Multiple IV Attempts

mikie

mikie

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*I tried a search, couldn't find anything specific*

What is your protocol on failed IV attempts? How many tries do you get?

I BELIEVE (I'm only a Basic, but familiar with the Intermediate/Paramedic protocols) that they are allowed 2 sticks before having to call MedControl.

For example, for hypoglycemia, dextrose would be administered IV unless after two attempts it has failed, then we use Glucagon (which basics can administer, IM (I'm on an ILS truck, so that's why Glucagon would be administered after attempted Dextrose). Depending on the Tx time, we would probably be allowed another stick, but ours is usually 5-10min, so we usually don't.

This is just a scenario for blood sugar, what about other situations?

If protocol only allowed 2 and you couldn't get a hold of MedControl, or whomever, would you try again?

Thanks!

(Lets not turn this into why the 'bad protocol' or why can Basics give IM or IV, etc.....lets just hear about other people's protocol & experience)
 
emt-b's give glucagon IM? Thats weird.

There is no protocol reguarding failed attempts but they are to be kept to a minimum. Don't ruin access for the ER staff. They will get it if you can't.
 
Seen something like that....

mikie333 said:
*I tried a search, couldn't find anything specific*

What is your protocol on failed IV attempts? How many tries do you get?

I BELIEVE (I'm only a Basic, but familiar with the Intermediate/Paramedic protocols) that they are allowed 2 sticks before having to call MedControl.

For example, for hypoglycemia, dextrose would be administered IV unless after two attempts it has failed, then we use Glucagon (which basics can administer, IM (I'm on an ILS truck, so that's why Glucagon would be administered after attempted Dextrose). Depending on the Tx time, we would probably be allowed another stick, but ours is usually 5-10min, so we usually don't.

This is just a scenario for blood sugar, what about other situations?

If protocol only allowed 2 and you couldn't get a hold of MedControl, or whomever, would you try again?

Thanks!

(Lets not turn this into why the 'bad protocol' or why can Basics give IM or IV, etc.....lets just hear about other people's protocol & experience)
Click to expand...



We arrived on scene (about 9:20 a.m.) after the neighbors thought something was wrong and gained entry into pt/her house, pt was unconscious, not responsive to anything, very rapid respirations/shallow, and was sweating so bad the sofa had a wet body outline...(Pt was diabetic informed by friend) Anyways the IV part, there were 4+ attempts made (FF/Medic was on L. hand and arm, Paramedic tried R. hand, arm and top of R. foot) but nothing (I was on + pressure vents) M.D. advised admin. of drugs (which was carried out by another FF/Medic on scene)... still nothing... transport time to ER was less than one minute... Basically after all of them failed we jetted... Hope this helps....

oneluv79
 
We're allowed 2-3 IV attempts. If the pt is critical we're allowed to do IO.
 
For us there are no restrictions on the number of attempts published in the protocol. The teaching however is in line with ACLS/PALS etc, whereby it is recommended that after two unsuccesful attempts, you attempt IO.

Great if you have the correct equipment readily availble, otherwise IO is mainly reserved for those who really need them. Should you take ITLS into consideration, they advocate that scene time is not prolonged for IV access, unless it is needed for serious fluid callenge.

So to answer your question, i would say that this is a practitioner based choice, and depending on what the purpose of the IV is.

PS-Last night we sited a Femoral IV, prior to Peripheral or External Jugulars. The reason/motivation was that we could not get to the patient's arms or neck.
 
mikie333- would it be possible (pleasepleaseplease) for you to take a look at your protocolls ASAP and post the actual restrictions/guidelines for venous access? I'm only asking because it's rather...um...insane...to make someone call medical control if they are unable to start an IV, especially if it's after only 2 starts. I'm just curious, but were you specifically talking about with hypoglycemic pt's (still wrong) or was it an overall restriction?

I'll hold further comments till this get's cleared up.
 
Our protocols are two attempts for stable patients. If they're critical, it's two attempts and then go for the IO.
 
Go for the neck.
 
triemal04 said:
mikie333- would it be possible (pleasepleaseplease) for you to take a look at your protocolls ASAP and post the actual restrictions/guidelines for venous access? I'm only asking because it's rather...um...insane...to make someone call medical control if they are unable to start an IV, especially if it's after only 2 starts. I'm just curious, but were you specifically talking about with hypoglycemic pt's (still wrong) or was it an overall restriction?
Click to expand...

I was just throwing in the hypoglycemia pt as a scenerio regarding IVs and another medicinal option (Glucagon), since it can be administered if they can't 'protect their gag reflex'

This is from my big protocol book they issued us (it has all providers in it)

#14- If blood returns through the catheter, proceed with insertion. If you do not see blood return, release the tourniquet and discontinue the attempt. It time and patient condition allows, you may attempt another site with a new catheter (do not exceed more than two (2) attempts
Click to expand...

That was step #14 in the Intravenous Cannulation Procedure

-hope that helped
 
Zero time IV... If I can and its possible I don't site IV on scene. Do it en-route to hospital.

There is no guidance according how many attempts you have for an IV. As mentioned earlier, ITLS protocols. Don't waste time though, get help if you cannot, but don't delay transport if the patient can be safely moved.
 
Up north here, I can perform 3 pokes and my IV qualified partner can perform another 3 PRN.

With diabetics (especially IDDMs) we generally try to avoid the hand since they are highly prone to infection and have microvascular issues (it's all about Quality of Life and how much they'll love you if they lose their hand) and we are putting Dextrose in those tiny papery veins that are oh-so susceptible to extravasation.

And like I mentioned before, we'll roll the UnCx pt into the recovery position and apply a small amount of GlucoGel into the dependent buccal pouch of the mouth to absorb or drool out.

And if or when that fails, I have glucagon SC.
 
3 pokes stable. 2 pokes critical and then IO. EJ if you're gooooooooooooood.

ewwwwwwww........IO. :P (personal pucker factor for Your's Truly.)

Dual EJ's? That's some Cool Points with the ED staff around here. First time I did that (When I was in the Navy), I went home after shift so juiced up I pounced on the husband with evil intent.
 
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If arm veins are crappy, and they NEED an IV (hypotension, hypoglycemia, seizure, brady), I might give an arm 1 shot, MAYBE 2, then go for EJ. It's a peripheral vein that's not used very often so you can usually get it.
 
Two IV attempts per person, unless only one medic is available. Typically three IV attempts total before giving up. IO after one-two attempts if vascular access is necessary.

And in comparison...

One intubation attempt per person, unless only one medic available. Two attempts total before Combitube.
 
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No statement regarding # of attempts. I think it is implied that one will not treat the pt. as a pin cusion. As far as IO, it's indicated for arrest or peri-arrest only. Though some agencies 'round here have been know to push D-50 through an IO and release. Shame

Egg
 
eggshen said:
No statement regarding # of attempts. I think it is implied that one will not treat the pt. as a pin cusion. As far as IO, it's indicated for arrest or peri-arrest only. Though some agencies 'round here have been know to push D-50 through an IO and release. Shame

Egg
Click to expand...

WOW :sad:

We do not have a limit. If you need it, try for it. We can go to an IO after trying one IV. Just remember, arms, legs, feet, neck, everything is fair game. Don't think that you have to have it in the arm. ;)
 
Interesting to see the variance in protocols...and more proof that for some reason many doctors are not comfortably in letting their paramedics use their own judgement in treating their patients.

Starting an IV is not (or at least should not be) something that needs to be spelled out in explicit detail in the protocols; if needed you do it. If you are unable to and steel need access, you move on to your secondary device if you have one. And all paramedics should be well educated to know when it is pointless and/or uneccasary to continue to stick someone; this is something that every service should be ensuring with good QA/QI and in house training. Not to mention something that should be covered in learning to be a paramedic.

I mean come on, if we aren't trusted enough to use our own judgement in starting an IV, is it any wonder that people have such problems with RSI, intubation, cardioversion, minimal on-line control, med administration, spinal clearance and the list goes on. Does anybody still have doubts about EMS education in the US?

(there is no specific limit here; if the pt needs venous access they get it. Like eggshen, we are expected to base the number of times we stick someone on what is wrong with them and why we are trying for a line with the understanding that poking them when it's pointless is wrong. As for going to an IO...that can be the first access point if the paramedic deems it neccasary.)
 
No specifics in protocol here either, although under IO it says PED after one IV attempt and IV access is essential, Adult Cardiac Arrest after 3 attempts. 3 seems to be the accepted standard per provider (on the rare occasion there's more than one medic on scene). Our local diagnostics lab has a 3 sticks per practitioner policy.
 
we have three chances to get a line. after that we all med control. usually after the first failed attempt with a diabetic pt we adminster glucogon incase we miss the next one.
 
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