Question about IV starts

N

NYMedic828

Forum Deputy Chief
2,094
3
36
Some people claim that by going bevel down you don't run as much risk of piercing the opposite side of the vessel but the needle is meant to be inserte bevel up because any hole is easier to make with a smaller sharper object. That's the way it is designed to be inserted and I personally have never had a problem with it...
 
NomadicMedic

NomadicMedic

I know a guy who knows a guy.
12,129
6,874
113
Because bevel up allows the sharp point to pierce the skin first.
 
Anjel

Anjel

Forum Angel
4,548
302
83
I had a classmate start an IV on me bevel down and it hurt really bad, and left a big hole.
 
N

NYMedic828

Forum Deputy Chief
2,094
3
36
As for the article, I don't particularly care to continue reading when the author titles himself an ambulance driver...
 
TransportJockey

TransportJockey

Forum Chief
8,623
1,675
113
I haven't read the link but I'm assuming its written by Kelly Grayson... He's one hell of a medic, and a pretty strong advocate for our profession advancing.
 
Anjel

Anjel

Forum Angel
4,548
302
83
Kelly Grayson is a very smart experienced medic. Who lectures at all of the EXPOs, and is pretty well respected.
 
Shishkabob

Shishkabob

Forum Chief
8,264
32
48
NYMedic828 said:
As for the article, I don't particularly care to continue reading when the author titles himself an ambulance driver...
Click to expand...

Kelly Grayson has been around for a very long time and is a respected EMS figure / blogger. He chose Ambulance Driver as a joke, not as a true to self title.
 
Aidey

Aidey

Community Leader Emeritus
4,800
11
38
He even posts here once in a while. He seems to have a detector for whenever we talk about him. :p
 
MagicTyler

MagicTyler

Forum Lieutenant
172
0
16
Bevel down hurts, the needle rips through your skin instead of piercing it. Please dont cause harm to your patients because you're not confident with ivs. If ivs are hard for you, then practice, practice, practice! If you get good at feeling for veins, and take your time, even tiny pediatric ivs are possiable.
 
A

Ambulance_Driver

Forum Crew Member
40
5
8
Aidey said:
He even posts here once in a while. He seems to have a detector for whenever we talk about him. :p
Click to expand...

It's called "Google Alerts," an indispensable tool for narcissistic EMS speakers and writers. ;)

The title "Ambulance Driver" is satirical, yes.

As for the bevel-down technique, there's a learning curve to using it, but I've found it to work well for me after I got the trick. Using shielded catheters that way does require some serious finagling, though.

At the least, it's a useful trick to pull out of the bag on those rare occasions.

Use a steeper angle when inserting, just to pierce the skin, and pull greater skin traction. If you *****foot around with it, yes, it will probably hurt more and tear the skin. If you make a decisive stick, however, it works pretty well. The trick is learning how to be decisive and delicate at the same time.

I didn't come up with the technique. It was taught to me by a grizzled old peds nurse in a PALS class years ago, and used to be a commonly taught trick.

I would object to the notion that needles are expressly designed to be inserted bevel-up, however. They may work well that way, but that's not necessarily a function of design.

A lot of things we do have their roots in tradition, and have no legitimate application any more. For instance, we were all taught never to withdraw the needle from the cath and then re-advance it, right?

The stated reason for not doing that was the danger of catheter shear and resulting embolus. Y'all try that some time: TRY to shear off a piece of catheter that way. It may bugger up the cath, and cause a little more trauma when you D/C the IV, but it is damned near IMPOSSIBLE to shear off a piece of the catheter.

To do it, you have to poke the stylet through the side of the catheter, hold it against the cutting bevel of the needle, and then rotate it 360 degrees to shear off anything. And supposedly, we're supposed to be at risk of doing this ACCIDENTALLY, while INSIDE a vein? Not gonna happen.

That caveat was a holdover from the days of THROUGH-the-needle catheters, and do not apply to modern over-the-needle catheters. Yet it still gets taught as gospel every day.

Why? Because your instructors were taught that way, that's why. As were their instructors, and their instructors... and no one ever bothered to question why.

ALWAYS question, especially when the rationale doesn't make sense, whether it comes from your medical director, your EMT instructor, me or some other dude with a laptop and Powerpoint presentation.

That's how we discard the dogma in our profession.
 
Anjel

Anjel

Forum Angel
4,548
302
83
See... Told ya he is a pretty smart fella.
 
Aidey

Aidey

Community Leader Emeritus
4,800
11
38
Ambulance_Driver said:
It's called "Google Alerts," an indispensable tool for narcissistic EMS speakers and writers. ;)
Click to expand...

So you're like Beetlejuice...except you help new EMTs rather than dead people.

Edit: In the interest of keeping this thread on topic, I have never used the bevel down technique. I would consider trying it, but I start so few IVs on peds as it is, I'm not sure it is a good idea to start experimenting too much.
 
Last edited by a moderator:
A

Ambulance_Driver

Forum Crew Member
40
5
8
Aidey said:
So you're like Beetlejuice...except you help new EMTs rather than dead people.

Edit: In the interest of keeping this thread on topic, I have never used the bevel down technique. I would consider trying it, but I start so few IVs on peds as it is, I'm not sure it is a good idea to start experimenting too much.
Click to expand...

Honestly, I wouldn't. If you do, practice it on a manikin arm or people with good veins.

I have gotten to the point in my career where I have realized that, when it comes to peds patients, they either need vascular access RIGHT NOW, or it can safely be deferred until ED arrival, and I'm far beyond caring what some ED nurse thinks about me for not attempting an IV in the field.

And if the patient needs a vascular access RIGHT NOW, I'm going with an IO.
 
Clare

Clare

Forum Asst. Chief
790
83
28
I am a little weary of putting a drip into paeds especially asthmatic children.

While we still carry 2% lignocaine for IV cannulation in practice nobody uses this, I have never used and only heard of it being used once in a 6 yof where it was such a pain in the *** the AO said would never use it again.

I have always been taught to start an IV with the bevel up, bevel down is an interesting idea.

Distraction and such is a good technique and one I find works fairly well; but luckily most of our common paediatric drugs come in forms other than parenteral such as intranasal fentanyl and midazolam, oral ketamine, nebulised salbutamol etc.
 
VFlutter

VFlutter

Flight Nurse
3,728
1,264
113
Quote...

"Every post, without fail, there’s an avalanche of “ZOMG! I went to school for [insert length of curriculum here] to learn how to do questionably beneficial stuff without really knowing why, and I didn’t give up a rewarding career in the fast food service industry just to be called an AMBULANCE DRIVER!"

:rofl::rofl::rofl:
 
You must log in or register to reply here.
Top