Poor IV access

[cruiseforever]

I have found myself not trying to start an IV on pt.s that I cannot find a good site to try. I hate causing the pt. discomfort when I know my chances of getting a line is just about zero. If push comes to shove and I need to have an access point, I will use the IO.

I will treat the pt. with IM meds instead. Is there anyone else that feels the same way?

 

[Medic2409]

Yep.

Course, there will be people who will jump in with disparaging remarks concerning how any medic should be able to get a line on anybody, and if you can't, you're not a good medic.

Bologna, or Baloney, either way you choose to spell the word.

IMHO, why waste time hunting an IV site when you can get potentially life saving interventions on board IM or IN, and then continue your hunt for an IV?

 

[medicRob]

I have found myself not trying to start an IV on pt.s that I cannot find a good site to try. I hate causing the pt. discomfort when I know my chances of getting a line is just about zero. If push comes to shove and I need to have an access point, I will use the IO.

I will treat the pt. with IM meds instead. Is there anyone else that feels the same way?

We have all been through this at some time or another. Diabetics and dehydration patients are the worst! The key is to practice, practice, practice... but also remember.. there are some people that are impossible to stick.

 

[Aidey]

I have elected not to start an IV more than once. It completely depends on the patient and situation. If I've got 95 year old grandma who is running a fever and has one vein you can stick anything bigger than a mosquito into I may not start an IV knowing the hospital is going to want blood cultures.

1/2 the time the RNs thank me for being considerate, the other 1/2 of the time they roll their eyes and say "whatever".

 

[Shishkabob]

I'm of the view that if I don't NEED an IV to do something, I either don't do one or limit it to just one try.

If they need an IV, they get a few tries. If they NEED NEED a line, they will get an IO, which is why I won't really let misses bother me as much.



However, I had an EMT I had never worked with before last shift, go to the station captain complaining about my IV skills (over a single missed IV). Yes, a single IV, one of 2 that I attempted that day, and on a patient that didn't necessarily need it at that moment.


Obviously I did something to piss him off that day for him to moan about a single IV, I just don't know what.

 

[fast65]

I'm of the view that if I don't NEED an IV to do something, I either don't do one or limit it to just one try.

If they need an IV, they get a few tries. If they NEED NEED a line, they will get an IO, which is why I won't really let misses bother me as much.



However, I had an EMT I had never worked with before last shift, go to the station captain complaining about my IV skills (over a single missed IV). Yes, a single IV, one of 2 that I attempted that day, and on a patient that didn't necessarily need it at that moment.


Obviously I did something to piss him off that day for him to moan about a single IV, I just don't know what.

That's where I pretty much stand as well. I mean, I love starting IV's, but I know it's anything but comfortable for the patient and they already called us because they have a problem, why cause them more pain than necessary.

On a side note, you should really work on your IV skills Linuss, I can't believe you missed one.

 

[Combat_Medic]

What you all have trouble getting IVs? Come join the army. We teach you to never miss. :lol: j/k

 

[Shishkabob]

What you all have trouble getting IVs? Come join the army. We teach you to never miss. :lol: j/k

Yes, because starting an IV on a healthy 20 year old is the same as starting an IV on a dehydrated 84 year old.

 

[fast65]

Yes, because starting an IV on a healthy 20 year old is the same as starting an IV on a dehydrated 84 year old.

Eh, tomato, tomato...huh, I guess it doesn't work the same when you type it

 

[medicsb]

I'll second the "go IM [or IN] and continue looking" based on the assumption that the patient actually NEEDS an IV for meds or due to a possible deterioration for which meds may be needed. But, don't forget the feet or the EJ if you really need an IV. 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.

 

[Veneficus]

cephalic and basilic veins.

Not just terms to memorize for anatomy.

 

[CAOX3]

Im partial to the venous cutdown.

Of course you need to attend the four hour add on

And your given a new patch, EMT-SAPHENOUS

 

[mcdonl]

When doing my hospital time I started to get discouraged... I was only allowed one attempt (Instead of the two our protocol allows) and I missed on my first two patients... but, when it took TWO nurses who were both 30+ year vets to finally get a line I realized that it happens. Even to the best of providers.

I find that most people who end up in the back of an ambulance have a detailed history and knowledge of their "stick" ability....

 

[CTBryan11]

Linuss i agree that starting lines on a 20 yr. Old healthy pt may be easier than a 84 yr old dehydrated one.. but at the same time combat medics are EXTREMELY good at starting IVS seeing as how there patients can be wounded from gsw or something worse.. and if they have been in battle for 8-9 hours in the heat of the day they will also be dehydrated and depending on the wound..hypovolemic shock with collapsing veins.. and they can hit on them most the time.. if that fails then they will go IO but its rare

 

[Shishkabob]

Because civilian medics never have GSW patients... or GSW patients who've bled out... or GSW patients that are geriatric.


The same injuries that happen in a warzone could NEVER happen at home. Nope. Never.

 

[bigbaldguy]

While doing my ride time we transported an IV drug user. Guy had lit himself on fire in his kitchen. 7 people tried starting a line on the guy, two tries on the bus and 7 tries at the ER. They finally called in a life flight nurse/paramedic to start a EJV line. The whole time the guy was telling us where he might have a vein left, which ones wouldn't work Ect.

 

[jwk]

Linuss i agree that starting lines on a 20 yr. Old healthy pt may be easier than a 84 yr old dehydrated one.. but at the same time combat medics are EXTREMELY good at starting IVS seeing as how there patients can be wounded from gsw or something worse.. and if they have been in battle for 8-9 hours in the heat of the day they will also be dehydrated and depending on the wound..hypovolemic shock with collapsing veins.. and they can hit on them most the time.. if that fails then they will go IO but its rare

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.

 

[MediMike]

Because civilian medics never have GSW patients... or GSW patients who've bled out... or GSW patients that are geriatric.


The same injuries that happen in a warzone could NEVER happen at home. Nope. Never.

You always crack me up Linuss. Agreed with whoever mentioned the feet. Had numerous pt.'s who say they can't be stuck anywhere, been drilled before etc. etc., pull them socks down and take a gander. Man it stinks sometimes though...

 

[CTBryan11]

Civilian medics never have gsw pts? Or gsw pts that bleed out?? What perfect town do u work out where there is never a shooting?

 

[CTBryan11]

And yes jwk I know... but they do practice alot.. which is why they are good.. my dad was a combat medic for 10 yrs and my uncle was a parajumper for 8