Slicing Wrists for IV's?

[EMTkels]

Hey all,

I didn't really know where to post this question, so I'll start here.

My aunt recently came down with a really bad case of that Norovirus, (at least that's what the doc says), and was suffering from severe dehydration so much so, that the ER doc couldn't start an IV in her arm or wrist, and actually cut her wrist started it there.

I don't know anything about starting them, but was just wondering, have any of you done this yourself or ever heard of this kind of method? I've heard of trying it in the foot or somewhere else, but haven't seen this before.

Thanks!

 

[akflightmedic]

Wow!

A venous cutdown to gain access...I don't know what to say.

I have never heard of a doctor going to this extent, especially when there are other options avalliable such as an EJ, a central line or an IO.

Seems to me like a tibial IO would have been pretty darn easy to access.

 

[MICU]

Wow!

A venous cutdown to gain access...I don't know what to say.

I have never heard of a doctor going to this extent, especially when there are other options avalliable such as an EJ, a central line or an IO.

Seems to me like a tibial IO would have been pretty darn easy to access.

And pretty darn painfull. Central line will be the best way to handle this kind of problem.

 

[Ridryder911]

Albeit I/O's are favorable and popular in the EMS setting, I can attest it is not that favorable yet at most physician level. I was discussing this two days ago with one of the local flight Paramedic that is based out of Children's hospital. I know I have had more than one "discussion" in regards over an I/O placement.

I know many physician feel that I/O should be used as a "last resort" ditch when all other means have failed. Apparently the reasoning is pain control, potential infection, danger to growth plate, etc... So I can see where a "cut down" was used. Especially for any fluid replacement therapy. Infusing large amount of fluid I/O is very painful due to the forceful pressure exerted on the periosteum. True, by adding Lidocaine this usually eliminates this, the physician was probably thinking more prolong treatment and the dangers of Lidocaine in pediatrics.

Actually, venous cut downs on pediatric patients is not that uncommon and has a very high success rate. Usually the preferred sites are the wrist, and ankle since venous prominence is easy to cannulate in these areas.

Since the child needed a "long term" IV dwelling & large amount of fluid, they did the least painful and least risky option, the right choice and option.

I am surprised they did not place a central line, yet again the physician was smart by not exposing to a higher risk, and potential infection. They used the more easier and safer mode... good thinking Doc!

R/r

 

[Fedmedic]

Actually, venous cut downs on pediatric patients is not that uncommon and has a very high success rate. Usually the preferred sites are the wrist, and ankle since venous prominence is easy to cannulate in these areas.

R/r

I don't think it was a pediatric patient. He stated his aunt. Maybe he can post an age and clarify things.

 

[Ridryder911]

Oops!.. thanks for the clarrification. Hmm still a less dangerous procedure than an I/O and maybe did not want the potential problems with a central line. I know more and more are trying to avoid central lines if the patient is only going to be in the hospital for a few days.

Again, thanks for the spot check..

R/r 911

 

[EMTkels]

A little clarification...

Yep, Medic, my aunt is 41 years old.

And I'm not a he! I'm a she!

Lol, sorry for the confusion.

And thanks for your replies!

 

[Anomalous]

...maybe did not want the potential problems with a central line. I know more and more are trying to avoid central lines if the patient is only going to be in the hospital for a few days.

Again, thanks for the spot check..

R/r 911

I went in for staph infection. While placing the central line they hit an artery, leading to a pleural effusion. 6 weeks in the hospital...6 months off work. I'd skip the central line next time.

 

[Fedmedic]

And I'm not a he! I'm a she!

Oops! Sorry about that. Now I know better next time.

 

[Jon]

Ok... in short... a venous cutdown is a method to access a vein surgically... it is a skill best left to the physician, in the hosptial... despite what you may see on ER.... Yes.. it can be done. Have I seen it done? No.

 

[Fedmedic]

Ok... in short... a venous cutdown is a method to access a vein surgically... it is a skill best left to the physician, in the hosptial... despite what you may see on ER.... Yes.. it can be done. Have I seen it done? No.

We had a medic here do a subclavian cut-down while waiting for Lifeflight. When the flight crew got there they wanted to know which one was the MD. He said, "ain't no MD's here, just us medics." The flight crew was flabbergasted....

 

[Ridryder911]

Actually, venous cutdown is not really considered a true "surgical procedure" and should not take more than a few minutes to incise the dermal layer for exposure of the vein, the vein is then easily cannulated and sutured or taped in... that's it. It is much more simplistic than a central line, that is sometimes performed in the field. If the flight crew was shocked.. shame on them for not knowing EMS. Seattle has been performing subclavians since 1982. (there is even a 60 minute documentary of that year showing a medic performing one).

First year residents, P.A's. NP's can perform venous cutdown procedure. Much easier than "popping" a sebaceous cyst.

After the IV is d/c, the skin is steri stripped together or dermabonded. The incision is usually less than 1-2cm in length.

R/r 911

 

[jeepmedic]

We had a medic here do a subclavian cut-down while waiting for Lifeflight. When the flight crew got there they wanted to know which one was the MD. He said, "ain't no MD's here, just us medics." The flight crew was flabbergasted....

Would that be Dr. **k*

 

[Fedmedic]

Would that be Dr. **k*

That would be "have no fear, God is here." LOL

Nah, Prizonmedik didn't do a cut down, he just started a subclavian line in the back of the ambulance.

 

[Stevo]

well i guess someone should inform the Fla state penal system that there's a sure fired way to gain venous access

~S~

 

[jeepmedic]

well i guess someone should inform the Fla state penal system that there's a sure fired way to gain venous access

~S~

I thought that they had access. They just needed to give a second round of drugs?

 

[Jon]

I thought that they had access. They just needed to give a second round of drugs?

They had the same sort of access I've gotten a few times... It went in and they hit the vein... problem is, they supposedly kept going.


Bring back the firing squad! It is Humane.

Even better, kill them like they killed their victim.... run them over with cars, slit their throats, something.

 

[captoman]

R/r911- I agree with you about IO placements, but the new "power drills" we carry feel just about the same as a needle stick. The drilling of the bone makes a smaller, tighter fit for the cannula ,making a more secure fit. I see this as becoming a far safer and more accepted option. what do you think?

http://www.vitaid.com/canada/ez-io/index.htm