IV Sticks - AEMT noob tips and tricks?
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I would, Dehydration is diagnosed with Lab values. So in essence, we are guessing, and in the meantime treating hypotension.
* Giving a patient a dose of NTG (which is what spraying NTG on the skin does -- anyone remember the dosing on a nitropatch?) to facilitate IV access, doesn't seem like a good idea.
* The flashlight / trans-illumination technique can work, but be very careful with how hot your flashlight can get. A lot of people try and do this on little kids. If you give them a second degree burn with a Stinger flashlight trying to get a line, you will be asked why you didn't go for an IO.
* The flashlight / trans-illumination technique can work, but be very careful with how hot your flashlight can get. A lot of people try and do this on little kids. If you give them a second degree burn with a Stinger flashlight trying to get a line, you will be asked why you didn't go for an IO.
Nervegas
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Idk about using nitro, but using an alcohol swab and rubbing vigorously can cause them to become agitated and stick out more pronounced. I have been known to just run my fingers across the skin lightly and wait until I feel a trough that is springy to the touch and that has no pulse.
For every medic you meet, there will be another way to start an IV, find what works for you, practice as much as possible and eventually you just get comfortable with them, and know that you won't always be able to hit it, even the giant A/C that could take two 14ga's.
Ardmoreff
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Yea it was a pretty seasoned Paramedic that told me that trick. Haven't used it myself and don't plan to. I was just curious of what you guys thought.
Try one on yourself.
For what it's worth, I was told the same thing myself when I was training. But I still think it's a terrible idea.
airbornemedic11
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Dehydrated 80 yr old
Welcome to the suck. 1st, I would find the biggest, bluest vein you can find on her, hopefully forearm or AC. 2nd, I would use a 20 or 22 g. 3rd, I would use my favorite beer bottle grip on her arm, using your thumb to pull down on the vein and straighten it out. Be carefull, that paper thin, flabby skin is not going to move in tandem with the vein. Also, since she's dehydrated, make it a quick, smooth motion. If you go slow, you will blow that vein. Hooah.
Welcome to the suck. 1st, I would find the biggest, bluest vein you can find on her, hopefully forearm or AC. 2nd, I would use a 20 or 22 g. 3rd, I would use my favorite beer bottle grip on her arm, using your thumb to pull down on the vein and straighten it out. Be carefull, that paper thin, flabby skin is not going to move in tandem with the vein. Also, since she's dehydrated, make it a quick, smooth motion. If you go slow, you will blow that vein. Hooah.
dawgsfan11
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x2!
kindofafireguy
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+1. Or on classmates. My wife said I looked like a hardcore heroin addict with my track marks. But I took every stick I could get, and did a few on myself.
Still do from time to time to stay sharp.
the_negro_puppy
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Yep the only way to get better is to do as many as you can on real people. Training arms are next to useless. We weren't permitted to do them on each other during our training so basically we did a few on fake arms then had to 'practice' on live patients.
I feel sorry for patients getting stuck lots of times but I guess everyone has to learn somehow.
I feel sorry for patients getting stuck lots of times but I guess everyone has to learn somehow.
jroyster06
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I can see the OP was taught with a Nacy book. Don't start at a 45. Penetrate the skin shallow, you can always work a little deeper.
Alcohol preps can help you see the vein a little better. Also those hard stick pts i like to use a BP cuff for a tourniquet instead of the band. Inflate to diastolic pressure and watch the veins pop up.... IT WORKS. My pts that say oh you can't get a line i was stuck 7 times before they got an IV last time in the ER usually get the BP cuff! It works 90% of the time or maybe I'm just lucky. Its also more comfortable for the pt.
And those pts that you need a line on and don't really want to drill, use the bp cuff as well as a heat pack. Heat packs seem to help the vein rise up a little more.
Older medics told me when i was new that the iodine prep in your start kit makes it easier to see the vein. Its never worked for me but it may for you!
Im also a fan of going just proximal to the a/c. All to often those pts that need fluid get stuck in the a/c. Problem is the pt can usually pinch the cath off just by moving their arm around. Go above the joint and you isolate that problem. And one more bit of advice, your ob pts that are in labor, avoid the A/C. The pts pinch it off when they are laying on their back pushing. Go for the forearm or above the a/c and your will be an L&D nurse's hero!
Alcohol preps can help you see the vein a little better. Also those hard stick pts i like to use a BP cuff for a tourniquet instead of the band. Inflate to diastolic pressure and watch the veins pop up.... IT WORKS. My pts that say oh you can't get a line i was stuck 7 times before they got an IV last time in the ER usually get the BP cuff! It works 90% of the time or maybe I'm just lucky. Its also more comfortable for the pt.
And those pts that you need a line on and don't really want to drill, use the bp cuff as well as a heat pack. Heat packs seem to help the vein rise up a little more.
Older medics told me when i was new that the iodine prep in your start kit makes it easier to see the vein. Its never worked for me but it may for you!
Im also a fan of going just proximal to the a/c. All to often those pts that need fluid get stuck in the a/c. Problem is the pt can usually pinch the cath off just by moving their arm around. Go above the joint and you isolate that problem. And one more bit of advice, your ob pts that are in labor, avoid the A/C. The pts pinch it off when they are laying on their back pushing. Go for the forearm or above the a/c and your will be an L&D nurse's hero!
NYMedic828
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Not sure whats already been said as I am not in the mood to read 6 pages but,
IV's in the ER are MUCH easier for the simple fact that the patient is elevated and situated in an optimal position for you to work and have a nice work space. This is also an optimal way to learn, obviously.
Quite honestly, it isn't that neccesary to do an IV while moving. Sure we all do it. Personally I don't really even try while moving unless its a real nice vein. The streets of NYC are so bumpy its just asking for failure.
Also, if it was that detrimental for me to establish an IV, I'd rather pull over for the 10 seconds it takes to physically cannulate the vein than try 5 times while moving and not succeed.
Working with needles while moving also has its obvious safety issues.
As far as tips for performing the IV/finding veins I think they were all covered.
For hands I personally like to aim for bifurcations, makes it pretty hard to miss if you go right at the angle of the Y.
IV's in the ER are MUCH easier for the simple fact that the patient is elevated and situated in an optimal position for you to work and have a nice work space. This is also an optimal way to learn, obviously.
Quite honestly, it isn't that neccesary to do an IV while moving. Sure we all do it. Personally I don't really even try while moving unless its a real nice vein. The streets of NYC are so bumpy its just asking for failure.
Also, if it was that detrimental for me to establish an IV, I'd rather pull over for the 10 seconds it takes to physically cannulate the vein than try 5 times while moving and not succeed.
Working with needles while moving also has its obvious safety issues.
As far as tips for performing the IV/finding veins I think they were all covered.
For hands I personally like to aim for bifurcations, makes it pretty hard to miss if you go right at the angle of the Y.
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VFlutter
Flight Nurse
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Anyone else ever use one of these? http://http://www.accuvein.com/
We have them on a few floors of the hospital, they can be very helpful in patients with dark skin. Not sure if they are used prehospital.
We have them on a few floors of the hospital, they can be very helpful in patients with dark skin. Not sure if they are used prehospital.
Christopher
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From experience I would not do this if the truck is moving
If you get any sort of blood on your gloves or the screw which deflates the BP cuff you're gonna have a hard time deflating it...
jroyster06
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From experience I would not do this if the truck is moving
If you get any sort of blood on your gloves or the screw which deflates the BP cuff you're gonna have a hard time deflating it...
You are correct, I have only done this moving once or twice, with those oh crap drive fast pts. If they are a hard iv stick then i usually do it on scene.
Personally, I had more problems with the AC's than more peripheral veins, I know that's kind of weird. A medic told me to take a tourniquet home and put it on, then close my eyes and feel for my own veins, just to get an idea of how they feel and bounce. After doing that I didn't have problems with AC's either. STILL to this day I struggle with tamponading AC's and not freaking my pt. out by covering them with blood, but it's getting better. Just practice, practice, practice, and accept criticism from your preceptor, most of them want to help you learn and aren't just being rude!!!