Accessing Delicate Veins

[8jimi8]

last i checked there was no "directions for use" for the catheter. i checked the box, the wrapper, the safety cath itself, hell i even read the whole pamphlet that comes in the box printed in 20 different languages. Nowhere did it say there was a specific way to use it and that is the only approved way. I spoke with a few more medics and they all said that they have tried it before, some had no idea about the bevel and had apparently never thought about the orientation, they just knew that the "button on the thingy" goes up. so i am sticking with my bevel down technique, if it comes up in a court of law "I cant recall how i performed the intravenous canalization" remember they have to responsibility of incriminating you. further more i have to agree with whoever said if you are in court defending yourself you probably have bigger things to worry about than which way the bevel was facing.

Dude, i hope your instructors don't read this site. You need to think about some ethics before you pass your NREMT.

so you say you'll just lie? Get out of this profession, please.

 

[Sasha]

Dude, i hope your instructors don't read this site. You need to think about some ethics before you pass your NREMT.

so you say you'll just lie? Get out of this profession, please.

Plus one. If you caused harm to a patient, man up and take responsiblity. Don't lie to cover your own butt. If you'll be dishonest to save your skin, then you really have no business being in EMS, or health care for that matter. Or really any profession that deals directly with people.

 

[medicRob]

None of the guns I've owned have ever come with instructions either. Doesn't mean there isn't a right and a wrong way of using them. And legal/ethical implications for their incorrect use.

Not commenting on the bevel down technique. Just questioning the "it didn't say so on the label" logic.

Every thing comes back to bite you in the butt eventually. There is a certain karma that exists in EMS & Fire that doesn't seem to exist in other professions. If you lie, the universe will in some how and in some way ensure that something comes up that brings that lie out. I have seen it all too many times. Usually, it is just little inconsequential things, but if it involves patient care that is far from inconsequential. You have a responsibility to your patients to treat them to the best of your ability and to maintain the honesty and integrity of your profession. Get with it.

 

[Melclin]

Every thing comes back to bite you in the butt eventually. There is a certain karma that exists in EMS & Fire that doesn't seem to exist in other professions. If you lie, the universe will in some how and in some way ensure that something comes up that brings that lie out. I have seen it all too many times. Usually, it is just little inconsequential things, but if it involves patient care that is far from inconsequential. You have a responsibility to your patients to treat them to the best of your ability and to maintain the honesty and integrity of your profession. Get with it.

Ahhh...I agree, but not sure what that has to do with my post.

Click on the wrong reply link?

 

[8jimi8]

Either that, or he agreed with your point.

 

[socalmedic]

wow this thread is in left field now. maby we can move the last 4 pages to the med/legal section. to jim i never meant to imply lieing or dishonesty. to the OP i guess we have decided that you will just have to go without an iv as it is unethical to think outside the box. i guess its a good thing we have IO now because god forbid you use the IV needle upside down to get a vein. i guess the easy thing to do would be to ask my Med director for permission.

 

[MediMike]

Easy solution! Lets someone contact the manufacturers of said angiocaths and ask if there is some detrimental effect produced by inserting bevel down!

And to everyone jumping SoCal's case regarding this hypothetical court situation, what harm do you see being done with the bevel down?

Just curious

 

[8jimi8]

if it comes up in a court of law "I cant recall how i performed the intravenous canalization" remember they have to responsibility of incriminating you.

Socal, I don't see any way you can interpret this as being honest. I understand you may be backpedaling now, but the way to do that is to admit you were wrong, not deny what you stated. I didn't put any words in your mouth. People are reacting to your intent to be dishonest, we aren't in left field. PLEASE don't misrepresent yourself as a professional, if you can't even be honest.

 

[MasterIntubator]

Easy solution! Lets someone contact the manufacturers of said angiocaths and ask if there is some detrimental effect produced by inserting bevel down!

And to everyone jumping SoCal's case regarding this hypothetical court situation, what harm do you see being done with the bevel down?

Just curious

There will be no harm. You can "what if" any situation long enough. The catheter folks probably won't endorse chest decompressions either, as it is an off label use and there are better devices. But heck.... it works.

 

[zzyzx]

"Case in point: Why were we all taught never to retract the needle from the catheter and re-insert it? Risk of catheter shear, right? Have you ever TRIED to shear a catheter that way? It takes a 90 degree bend in the cath, and a very delicate 360 degree rotation of the needle, all while *inside* someone's vein. In other words, not likely. You may bugger up a cath, but it is highly unlikely that you will ever shear off a piece. That particular admonition is a holdover from the days of through-the needle catheters. Doesn't apply to modern equipment."

Are you sure about this? I have also wondered how that could really happen. But perphaps it is possible to break off a small piece? I never re-insert the needle, but I have seen a few nurses using this technique. It would certainly be helpful to use if you could be 100% sure that there is no risk of breaking off any part of the catheter.

 

[Ambulance_Driver]

Socal, I don't see any way you can interpret this as being honest. I understand you may be backpedaling now, but the way to do that is to admit you were wrong, not deny what you stated. I didn't put any words in your mouth. People are reacting to your intent to be dishonest, we aren't in left field. PLEASE don't misrepresent yourself as a professional, if you can't even be honest.

Since when are lawsuits about honesty? They're about blame.

It's not unusual at all for a defense attorney to coach his client to state "I don't recall" in response to the questions that can't be proven.

The plaintiff's attorney is going to *let* you tell the *truth.* He's only going to ask/let you answer questions that strengthen his case. Your attorney will do the same.

 

[Ambulance_Driver]

Are you sure about this? I have also wondered how that could really happen. But perhaps it is possible to break off a small piece? I never re-insert the needle, but I have seen a few nurses using this technique. It would certainly be helpful to use if you could be 100% sure that there is no risk of breaking off any part of the catheter.

You may poke the stylet *through* the cath, and thus bugger it up, but it's not going to shave off a piece. Of course, buggering it up makes it more difficult/traumatic to remove the cath when you discontinue the IV, but there is little danger of a catheter shear and resulting embolus.

In the early days of intravenous therapy, through-the-needle catheters were used, and the earliest of those devices lacked any protective guides to prevent catheter shear - hence the admonition never to withdraw the stylet and then re-insert it. Doing so in those catheters posed a risk of shaving off a piece of the catheter with the sharp bevel of the needle.

Through-the-needle catheters are only used these days for central line insertion, and have built-in safeguards such as breakaway or splittable needles, or catheter guides to limit the potential for catheter shear.

Of course, I can't provide a specific cite, but Judy Hankins book "Infusion Therapy in Clinical Practice" is an excellent source with plenty of historical background on intravenous therapy. It may well be where I first read of this.

 

[8jimi8]

Since when are lawsuits about honesty? They're about blame.

It's not unusual at all for a defense attorney to coach his client to state "I don't recall" in response to the questions that can't be proven.

The plaintiff's attorney is going to *let* you tell the *truth.* He's only going to ask/let you answer questions that strengthen his case. Your attorney will do the same.

Courtroom tactics aside. Honesty is black and white. Your ok with a student who intends to lie to cover himself as a professional? This thread has been hijacked enough. I'm interested in any further discussion, clarification concerning the bevel down. I thought someone was going to contact the manufacturer?

 

[Ambulance_Driver]

Courtroom tactics aside. Honesty is black and white. Your ok with a student who intends to lie to cover himself as a professional? This thread has been hijacked enough. I'm interested in any further discussion, clarification concerning the bevel down. I thought someone was going to contact the manufacturer?

I wasn't the one who hijacked the thread, but I take your point. I just doubt that any plaintiff's attorney is ever going to ask which way a bevel was oriented in court, and whether it is capable of causing injury. It's akin to asking if your needle was at 90 degrees or 75 during your IM injection.

I'd also be interested in what the manufacturer says, but I'll take bets that you won't get a firm answer, and if you do, it will be some reiteration of their package insert.

 

[8jimi8]

I wasn't the one who hijacked the thread, but I take your point. I just doubt that any plaintiff's attorney is ever going to ask which way a bevel was oriented in court, and whether it is capable of causing injury. It's akin to asking if your needle was at 90 degrees or 75 during your IM injection.

I'd also be interested in what the manufacturer says, but I'll take bets that you won't get a firm answer, and if you do, it will be some reiteration of their package insert.

agreed!
Thanks for posting up to weigh in!

 

[socalmedic]

I thought someone was going to contact the manufacturer?

smiths medical (maker of the jelco ProtectIV) has been contacted. two clinical support representatives (James, and Kathy) have stated that they see no reason why you cant use the device any what you wish, and they they are not certified for a particular technique. to who was asking about thoracic decompression, they again to that "use it any way you feel clinically necessary". they have however refered my question to their "equipment specialist" and he should get back to me within a week as to if their is a design reason as to why to use bevel up.

 

[zzyzx]

SoCal Medic: Thanks for taking the time to do all that!

If you get a chance to talk to the rep, ask him about the possiblity of shearing off part of the catheter if you advance the needle through the catheter after you have drawn it back.

 

[MasterIntubator]

Yeah.. that was me... about the thoracocentesis. As you found out... there are many 'multi-taskers' in our toolbox. And the catheter is one of them.

Back in the day when those IV catheters were made of a more ridid plastic, ( especially the Insytes - catheter within the stylus ), there was more concern. The teflon stuff and other exotic plastics are super resilient to tearing and shearing. Take one out and play with it... stretch it... poke it. I would be quite impressed if it sheared on first or second F-up.

Another lost art trick when re-treading the stylus, was to turn the stylus bevel down so it would glide along with the sheath curveture, instead of piercing it. Many manufactures would put a mark/logo/indent on the flash chamber so you would know when the bevel was up... just turn it 90 deg ( Terumo had a "T", angiocath had a dot, etc etc etc )

 

[Ambulance_Driver]

Many manufactures would put a mark/logo/indent on the flash chamber so you would know when the bevel was up... just turn it 90 deg ( Terumo had a "T", angiocath had a dot, etc etc etc )

Watch a doc inserting a central line, and you'll often see them take great pains when attaching a syringe to their needle, and for the same reasons - so they can look at the syringe markings and know what way the bevel is oriented.

 

[Hockey]

Bevel down works. Great in some cases. I was really against it at first, until I tried it on a next to impossible start and it worked