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kali27

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I'm in the Intermediate class and having some trouble with IV's, I can get the flash most of the time but have trouble with advancing the cath, I'm hoping I'll get it in time with practice but I was just wondering...how long did it take before you got a successful IV? I'm hoping I'm not the only one that hasn't got it yet. I've been doing really good in class with my grades but I'm just wondering if maybe I'm not cut out for real world, and it makes it worse that I'm one of the only ones in class that doesnt already work in EMS. Thanks :)
 
Hang in there. Find someone with garden house veins just so you can get a successful stick. Once you feel the first successful one they start becoming easier.
 
medic417 said:
hang in there. Find someone with garden house veins just so you can get a successful stick. Once you feel the first successful one they start becoming easier.
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+1. .
 
Make sure you pull the skin tight.

Skin is elastic it likes to move when you try to put things through it. Veins are not really secured in place beneath the skin they kind of just float and attach at points to where they pick up blood. The tighter you can hold it in place the better just be watchful when you pull the skin because the vein will still shift from where you thought it to be.

Make sure the VCB is real tight, but not too tight to hurt the patient. (Dont put it on just enough to tie it under and it stays on, it needs to effectively create a backflow of blood)
 
When you get the flash make sure to advance the needle just a little further, so that the cath actually enters the vein. Sometimes if you are up against valve you can try to float the cath into the vein. Start with the smaller gauges (20,22) then move to the larger ones. One thing I have found is that you don't want to pull the skin too tight because it can flatten the vein out; you just need to provide secure traction so things don't move around.

How many attempts do you have so far? It is a skill that comes with practice, and there will be times when you nail it and other times when you can't figure out why it didn't work.
 
I've tried about 3 times, seems like I have trouble advancing the cath, when I try the vein moves and sometimes I cant see it. But this info helps though...Thanks a lot :)
 
kali27 said:
I've tried about 3 times, seems like I have trouble advancing the cath, when I try the vein moves and sometimes I cant see it. But this info helps though...Thanks a lot :)
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Hands are harder than ACs, so if you need confidence builders, go for ACs until you've gotten a few good sticks, then continue working on hands. I need more work on hands...
 
kali27 said:
I've tried about 3 times, seems like I have trouble advancing the cath, when I try the vein moves and sometimes I cant see it. But this info helps though...Thanks a lot :)
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Don't stress. Make sure you have the vein anchored by keeping the skin tight. Don't worry about seeing so much as feeling. Three times isn't a lot. Just be patient you'll get it.
 
Sasha said:
Don't stress. Make sure you have the vein anchored by keeping the skin tight. Don't worry about seeing so much as feeling. Three times isn't a lot. Just be patient you'll get it.
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This along with everything else is good advice.

Don't look for them, feel for them.

Practice finding them on family members, significant others, cousins, your kids, your friends kids, anyone that will let you be a creep and feel around on their arms.

Like someone said once you get the flash advance it just a little bit further, the need extends out past the catheter. That's probably why you are having trouble advancing them. I had the same problem so I know the feeling!!

Hang in there. It's a skill and even the best, most experienced people have dry spells. The last two weeks my partner couldn't hit anything. Finally got out of his rut today, thank goodness.

If you think hands are hard wait for a foot vein!
 
NVRob said:
******Don't look for them, feel for them******

Practice finding them on family members, significant others, cousins, your kids, your friends kids, anyone that will let you be a creep and feel around on their arms.

Like someone said once you get the flash advance it just a little bit further, the need extends out past the catheter.

If you think hands are hard wait for a foot vein!
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What he said
You can do this for 100 years and still have bad days... Or weeks where you couldn't hit the broad side of a barn.
 
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Someone once told me about a way of practicing with cooked spaghetti and cellophane. Not sure if it was a legitimate thing or not. Anyone else heard of this? He said it was a good way to visualize how the veins roll around under the skin. He said you take some cooked spaghetti, put it between two sheets of oiled cellophane then try to get a needle in it. I'm just a basic so might be an EMS urban legend thing as I haven't tried it myself.
 
bigbaldguy said:
Someone once told me about a way of practicing with cooked spaghetti and cellophane. Not sure if it was a legitimate thing or not. Anyone else heard of this? He said it was a good way to visualize how the veins roll around under the skin. He said you take some cooked spaghetti, put it between two sheets of oiled cellophane then try to get a needle in it. I'm just a basic so might be an EMS urban legend thing as I haven't tried it myself.
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That could work. I've personally never heard of it but I don't see why it wouldn't help with the feeling but the nothing is a great substitute for the real thing. My question is why would you waste perfectly good spaghetti!?!?!?!?!?!?!? :P
 
I'm still quite new at it too.

That said, what helped me was that as soon as I saw the flash, I paused a beat and then dropped the angle of the cath way down to make sure I was going to stay in the vein when I advanced that little bit farther. I found that early on I was popping out of back of the vein too easily because I was not dropping the angle low enough.
 
NVRob said:
This along with everything else is good advice.

Don't look for them, feel for them.

Practice finding them on family members, significant others, cousins, your kids, your friends kids, anyone that will let you be a creep and feel around on their arms.

Like someone said once you get the flash advance it just a little bit further, the need extends out past the catheter. That's probably why you are having trouble advancing them. I had the same problem so I know the feeling!!

Hang in there. It's a skill and even the best, most experienced people have dry spells. The last two weeks my partner couldn't hit anything. Finally got out of his rut today, thank goodness.

If you think hands are hard wait for a foot vein!
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All too true, if you can't feel the vein you're not going to have much of a shot at getting it on the first shot.

Happily I'm not allowed to start lines anywhere but the arms...
 
Tigger said:
Happily I'm not allowed to start lines anywhere but the arms...
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Pediatrics are great fun too.

I want the little laser thing they have in the PICU. That'd be cheating though.
 
Don't be too hard on yourself. I've never met a bigger obstacle in paramedic practice than my own nerves and internal critical narrative. Also, everyone has those day/weeks and god forbid..months where they couldn't hit the back side of barn with a 22.

A few points that have probably already been mentioned.

Cannulation is seems to directly correlate with my level of confidence. When this happens I find someone to have a laugh with, I sink a few beers, remind myself that s**t happens and start again the next day.

I once came across a senior paramedic that said, any time you miss a line, its is because of a lack of preparation. Mostly, I agree with him. There will always be the 240kg diabetic or the 20yr IVDU who you can't stick. However, I agree that most of the time I've pranged lines, it turned out I wasn't that comfortable with the deal before I pierced the skin. Set yourself up for success. Turn the lights on in the house, open the window, slap them silly, take your time, select a good vein, ANCHOR THE VEIN WELL, have them bring the piano chair in from the other room so u have a better seat (did that the other day), drop the arm bellow the heart, irritate the vein, have them clench their fist... all that usual stuff. Then when you like what you see...have a crack.

Remember despite "ANCHOR THE VEIN" being bolded, simply squeezing or stretching more doesn't necessarily equal more anchorage. Pt appropriate variable combinations of stretch, press and hold may be in order.

For labile or fragile veins, swift and confident is the trick I reckon. The temptation is, the more subtle or fragile the vein, the slower and more careful you are.

The other thing, I think, is once you've got a flash and you drop the angle a bit and want give it that final advance, lift the vein. Move the cannula essentially parallel to, but further from, the skin so that you're launching that final advance into friendly territory and not across the border.
 
I love not being able to sleep.

Another thing to think about is the slower you go the more likely the vein is to roll and the more painful it is for the patient. Like Melclin said "swift and confident".

I'm not saying go in guns blazing stabbing like a cheap slasher film. Take your time, find and clean your site, then a nice quick poke. If you miss remember you can always back out a little bit without totally removing the angiocath and try again, however ***DON'T GO DIGGING AROUND IN YOUR PATIENTS*** Pull back once, maybe twice then try somewhere else. It's terribly uncomfortable for them to have you mining for gold in their arm.

There are always exceptions to that though. If a patient is circling the drain where you need access, you need access. Sorry that it is painful but it's one of those things that has to happen. Another thing to consider is if you are at this point you should probably be considering an IO or your medic partner should be looking for an EJ.
 
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^^^^


I have vastly improved over the last year to the point now where i rarely miss. Preparation and confidence plays a huge part. Have everything set up properly and one of the most important aspects is making sure you are in a comfortable position to hit the vein.

Also as others have said, once you get flash make sure your angle is almost as flat as possible then advance just a tiny bit further.

I have a strange thing where basically I position the limb and put on a tourniquet and the first good vein I see (within reason) I tend to go for rather than go searching for the perceived "best vein". I cant really explain it but this approach has always worked for me.

Practice makes perfect. You just need to do more on many ages and types of people. Having a good mentor/training officer to watch and give advice. Anchor, anchor, anchor
 
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