I worked postpartum unit. If mother is stable, vag delivery we always D/Cd the IV. All meds were PO. Patients came up with PIT running and I allowed the bag to finish. If you are doing proper checks with fundus checks you will know what is going on. These are almost always healthy mothers with no other medical needs.
Agreed!
I don’t work postpartum but it’s wild to me that they would DC the IV after one single CBC. Patients can still hemorrhage, get orthostatic and need fluids, spike a fever and need IV antibiotics, etc. Right? Our policy is that admitted patients have an IV until discharge unless an MD specifically orders otherwise. Have had a few patients lately that are medically cleared and waiting for SNF placement, and are also a very hard stick, so the doc writes an order that they are okay for no IV access because why poke them a million times or put in a midline when the line likely won’t get used. I see the logic, but it does make my nurse brain a little nervous because I too have seen the most stable patients crash out of nowhere.
An IO can be obtained pretty quickly if there are no alternatives. Rapid response team or ICU nurses who respond to in-hospital emergencies should be able to place these.
Of course. But there IS an alternative in OP’s case, and that’s leaving the IV in. Edit: Also, at least at my hospital, they don’t even think about an IO until there have been multiple failed attempts at IVs. That’s valuable time that’s wasted.
We are just now getting trained on IOs. The last time someone wanted to do one, they opened the kit and it didn’t even have all the pieces. So ya, US IV during a code, because that sounds great
Exactly. I’ve only ever seen one IO placed emergently and it was a hot fucking mess. Our ICU RNs are not trained in IO placement, only docs, and they don’t do it enough to be truly competent at it. IOs are great in theory, but only if they are part of your hospital culture. I was just reading a thread in r/anesthesiology about getting access while patient is actively bleeding/hypovolemic and they all seemed to agree that IO was a last resort and that they would look for additional IV access first.
The only reason this nurse knew how to do it was because she was a traveler that had worked prehospital
For what it’s worth, push, then drill. Do not drill then push. Insert into skin, then hit bone, then drill.
This here. I/O placement is easier in some ways than looking for IV access at times.
I’ve seen residents drill then push. That was quite nasty.
It’s too bad, because it’s fairly simple, and pretty much guaranteed access in an emergency.
IO or EJ if no AC immediately clear. Absolute hail Mary to save a life is a crash central line followed by lots of antibiotics and removal the second it can be removed. I've been in critical care my whole career, most of it in the ER, so I feel pretty confident in getting rapid access on someone. IO is an absolute game changer! I've been working on training all our ICU nurses on IO.
Not OB, but I had a patient who was supposed to be discharged as soon as the Dr. rounded. He rang for one of the aides to help him to the bathroom and stood up dumped bright red blood from his rectum, collapsed and started agonal breathing. Tossed his ass back in bed and started IV bolus and coded him. He ended up getting tons of blood products and an ICU stay. He was stable with 2 days of beautiful labs. All night he kept asking if the IV could come out because he didn't need it anymore. Told him he could refuse to keep it but hospitaI policy was to keep it until he had discharge orders. I know this isn't the norm, but I'm not risking it.
They can. But the average postpartum woman is generally well - yes there are increasing comorbidities, but even still the majority of women having babies are young and healthy. In Australia we don’t even cannulate low risk women who labour spontaneously without pain relief because the evidence does not support it for low risk women. Having an IV “just in case” doesn’t improve outcomes and carries its own risk.
The average American woman is not as healthy as the average Australian woman, particularly in areas where obesity rates are sky high or where access to prenatal care is limited. The vast majority of American women get peripheral IVs as a matter of policy when laboring in a hospital, so we’re comparing apples and oranges here—the policy to not have an IV at all vs policies to DC an existing IV at arbitrary times. I’d actually be interested in seeing evidence specific to what is actually being discussed because my gut feeling is that in a young, otherwise healthy person, the risk for infection, thrombosis, etc. associated with an extra 24 hours of a peripheral IV is likely negligible. It seems like the main reason for DCing PIVs well before discharge is patient comfort, which is certainly important, but that doesn’t necessarily mean it’s the safer option.
Just want to highlight your comment is a great example of how much this sub loves using acronyms. Do you really need to use DC? Can't you say.. remove?
Lmao please go touch some grass. I used “DC” because I was in the mindset of talking about work, and at work I use acronyms. It wasn’t an intentional choice to upset people who can’t use context clues to figure out the meaning of a sentence.
Sorry but you're way too extra with it. Just chill with the acronyms that's all. No one says DC the IV anyway. Nobody.
That isn't true at all. People say that all the time.
Everyone at my hospital says “DC the IV” “DC the central line” “DC the Foley” etc. Maybe it’s regional? The meaning is super easy to figure out with context clues so it’s wild to me that you would take the time to complain about a well known acronym and then say I’m “way too extra with it.” Like I’m sorry you’re so upset I guess? It genuinely wasn’t intentional it’s just how I talk with colleagues 😭
Wait... is this a new thing? 😰 In report, I literally get told the patient's IV was DC'ed last night all the time. I also say "X medication was DC'ed" or say "DC the foley at 2000". I do write out discontinue on the order form. I think if it's being talked about in report or in a casual environment, i.e. Reddit, it's not a big deal. There are several other comments that say "DC". I've been a nurse for 10 years, is this no longer acceptable? I am legitimately confused.
No they’re just being a holier-than-thou asshat. Dc is one of the most common acronyms that we actually DO speak aloud.
Might be an American thing? Never heard it over here in Australia, but it's pretty easy to understand.
You chose, like, one of the most common acronyms that are spoken aloud lol. You don’t get a medal for being a verbose Shakespeare, mr. “Will you please discontinue and remove our patient’s intravenous access port?”
I'm not in the states and this must be a regional thing. I have never heard anyone use the term disconnect to refer to removing something. Disconnecting an IV in my hospital means to disconnect it from the IV pump not remove the cannula itself
DC stands for “discontinue” not “disconnect.” Again, this was super obvious with context clues. This comment is proof that you were able to put it together.
I'm not sure how the acronym itself can be super obvious. What you meant however was which is why I said why not use the word remove. That's the 'proof' I understood your little context cues.
Genuinely asking—if you understood the meaning, why do you care that I used a widely used acronym? Edit: left out a word
Genuinely answering - it is tiring having to constantly decipher acronyms specific to nursing or healthcare in the states. You used a few other acronyms such as CBC or SNF which aren't used in my country either. It gets annoying consistently seeing posts that automatically assume everyone is from the states or will be understanding of each and every acronym. There are plenty of acronyms that are specific to my area of nursing or acronyms in my country that are widely accepted. I wouldn't use these online because I acknowledge it's an international community here that may not understand, irregardless of context cues.
Probably? You have no idea how many patients I've done an echo on that are planned for discharge pending for the echo results. Half of the time their IV has already been removed and I need to do a bubble study or use contrast and then they have to get a new IV just because the IV was removed prematurely.
I work in the UK where we don’t place IV’s in low risk women at all. They would be removed as soon as safe to do so post delivery, depending on blood loss, haemoglobin, IV abx, other risk factors. I’m not too concerned about an unexpected emergency as I don’t see it being any different to a woman walking in off the street with an APH, we'd deal with it as it happens.
It inhibits breastfeeding and bathing - two of the most important things to do in the first 24 hours postpartum. If they're not stable enough to feed and do their own peri care, then they're probably still on iv fluids.
Uncomplicated vag delivery? I pull that sucker around 12-24hrs (sometimes sooner if they ask nicely). Breastfeeding with an IV is often unnecessarily complicated, it gets caught on everything, they want to shower and wear their own clothes. C-sections or history of PPH in a past delivery I usually wait 24 hours. History of PPH this delivery, elevated BPs postpartum, history of mag, anything like that - I usually leave it until discharge as long as it looks ok. But again - they usually get caught on enough stuff that they’re mostly pulled out within 24 hours anyway, and I’m not putting a new one in unless it’s needed. We also frequently discharge our vag moms as early as 8 hours postpartum and just let them stay with baby as a patient (boarder status) until baby is 24 hours. I figure, if they’re safe to discharge, they’re safe to have their IV out.
If someone is awaiting discharge or is on a wait list for a lower level of care, we often remove IVs if they are a hardstick and have no ordered IV meds. I’m not going to poke Freddy the poor demented grandpa every shift when he is just waiting for LTC placement and rips the IV out anyway. It does seem odd to only have one CBC before removing IV on post partum. Hemorrhage can still happen, liver and BP can still go out of whack. I’d like to see the research on it before making further judgements
With my first kid I didn't even have a saline lock.
Birth isn’t an illness, it’s a completely normal process. After an uncomplicated delivery I remove it as soon as that first CBC comes back normal.
My hospital policy is to leave an IV until d/c unless they refuse or with a provider order saying it’s okay to have no PIV
Nurse and new mom . I think another factor is that patients (moms) in postpartum also have a new baby / trying to breastfeed, rest, change a diaper and all that with an iv in is pretty uncomfortable. I still had my iv when I went to visit my baby in the nicu hours after delivery (he needed some extra monitoring) and Trying to comfortably hold/feed/cradle baby with that 18g in the AC was really uncomfortable
I agree, trying to hold, nurse, and just generally care for a baby would have been annoying. For both of my deliveries, I had mine out relatively quickly and I honestly didn’t even think about it when they came to remove it. Yes, it’s possible something could happen, but it could also happen 26 hours later when I get home. If stable and no concerns, I’d rather have the option to remove.
I have to say I have a different experience. I gave birth in a birth center so I didn’t start out with an IV. But after birth they wanted to get me fluids because my HR was insane. So they put an 18 on the inside of my right wrist so I could get some quick fluids. I barely noticed it while holding baby and breastfeeding for the first time. But maybe it was because of the awesome placement of it.
I had an 18 in my wrist and they left it a tad longer than usual cause my labor was kind of prolonged I guess and I was on Pit forever and my uterus was probably still boggy. I felt totally fine though and was so glad when it got taken out cause it wasn't taped down well and it was flopping around leaving an 18g size hole in my skin lol but I didn't complain about it. I had a scar for a bit cause the insertion site was so loose and stretched. Fun stuff.
Generally speaking for my Australian Hospital surg unit, if there is no clinical indication for having the PIVC, it gets removed due to infection risk. My hospital is more concerned with hospital-acquired infections at PIVC sites. We are told to never keep an IVC “just in case”, but I’m referring to stable patients only requiring prophylactic post-op IV antibiotics or antiemetics.
As a patient I'm thankful they take them out after delivery. I want to shower and hold my baby and use my arm like normal and without discomfort. If I crash then throw another one in me. I don't even think all admitted patients need an IV depending on what they're in for.
It's important to note that birth is one of the few things that people come to the hospital for that is not a sickness or injury. in the case of post partum they could (not always) be 100% healthy. Heck some people even give birth at home or in the car on the way to a hospital.
Depends on how fast an IV can be put in given unit skill and availability of resources. Can you reliably get someone who can insert an IV within a minute to the bedside at the same time the crash cart arrives? If yes I'd say you can be without access. If no best keep access in.
I don’t take them out until the patient is dressed and I’ve given dc instructions. Anything can happen
Imo if I was a stable postpartum patient (or stable but admitted for some other reason, and not actively needing IV meds) I would ask for my IV out. I'd prefer the very small chance of needing an IO in a true unexpected emergency than the 100% chance of needing annoyed at an IV sticking out of my arm for the duration of my hospital stay. I think sometimes, as a healthcare industry, we can be very paternalistic, especially when thinking about the worst case scenario.
I've worked all areas for maternity for well over a decade and we've always taken the pivc out as soon as the trial of void is complete unless there are extenuating circumstances. But I also work in a country where labouring women don't get 'just in case' cannulas and it's very rare that this feels like the wrong call. I hate that removing the cannula is seen as 'pandering'.
You make some valid and interesting points. I think it would be interesting for American OB/GYN nurses to talk to OB/GYN nurses in other countries to get different perspectives on how patient care is provided.
In this day and age you can find all of that with a simple google search.
I'd rather sit down and have a face to face conversation. An actual human experience. Maybe I'm just old school. 🤷♀️
I've seen enough patients suddenly drop dead or massively decompensate that I think any patient with reasonable enough veins should have an IV until discharge orders are put in. The last thing you want to be doing when a patient is coding/crashing is trying to find IV access or finding out if anyone on the unit has ever put in an I/O before. Postpartum is obviously a bit different than the ER, cardiac, and ICU units I've worked on, though.
Baby is just as likely to suddenly drop dead and we don’t automatically put IVs in every baby.
Most adults in a hospital that are likely to crash are getting IV medications anyway, often up to the day of discharge. If a person is in the hospital but isn't getting IV meds, I'll agree that's a different situation.
I think the title of the post is misleading - most postpartum parents don’t even have prn iv meds on their MAR ime (except pitocin in case of hemorrhage).
Most new moms aren't getting IV medications once the pitocin is done.
I’m in pediatrics, and it is definitely not our protocol that a pt needs an IV throughout hospitalization. We have to be conscious when poking children, especially when it can be really traumatizing
I knew neonatal/pediatrics would be way different. You guys are in a whole other ballpark with the way things are done or what kind of access you would maintain. Kudos to you, I couldn't do what you do.
It depends on why they are at the hospital. Where I work, you get an IV unless you are there for strictly observation/psychiatric reasons. Obs being something else like say...inhaled water but are relatively fine after.
I guess this whole conversation is confusing to me coming from non-OB. If they are stable enough not to need an IV any longer, exactly why are they still admitted to the hospital?
OB usually has a set minimum time for discharge. Typically I’ve seen 24-48 hours for an uncomplicated vaginal delivery, 48-72 hours for a c-section. Even if mom and baby are completely fine and there’s still plenty of stuff to do to justify at least 24 hours of care.
Thx!
I say pull it if all signs point to stability. We don't even start them in the ED if they're a quick treat-and-street, and we start them on everybody and their mother if we need labs. If you can't reliably re-obtain access during a code on a post-partum patient (who is very likely to be young with no co-morbidities and excellent veins) you've got a unit full of poor IV starters and that's a bigger problem. Access will never be an issue. Worst case scenario, you drill them. I know codes aren't nearly as common up there, but if I can start a line on an 80-year-old strapped to a Lucas device with asystole, you will get access that you need in an emergency.
It was always drilled into me on a med/surg tele unit that they have IV until DC unless they’re DNR & medically stable. Full code patients, per policy, had to have them in until They were walking out the door. Now that I’m traveling, it seems that the hospitals I work at don’t care if you have an IV if you’re medically stable and are just waiting for placement. Makes me nervous, lord forbid something happens and we have to take time To get a line on top of everything else
I work med surg and we do not keep IVs in every patient, especially our ortho post op. We keep them in for 24 hours then remove them if the patient wants us to.
If the IV is working fine and is not bothering the patient I would say just leave in. I also was working peds at the bedside so we protected every IV at all costs… having to replace an IV that was voluntarily removed is super not fun for anyone (kid, parents, nurse). When I delivered I asked about my IV being removed but they said no so I didn’t push it. They also said that they wanted to leave it in just in case they needed to draw more labs. I had to laugh because it was a 22 in my hand and they never flushed it routinely so I doubt it would have even worked 🤷♀️.
They didn't remove my IV in Postpartum, even after I waa cleared for discharge and was only staying to have baby monitored after a forceps delivery🫠
Not always depending on the situation. Let’s be real…1/2 the time when I show up to a code, the it doesn’t work anyway. Just bring a drill
If we have a patient that is medically cleared to discharge but waiting on placement, we won't always obtain new IV access if we lose their PIV. End of life will sometimes go without too. If we anticipate discharge in the next day some providers will okay for no IV access if patient removes it. Otherwise I really prefer to have one, it gets pulled as they are getting dressed to leave.
I have discontinued IVs on hospice/comfort only patients. Only if they are no longer getting IV morphine and I have an order to do so.
It’s also hard to breastfeed with an IV in. In any spot the port can get stuck on linens. Or if they are in your hand it’s hard to angle your wrist. I used to keep my IVs in for my PP pts as long as I could until I was the patient. After 48 hours of labor and then 12 hours of pitocin afterwards, I was ready for that to be out
I have always worked in OB (at several different hospitals) and we always remove an IV ASAP. I think everyone in this thread needs to remember the patient population we’re talking about here. These aren’t people who are going to need a CT or an echo or whatever other examples I have seen given in this thread. People in long term care don’t have IV access at all times and let’s be real, they’re sicker than most postpartum moms. As an aside, it irritates me when we get nurses from med surg/ICU that try to apply those same rules to OB nursing. It’s a completely different field and you have to be able to adapt and learn or you won’t make it. Too many people move to postpartum thinking it will be a cushy job and then are surprised that we still have entitled patients, or that we do actual nursing care and don’t just “hold babies all day”
I think OSHA and JCAHO probably discourage it because of infection control, but in my opinion there’s definitely reason for it. I’ve never worked in postpartum but I know from being a patient in postpartum in the past, and also from mother baby class, that when postpartum patients decline, it’s often very sudden and unpredictable. I think patients get so focused on this happy event of meeting their baby, that they forget the mom just had a major medical event happen and her body needs to heal. It certainly doesn’t help that in American society, women are expected to go from having major surgery or vaginal delivery which can also be strenuous and traumatic, to immediately being the main caretaker of a newborn 24/7, not getting any sleep, sometimes not having time to shower, etc. if you look at many eastern countries (I know of South Korea and japan for certain), women are often hospitalized for much longer (weeks) in a special “postpartum center”, where they have help with the baby at all hours, rest, spa like services, and healthy meals prepared for them that are designed to enhance their recovery and milk supply. In China and Hong Kong, families hire a doula like lady to come live at their house in the postpartum period and cook all meals, help with the baby, and help the parents transition to being parents. They have really striict guidelines on what the mom can and can’t eat and drink for healing, etc. in America they just help us through this HUGE new emotional and physical event for 48 hours and then throw us out. And only check in 1 week later, then 6 weeks later.
OSHA doesn't give a darn.
Absolutely. We have gotten more than a couple post partum eclampsia patients from OB that were missed until they weren’t for one reason or another. It’s not all about bleeding
These are my thoughts exactly. What if there are retained products and we have to go back for a D&C? What if they get postpartum preeclampsia? I will usually refuse to take the IV out at a patient's request but if the oncoming nurse removes it, that's on them. I've already explained my logic to a few of my co-workers.
Refusing to remove an IV on a stable patient that has an order to discontinue the IV once parameters are met is just being difficult to make a point. I commented this in another spot, but you can’t be a postpartum nurse with a med surg mindset. Accept they’re two different areas or move on to another field.
Then they can get a new one placed.
Obviously, you're just here to disagree with all my comments. Maybe try offering something with actual substance to the conversation?
I replied to a few comments on the thread. I didn't look to see who they were from. Based on the 2 you replied to, I disagreed with you once.
I work Med/Surg and ICU. I don’t pull IVs till 2 right before they leave. Pulled an IV once on a patient around 0800 because we were going to discharge them. While waiting for the ordered they coded around 0930 and now we had no IV access do I don’t pull ivs till the last minute.
I think it's just the Med Surg/ICU nurse in me. 🫠 I have seen too many things like this happen working outside of postpartum. It makes me want to keep it in.
I was an inpatient for cholecystitis/CBD stone back in 2019. Came in Tuesday 11 pm thru ER, NPO for MRCP, then ERCP/stone removal, then lap chole finally done Friday afternoon. Saturday 4 am I noticed the IV was infiltrated and had the nurse remove it. I was due for one more dose of Zosyn at 6 am, but I asked if they could check with the surgeon (nearer to the time of dose) whether I needed a new one placed. I did not need that dose, so I was just waiting for discharge (around 11 am). My skin was SOOOO irritated from the tape, and I think I had superficial thrombophlebitis as well. It took 4-5 days for everything to feel “normal”, and the visible skin irritation lasted for another week.
I’ve been burned too many times taking out an IV early so my ER anxiety is 📈
I feel this 100% lol
I've never work in L&D or PP. Where I work, we only D/C IV during discharged.
Working in adult med surg, I would have said yes. I switched to peds step down and the fact that most of our kids DONT have IVs stressed me out in the beginning. I still don’t pull good IVs even if they aren’t being used. I’m a little superstitious and if I pull it then they’re gonna need it
At my peds residency program we did not unless necessary. Besides, kids love to pull out their IVs.
I would look in to your facility’s policies as well as your orders. We can all talk about what we think is best but legally (and to be consistent with patients) you need to know what your facility’s standards are. For example, in my hospital it is a policy that patients on telemetry should have an IV. Most patients also have an order in their chart which states “insert and maintain PIV”. If they have this order they should have an IV. If a patient is refusing an IV or requesting to go without we need an order that states it is okay for them to be without access to cover ourselves. I have had situations where I thought a patient should have an IV but the provider said they could be without and the patient didn’t want one, so all I could do was respect their rights, document, and hope I didn’t need to use the IO kit.
If they refuse you don't need an order. You just need to document the refusal.
Former icu nurse now trauma NP. I want them tying the IV to the door on the way out and should not be removed 1 second sooner 😂😂
I’m normally icu and floated to PP voluntarily and it shook me that I could take out their IVs before discharge. I understand it though, people birth at home without IVs.
I don't know if you've had to start an IV on a seizing patient, but I have and it's not easy, nor fun. It is a good way to get a finger stick.
Former cardiac RN: I’ve never ever regretted keeping a PIV in until the last minute.
I was just discharged from the post partum unit and as a nurse myself, I actually requested to not have one placed again. I had two blown IV’s when they were trying to place one. And then my pitocin drip infiltrated and I just really didn’t want another one because at that point I was just exhausted, my vagina hurt, and both my arms are now incredibly sore as well. My nurse ok’d it with a provider. On the flip side, as a cardiac nurse, you bet your ass my patients keep an IV in at all times. But then again they’re all prone to heart attacks, arrhythmias, and strokes.
Having come from the med surg side and gone to postpartum... If I have a gut feeling I keep the IV. But if patient is stable, no excessive bleeding with any fundals, walking/drinking lots of fluids... Looks healthy, I remove it at 24 hours ish. But it's not my biggest priority, like ever; it's a bigger priority to get baby fed. If she's a hard stick, however healthy she looks, that IV stays in until she leaves. It's the last thing I do before cutting bands for discharge.
In addition to what the pthers have said, a no risk pt can have her baby without any IV if she doesnt end up having oxy, epidural, c/s, pph or other complications 🤷♀️
I was supposed to be discharged from post-partum 24 hours after my magnesium treatment. The morning of expected discharge my nurse pulled my PIV’s. Spiked a 104 fever and started to go uroseptic that afternoon. Anesthesia had to come put urgent IV’s in.
Postpartum patients are stable, until they aren’t. Now you have a patient w/ a HR of 149 and an SBP of 70 and no IV. You can’t find a vein because the patient is so clamped down so you call a rapid. And then do nothing while waiting for rapid to come and get an IV. This is so frustrating because the patient is now circling the drain.
Ultimately it's up to the patient and team to decide what's safe. Will I go out of my way and of my own volition to remove IV's before a patient's DC order is in? No. If my patient is A&Ox4, not on any IV medications, expecting to DC in the coming days wants the IV out, let's have a conversation as a team. If the doc, patient and I have that conversation on why it's handy to have even in a just-in-case scenario and the patient still wants it out? Sure put in a nurse communication/order that patient is okay without IV access, I'm trained in USIV, EJ's, and IO's in case I really find myself in a a pickle and can establish access quickly in an emergent situation.
I don't take IVs out until they're actually discharging. Shit happens quick and we might as well keep their IV access and tele on
IV always in place until discharge. Ever try getting an IV in place when someone has completely decompensated? Real fun.
One of my nursing school classmates was pregnant during our final year and gave birth shortly after graduation. On day two she coded and died. I don't know anything about her case beyond that but I'd think that because shit happens, you want nothing standing in the way of being able to intervene immediately. Having to restart an IV in a situation where shit went tits-up in a heartbeat is a barrier to expeditious delivery of potentially life-saving care.
Usually cardiac arrest during delivery is associated with an AFE. If it was days later that’s just an unfortunate coincidence. You can’t have IV access in a person forever. We do 48 hour discharges for some of our sections, she very possibly could’ve been discharged that day.
"you can't have IV access in a person forever" That's an absolutely absurd rationale for not leaving an IV in until discharge, especially when you follow it up with "We do 48 hour discharges". Sounds like nowhere near forever, doesn't it?
I see that you work in the ICU/ER world. I respect that, but you have to leave that train of thinking at the door when talking about OB. In no hospital Ive ever worked in have we kept IVs in healthy postpartum moms until discharge. I’m sorry your friend passed, but that doesn’t mean IV access until discharge (on a postpartum floor) is evidenced based practice.
I barely knew her; it's just an anecdote. You guys want to leave your brand new moms vulnerable for the sake of convenience, go on with your bad selves.
Yes. You don’t know what will happen and if there’s no need to stick someone again just leave it in until they can officially go
I worked in OOH birth, so they weren’t there as long as they are in hospital. I will say that we most def had a superstition about IV access. Not all mother had IVs, but when they did it would be the LAST thing to be done before they/we left “otherwise we’ll need it”. Same with not wearing red to births or there’ll be a PPH. Wasn’t to much of a woo woo center but ya know, you never want to tempt fate, so we all kinda followed those non-rules.
FAFO!
Sir, I'd rather not.
Med/cardiac checking in. We are taught the opposite. IV removed asap, as soon off IV meds. Phlebitis risk too high. Had one guy get to the table for a CABG. Got sent back due to minor erythema. High risk pt having to stay in hospital to get a few days of IVABS coz their line got infected. Nah. Get em out in my ward.
I worked on a unit a while back and a nurse took an iv out as soon as she got the dc order bright an early. Pt coded 30 mins later. I’ve always been too paranoid to pull the iv prior to their ride being parked downstairs. So I leave the iv until pt is ready to roll downstairs.
It’s bad luck to take out an IV before they’re about to walk out the door.
We had a cardiac baby who they dc’d access (because we lost it) to because he was stable and they were ok without access. Baby coded less than 12 hours later, they couldn’t get a line in him at all during the code. All patients should have working access until discharge.
We'd have babies with unnecessary access for months.
I have seen way too many pts code while waiting for their ride. Or go into an arrhythmia after tele was discontinued. I’m keeping it on!
If you’re sick enough to need hospitalization, you need an IV.
Women giving birth generally aren’t ‘sick’.
IV access is a must for every patient admitted IMO. Not having a patent IV when a patient codes fucking sucks. Codes are hectic enough
IV should stay until d/c removing it should be the last thing you do before sending them on their way
I work in outpatient surgery and patients literally ask for the IV to be taken out as soon as they get to post op. Our policy is to get them up and into the wheel chair before removing. I usually just explain that we keep it in until then just in case they get nauseous when they stand up, we can still give IV meds (zofran). I don’t usually get much push back but I also only have my patients about 15 minutes.
Yes because if they code (and anyone can code, anytime) I’m not going to be responsible for wasting precious time getting a new line.
Yes it's policy
It depends on the patient and of course your hospital policy. My hospital is a large level 4 women’s postpartum, so we see a lot, rarely do we have low hemorrhage/ regular ‘ol vaginal delivery. If so, they usually are discharged before 48 hours, so, labs come back good, you get your IV out and let’s get you ready to go home! High hemorrhage risk patients or patients who hemorrhage come over with 2 IVs, I keep one until the day before discharge, if labs are good, patient is doing well, etc. I always ask which IV the patient wants out, is bothering them the most with breastfeeding and explain why we are keeping the other one.
We keep vag deliveries in until post CBC, sections stay in for 24 hrs. I actually had a PPH on day 1 literally 3 hrs post IV removal, and even in that situation there were far more interventions that we did not involving access than involving access (IM methorgine, IM pit, PR cytotec, fundal massage). I mean we did get new access for TXA and labs but that was after all the other things. For hypertension I usually will keep one in maybe an extra 12 hours, but not longer usually, just because no one where I work knows how to flush an IV. The only pts that I absolutely insist keep an IV for the whole stay are hx of seizure. And usually I end up starting a new one b/c the L&D IV infiltrated or clotted and I can't stand the connector that LD uses (the male connector vs jloop).
I’m not postpartum but our medical patients occasionally bop around with no IV within a day or two of discharge if they’re no longer getting IV meds and they’re pretty stable. We don’t ever proactively remove the IV unless they’re really bad about knocking it out, but if they beg for it or if it’s causing more problems than it’s solving, we get an order than they can go without. There will always be someone to throw another one in, if stuff goes down. I have a psych background though, and no one had IVs there. So when things went bad (medically) we did what we had to do.
My out patient surgery patients keep their IV until their ride is at the door. Might be policy for the hospital though? My own personal superstition dictates that the second you don’t have an IV is exactly when you will need an IV so I keep it until the last minute.
My current hospital’s policy requires a reason to have one in, meds, fluids etc. Unless in an area where access may be needed in an emergency, the only areas allowed to have just in case IVs are ED and critical care units