socalmedic
Mediocre at best
- 789
- 8
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hahahaahahaha, awesome pics
Accessing Delicate Veins
- Thread starter atticrat
- Start date
8jimi8
CFRN
- 1,792
- 9
- 38
ok two points!
I had a guy who was a terrible start. The night before i blew an 18 and a 20. Like as soon as the vein was pierced, the ivs blew. So having resolved that the manufacturer did not forbid bevel down, thanks for your efforts Socal, I tried the bevel down. I had terrible luck, it felt really awkward piercing the skin, like it got hung up somehow and the vein blew as soon as i pierced it. (Hence admonitions about having to be good at it...)
Next what happened.... I pierced the skin with a 22 on a guy with really "Tight" skin. He was quite edematous (non-pitting) and the veins were visible, barely palpable, but deceptively large. Somehow I missed on the first pass, i didn't feel the pop, i could see visually that i was past my landmark... so I backed the catheter up, when i pulled it back, the needle slid out about 1mm from the catheter, so i secured the catheter hub, and re-advanced the needle, i encountered resistance as I advanced the needle and thinking I had hit a valve, I pulled the whole array.
What did i find?
I found that the catheter had kinked while inside the the patients arm and the freaking needle had pierced the plastic, exactly 1 mm below the tip of the plastic catheter.
To whomever said that shearing off a piece of the catheter was MERELY a danger from the PAST...
you are WRONG. I didn't do it on purpose, but lo and behold, something that has never happened to me before, happened, when I had exactly ZERO fear that it ever could with our modern devices.
I will find out the name of the catheters that we use, so that you all can have a more complete picture. Going to work here in about an hour. So look out for my repost.
jimi
I had a guy who was a terrible start. The night before i blew an 18 and a 20. Like as soon as the vein was pierced, the ivs blew. So having resolved that the manufacturer did not forbid bevel down, thanks for your efforts Socal, I tried the bevel down. I had terrible luck, it felt really awkward piercing the skin, like it got hung up somehow and the vein blew as soon as i pierced it. (Hence admonitions about having to be good at it...)
Next what happened.... I pierced the skin with a 22 on a guy with really "Tight" skin. He was quite edematous (non-pitting) and the veins were visible, barely palpable, but deceptively large. Somehow I missed on the first pass, i didn't feel the pop, i could see visually that i was past my landmark... so I backed the catheter up, when i pulled it back, the needle slid out about 1mm from the catheter, so i secured the catheter hub, and re-advanced the needle, i encountered resistance as I advanced the needle and thinking I had hit a valve, I pulled the whole array.
What did i find?
I found that the catheter had kinked while inside the the patients arm and the freaking needle had pierced the plastic, exactly 1 mm below the tip of the plastic catheter.
To whomever said that shearing off a piece of the catheter was MERELY a danger from the PAST...
you are WRONG. I didn't do it on purpose, but lo and behold, something that has never happened to me before, happened, when I had exactly ZERO fear that it ever could with our modern devices.
I will find out the name of the catheters that we use, so that you all can have a more complete picture. Going to work here in about an hour. So look out for my repost.
jimi
8jimi8
CFRN
- 1,792
- 9
- 38
just wanted to note, the second guy. i went bevel up. on call. so i'll get that name of the angiocath before long
8jimi8
CFRN
- 1,792
- 9
- 38
BD Insyte Autoguard (non winged)
http://bricomedicalsupplies.net/brochures/BD%20Insyte%20IV%20Catheter.pdf
http://bricomedicalsupplies.net/brochures/BD%20Insyte%20IV%20Catheter.pdf
MasterIntubator
Forum Captain
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That may have been me... but I still stand by my statement. Piercing any part of the catheter with the stylus will MOST likely NOT sheer it off. They are designed to be tough and have stretching/flexing properties. Piercing the catheter is a risk when re-inserting the stylus at any point in over-the-stylus catheters, whether on purpose or not.
It happens, I have had it happen several times in the past as well, and it has ONLY happened to me when re-inserting it. Not saying that it can not happen to any of you unexpectedly, but if it did.... somwhere along your venipuncture, the styus was re-thread within the catheter causing that. ( especially if you are not in the habit of holding the stylus and catheter hub together as you fish for that vein, and backing up can separate the two. ) .... technique my friend... technique.
Around my area, they teach to "break" the seal of the catheter and stylus before doing venipuncture ( I suppose so you don't have such a hard time threading it once you get flash ), but that initial hesitation is most likely there so the catheter does not prematurely start leaving the rigid support of the stylus causing a freak accident. I do not break that seal. I want it there.
Not something to have a bad hair day about.
slb862
Forum Lieutenant
- 147
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Tricks of the trade...
For hard starts (pediatrics, elderly, etc.) in the field or in the ED, No matter what gauge I use, and if time permits, I go slow and when I get flash, I allow the chamber to fill, the I then advance slowly. I have had great success with this manuver. For some reason this works for me. B)
For hard starts (pediatrics, elderly, etc.) in the field or in the ED, No matter what gauge I use, and if time permits, I go slow and when I get flash, I allow the chamber to fill, the I then advance slowly. I have had great success with this manuver. For some reason this works for me. B)
Ambulance_Driver
Forum Crew Member
- 40
- 5
- 8
May have been Master Intubator who said that, but could have just as easily been me.
I never said it was impossible to pierce the catheter with modern through-the-needle catheters, I said it was nigh impossible to *shear it off.*
Big difference there.
Shishkabob
Forum Chief
- 8,264
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Jimi and I are at a pediatric hospital for a PEPP class today... should ask this question and see their views.