Poor IV access

[MrBrown]

It seems you Americans love to put a drip into anything that moves and Brown thinks the notion of a saline lock and extension set are somehow lost in translation ... perhaps its being reflected back out of the ambulance by that long spine board shielding?

Seriously tho, Brown is quite conservative and will only cannulate somebody who is crook i.e. needs fluids or medication. That might mean about 10% of patients, its not like crappy abdo or back pains, "can't breaf", Nana who fell over, little Timmy with the flu or sinusitis or a lot of routine other things needs an IV started.

Now, if the hospital want to start one to get bloods or give medication then let them do it, Brown would rather have the hospital start one anyway, its not like your living room holds up to being clinically clean anyway.

 

[firetender]

I have found myself not trying to start an IV on pt.s that I cannot find a good site to try.

This sounds more to do with your level of confidence than with the condition of the patient. If your patient needs an IV you don't NOT try. You take your best shot or shots depending on the severity of the case.

Though I never used one, I understand IO is backup and not a primary approach (I could be wrong; correct me please), and that comes AFTER you've tried, not as something used because you suspect you can't. It's something to use because you couldn't.

Back in the days when we didn't use gloves routinely, if you could feel it you could stick it. Have you ever tried palpating without gloves before giving up?

 

[usalsfyre]

its not like your living room holds up to being clinically clean anyway.

So I probably start more lines than I need to just based on expectations of my service, but I would guess the average living room couch harbors less nastiness than the average resuscitation bay stretcher....

 

[usalsfyre]

Though I never used one, I understand IO is backup and not a primary approach (I could be wrong; correct me please), and that comes AFTER you've tried, not as something used because you suspect you can't. It's something to use because you couldn't.

Depends. If I have a low likelihood of success and need a line RIGHT NOW (periarrest, unstable airway that needs medication to get control of, ect) then I'll jump straight to IO, as I can do it a lot faster than IV access

 

[Veneficus]

Starting IV's is a technical skill - the only thing that makes you good/better at it is practice. There are no deep dark secret IV starting techniques that are known only to a select few.

Why do yo have to take away the mystique?


There is no need to see veins. As Firetender pointed out, and even with gloves on, you can usually feel for them.

The point I was trying to make earlier is that certain veins are always there given an inch or there about of deviation.

The ones mentioned are very reliable, especially on heavier folk, no need to see them or feel for them, if you know where they are, no reason not to find one.

As for a saphenous. If you are bent on starting one n the lower extremity, what do you need a cutdown for? Just put the needle in.

 

[Aidey]

I can see my veins fairly clearly, on my R arm they are anatomically correct, on the L they are all screwy. The cephalic is so far lateral it is basically posterior, and the basilic crosses the elbow joint perpendicularly. I know the plural of anecdote is not data, but I highly doubt anyone could hit a vein in that area purely based on supposed anatomical position. I'm sure there are other people equally screwy out there.

When ever I have blood drawn I love presenting that arm to the Phlebotomists and watching them mentally go "oh damn". ^_^

 

[medicsb]

It seems you Americans love to put a drip into anything that moves and Brown thinks the notion of a saline lock and extension set are somehow lost in translation ... perhaps its being reflected back out of the ambulance by that long spine board shielding?

Seriously tho, Brown is quite conservative and will only cannulate somebody who is crook i.e. needs fluids or medication. That might mean about 10% of patients, its not like crappy abdo or back pains, "can't breaf", Nana who fell over, little Timmy with the flu or sinusitis or a lot of routine other things needs an IV started.

Now, if the hospital want to start one to get bloods or give medication then let them do it, Brown would rather have the hospital start one anyway, its not like your living room holds up to being clinically clean anyway.

Heh, I always am amused when I hear some medics stating how some large percentage (usually a multiple of 20) of their patients "require" ALS. 4 times out of 5 they're lining patients for the sake of lining them and calling it ALS. I'm kind of surprised that medicare hasn't started denying ALS level payments for stuff like that.

Moving on, I always preferred to palpate with an ungloved finger, so I'd palpate before gloving up. If I needed to repalpate, then I'd pull a finger off the glove, clean my finger with an alcohol prep and then wipe the spot again. Worked for me.

I'll admit that I was never really good at blind sticks, mostly because I rarely encountered situations that called for it. But when I was in training in Philly, there were some medics in the ED that did it all the time and almost always hit a vein. It was impressive.

 

[18G]

If I feel my pt. needs an IV I will at least try. I won't give up before I even attempt. Some pt's. have crappy veins and it takes 4,5,6 or more times to get an IV in the ED. When I try 2 or 3 times and the nurses try 3 or 4 times on certain pt's. I don't feel so bad But it can hurt your confidence at times especially when you have runs of where it seems like you can't stick anything.

Where I'm at the hospital appreciates a line already placed especially if they are busy. Our protocols don't define a certain number of attempts but our service policy is no more than 3 attempts per provider.

To the person who said they only got one try as a student.... that is crappy precepting! I had a great RN as a preceptor in the ED who would stand there and watch me, offer tips on technique, and give me feedback until I got it. If I missed the first attempt, she handed me a second catheter. Her philosophy was the only way your gonna learn is to do it and I am thankful to have had her as a preceptor.

At least the germs in someones living room are their own and the patient has already been exposed to them for years and years. Germs from a hospital are a whole 'nother game.

 

[Akulahawk]

I'm with 18G... I had a great preceptor. Similar mentality. As it turned out, I was unable to cannulate only one patient during my ED time... and nobody else there could get a line in him either. His veins were very fragile. Poke 'em with a needle and they'd just go "pop" like the proverbial balloon... He got stuck many times... Unfortunately, I never did find out what they finally did to get a line in him as he came in right at shift change and care was turned over to the next shift.

I did learn a lot though!

 

[Gecko24]

EJ.Femoral, or IO. Yes you can do those on adults, even if they are awake.


Or for those male pts. that tell you that there is no way your can get a IV in them. Bet them 20 bucks they got one vein you can usually get, but they may not like it much.

Come on, did you really have to think about what vein I was talking about?

 

[18G]

Unfortunately, I never did find out what they finally did to get a line in him as he came in right at shift change and care was turned over to the next shift.

I had a patient like this. Nobody could obtain IV access so they put in a central line for the 3-day hospital admission.

 

[Akulahawk]

I had a patient like this. Nobody could obtain IV access so they put in a central line for the 3-day hospital admission.

I heard they were thinking of doing the same thing to my patient... but shift change happened before the doc had actually ordered anything done.

 

[cruiseforever]

This sounds more to do with your level of confidence than with the condition of the patient. If your patient needs an IV you don't NOT try. You take your best shot or shots depending on the severity of the case.

Though I never used one, I understand IO is backup and not a primary approach (I could be wrong; correct me please), and that comes AFTER you've tried, not as something used because you suspect you can't. It's something to use because you couldn't.

Back in the days when we didn't use gloves routinely, if you could feel it you could stick it. Have you ever tried palpating without gloves before giving up?

I am very confident in my ability to start IVs. The longer I do this the more I question why I do something. Our standing orders guide us to start IVs on pts. with certain conditions. If the pt. is stable and has no viens that I cannot see or feel. I will not try to start one. I will always look. If they are sick I will be more aggressive. Up to an IO. You should check them out.

I was just wondering how aggressive other people were to get a line. When I was new medic it was get that IV, get that tube, do this,do that. I now look to see if it's a pt. thing or an ego thing.

 

[jwk]

One of the more unusual stories I have heard was of a medic starting an IV in the dorsal vein of the penis of a cardiac arrest patient.

I have heard this for years, but honestly wonder if it's more of an urban myth kind of thing. I've never seen it in 35+ years of in the medical profession, but have always heard stories that one of my classmate's best friend's 2nd cousin's son-in-law actually started an IV there. Has anyone ACTUALLY seen this?

 

[medicRob]

I have heard this for years, but honestly wonder if it's more of an urban myth kind of thing. I've never seen it in 35+ years of in the medical profession, but have always heard stories that one of my classmate's best friend's 2nd cousin's son-in-law actually started an IV there. Has anyone ACTUALLY seen this?

Here is one that will make you cringe. Back when I worked a paramedic ambulance, there was a frequent flyer, not because he always called us, but because he was always doing something: overdosing, getting hurt, etc.

Anyways, can you guess where he injected his methamphetamine? I'll give you 2 guesses, but you'll only need 1.

 

[fast65]

Here is one that will make you cringe. Back when I worked a paramedic ambulance, there was a frequent flyer, not because he always called us, but because he was always doing something: overdosing, getting hurt, etc.

Anyways, can you guess where he injected his methamphetamine? I'll give you 2 guesses, but you'll only need 1.

Into some sort of peripheral vein

 

[medicRob]

Into some sort of peripheral vein

He lovingly called it, "hitting the monkey wrench", but sure... we'll say that.

 

[fast65]

He lovingly called it, "hitting the monkey wrench", but sure... we'll say that.

Do I get a prize?h34r:

 

[medicRob]

Do I get a prize?h34r:

Sure. You get to bandage the monkey wrench any time you want.

 

[fast65]

Sure. You get to bandage the monkey wrench any time you want.

Yay!!! Wait...dammit