Butterfly or No?

mycrofft said:
Carpal tunnel and c4-c5 compression robbed me of my stick talents. Limit those video games kiddies!

Not to advertise, but here's the brochure about the BD bloodless IV sets, and they make them up to 18g.

http://www.bd.com/infusion/pdfs/D14441.pdf
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Those are the winged sets that I'm thinking of... I like them, but I prefer a regular angiocath. I like the Insyte Autoguard and the Jelco Protectiv caths. Of the two, I like the Jelco because it's really easy to get a blood sample to feed the glucometer (if glucometer is OK with venous blood).

Like others here, I'm also a fan of permissive hypotension. To me, it just makes sense... and while I'd still put in a larger bore IV (or two) it's basically because one port in a storm is good, two is better, and it's far better to reach a safe harbor before the storm hits. In other words, I believe in getting access while it's still easily possible, and if the patient is going to surgery, all the better. If not, the facility still has the choice to stick with what they've got or they can start new IV's before removing the old ones.
 
Akulahawk said:
I'm just glad I never got into those games much... I'm far more a fan of X-Plane. Not exactly a game with lots of action though. -_-
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Fits perfectly with my ADHD. Though sometimes it does Get old always getting cut from behind by some 9yo mouth breathing, chewing bubble gum, and crying when Mama makes them stop to do homework.
 
ADHD? Those folks have a longer attention span that I do. Heck, even a gnat sometimes has a longer attention span. ;) I'm mostly glad I didn't get into those games because my wallet would be perpetually empty... or at least worse than it is now.:blink:
 
I forgot the other EMTLIFE Black Hole: video games
 
NYMedic828 said:
A doctor or few have told me that unless you have access to transfusions in the very near future, the infusion rate of a 14/16g catheter can quickly turn into a mistake.

If a patient has lost 1/4 of their blood volume to a traumatic injury, a 14/16g isn't easily obtained for starters if vascular collapse occurs and in theory if we establish a pair of 14g IVs, we could infuse 500ccs a minute. How quickly do you think that would turn your blood into kool-aid?

If a tank of red liquid is leaking and we put clear liquid and pressure into it, we only force out the red liquid faster and make what remains diluted.

I work around a few of the busiest trauma centers in NYC and they rarely go bigger than 18g in the trauma room.
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I understand this physician's rationale behind dumping in too much fluid simply because it's possible with a larger bore catheter - BUT - if you still have access to rope like veins prior to cardiovascular collapse in a big trauma patient, I, your OR friend, will GREATLY appreciate that big access. You have to think past the first 15 minutes of a trauma case - that patient will in all likelihood end up in an OR. Early vascular access is a HUGE help, and can save some precious time.

No offense to your NYC trauma buddies, but I can promise you that if that trauma patient comes to my OR with a couple of 18's because the damn ER doc thought that was big enough, we will have a chat post-op - and I will be putting in an 8FR introducer in the IJ so I will have plenty of access. And having to take the time to put in bigger access when it could have been done earlier is really gonna irritate me.

Butterfly needles are for drawing blood - nothing more, ever - end of discussion.
 
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jwk said:
I understand this physician's rationale behind dumping in too much fluid simply because it's possible with a larger bore catheter - BUT - if you still have access to rope like veins prior to cardiovascular collapse in a big trauma patient, I, your OR friend, will GREATLY appreciate that big access. You have to think past the first 15 minutes of a trauma case - that patient will in all likelihood end up in an OR. Early vascular access is a HUGE help, and can save some precious time.

No offense to your NYC trauma buddies, but I can promise you that if that trauma patient comes to my OR with a couple of 18's because the damn ER doc thought that was big enough, we will have a chat post-op - and I will be putting in an 8FR introducer in the IJ so I will have plenty of access. And having to take the time to put in bigger access when it could have been done earlier is really gonna irritate me.

Butterfly needles are for drawing blood - nothing more, ever - end of discussion.
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There needs to be a thumbs up icon. . .
 
MSDeltaFlt said:
I'm a Rainbow Six and COD man, myself.
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Original R6 with Red Storm Entertainment? Yes. Ubisoft? No. They ruined the Tom Clancy franchise by catering to ADHD kids and going away from actual tactics.


Same with COD... too much catering to the ADHD generation. It's a fun game and I play it from time to time, but far from the 'greatness' that people proclaim, especially since each iteration is essentially the same as the last.
 
Field 14's ok if you can do it first try and don't crank it up to 11. And if it is appropriate.
We have had so many inappropriate IV starts and failed ones that our local EMSA has a specific prohibition against starting IV's "just in case". That way the anesthesiologist can still find an unused site when it is REALLY needed.
 
mycrofft said:
Field 14's ok if you can do it first try and don't crank it up to 11. And if it is appropriate.
We have had so many inappropriate IV starts and failed ones that our local EMSA has a specific prohibition against starting IV's "just in case". That way the anesthesiologist can still find an unused site when it is REALLY needed.
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That prohibition against "just in case" IV starts was in place about 10 years ago... If I needed to start a line, I could always articulate a reason for doing so... however, if the patient didn't need a line, they didn't get one. Not everyone got a line.

And I'm not a "go big or go home" kind of medic when it comes to IVs. If I have to go big, I will. Otherwise, they'd get a small/medium bore as needed/indicated.
 
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mycrofft said:
Field 14's ok if you can do it first try and don't crank it up to 11. And if it is appropriate.
We have had so many inappropriate IV starts and failed ones that our local EMSA has a specific prohibition against starting IV's "just in case". That way the anesthesiologist can still find an unused site when it is REALLY needed.
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I think you missed my point. A major trauma case assumes an IV - it's hardly inappropriate. It is not a "just in case" IV. It's putting in a big IV while you still are able to do so - 5 minutes from now when they've bled out another liter, you're not going to see those big rope veins. A major trauma case is going to get fluid, colloid, and blood products. More viscous substances like blood flow far better through a 14 than with an 18 or 20. If you're trying to stick in a 20, you might as well just load and go anyway so I have more time to stick that 9FR cordis in their IJ.
 
Akulahawk said:
And I'm not a "go big or go home" kind of medic when it comes to IVs. If I have to go big, I will. Otherwise, they'd get a small/medium bore as needed/indicated.
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I put a 16g in a 75yo with a temp of 103.2 and GCS of 10 the other day. It feels so wrong, even though it was the right thing to do. The fluid brought her GCS up to a 14.
 
My "go to" size is an 18g, but ill take what i can get. The hospital is always appreciative if we get it high and it draws, especially if they are going to CT. I'm guilty of starting up near the AC, or in it, if there's a good vein. I try to keep it distal though so they can still bend their arm. I don't care who you are. AC IVs aren't comfortable.

I've started one 14, I haven't really had the trauma calls to warrant it. If its a critical patient I'll usually start with a 16 though.
 
Aidey said:
I put a 16g in a 75yo with a temp of 103.2 and GCS of 10 the other day. It feels so wrong, even though it was the right thing to do. The fluid brought her GCS up to a 14.
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Believe me, I know exactly how you feel. I've had to do a very similar thing... once upon a time, way back when.
 
Akula I was working Methodist ER (before the Grey Sisters took it over) and we had to bite our tongues sometimes when we saw the IV's coming in. House policy was to DC every field IV, but sometimes they left no unpunctured veins for the OR to use. (We could always weasel something).
 
NVRob said:
My "go to" size is an 18g, but ill take what i can get. The hospital is always appreciative if we get it high and it draws, especially if they are going to CT. I'm guilty of starting up near the AC, or in it, if there's a good vein. I try to keep it distal though so they can still bend their arm. I don't care who you are. AC IVs aren't comfortable.

I've started one 14, I haven't really had the trauma calls to warrant it. If its a critical patient I'll usually start with a 16 though.
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CT won't put contrast in anything less than an 20 and will not take hand IVs.

Learned that while we stood in a hallway with a patient with crap veins, transport nurse with one arm, me with the other, trying to get a line for grumpy CT lady, despite a patent 20 in the hand.


Edited to fix a mistake.
 
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The hospital where I did my clinical time used almost exclusively 20s, so that's what I used too. I wanted to try an 18 or 16 (gasp) when I got some rope veins but was quickly told that was "overkill," and that a 20 could be used for "pretty much anything." When I get home I need to go back and do more clinical time with a preceptor that's a bit more open minded I think.
 
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