Starting IVs Next Week, any Tips?

medic417 said:
Some clinical sites require students to introduce themselves as students and to ask if the patient minds them performing the procedure.
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Not to mention, we wear shirts that say "EMT Student" and ID cards that say "Student".
 
Everybody needs a 14ga. drip in the AC, now, chop chop! :D

Brown has found vein stabilisation is most important, as is proper explaination to the patient "we need to put a drip in for fluid/medicine, here comes the sharp scratch" works well here.
 
jjesusfreak01 said:
Awesome picture, I need more of these to take in and show my classmates during our first IV lab.
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the table after the same stick.
 
My favorite trick is to find a bifurcation. A point at which 2 veins converge into one. Slide in between them and you're bound to hit the vein because there's one on either side.
 
Brown has found vein stabilisation is most important
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Once I've found a site I like, I'll always lightly push the skin in a perpendicular direction with my finger. It gives me a good idea how much of a "roller" the vein is, as well as letting me know how much I'll need to stabilize it.

Good luck ^_^
 
usafmedic45 said:
Good G-d man...I've done cutdowns that were less bloody....
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Lol, at first glance I thought that's what I was looking at!

Here's a tip: occlude the catheter just beyond the tip, where all you are compressing is the vein. Many catheters can be pinched off with a little pressure, but some (those spring loaded ones) are super space age plastic the is too resilient to be pinched.

Wise medic say...the less blood on the outside of the patient,the more skills in the medic.

Ice cream for the entire crew if you spill blood on the floor staring an IV
 
usafmedic45 said:
Good G-d man...I've done cutdowns that were less bloody....
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Well, I know..... But hey, it was my first stick and to be honest, as soon a blood started squirting everywhere, I kind of stared at for a few seconds thinking "WTF did I forget?" Then my partner occluded the cath in his own arm and got things back under control. Lol!
 
jjesusfreak01 said:
Taping Suggestions?
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Veniguard.

Otherwise, a criss crossed skinny piece, a 2x2, and 2 fat pieces over the site, with one more to secure the line. And if they are diaphoretic, just wrap around and around the arm
 
I've found Venigaurds to be great...until something around the IV site gets wet. At that point standard tape seems to hold better to me.

For the diaphoretic or combative patient? Coban. It's not pretty, but it sure hold the line in well.
 
Coban is definitely a great alternative. I like to have that or gauze on hand for the elderly with super thin skin. Getting tape back off of those frail arms can be painful.
 
Reminds me of a call I did last night. 2 hour transport of a 16 year old male with a splenic rupture. 14 ga in the right AC, 16 ga in the Left AC. I didn't start the lines, otherwise I'd have selected better sites.

Over the 4 hours while he was in the system he received 7 litres of saline and Ringers, and 1 litre of pentaspan.

On arrival at the trauma centre a paramedic student on practicum tripped over the 14ga line and dislodged the IV. She extracted the remainder of the cathalon and my patient bled a substantial amount. I didn't see it but the medic student started yipping about how the IV line was in an artery and couldn't stop the bleeding. She had to stand there and hold direct pressure for several minutes.

Personally, I would think that an IV with a cath located in an artery would likely not run all that well and actually have significant back pressure with blood entering the tubing. I had no problems bolusing through the line. In addition, after 8+ litres of fluid and most of his red cells in his belly somewhere, his clotting was likely not quite up to par. Finally, I doubt the student had much experience in removing an IV cath that large and the hole left...especially after a traumatic removal like her feet made would allow for much more blood loss than she might have ecpected from an 18 ga.
 
If the vein has a pulse, don't poke it.
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And if you do, whatever you do, don't push epi through that line unless you want to experience the full wrath of your medical director.
 
Personally, I would think that an IV with a cath located in an artery would likely not run all that well and actually have significant back pressure with blood entering the tubing.
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Depends on the patient's BP. It won't flow rapidly but you should get some flow.

14ga line and dislodged the IV
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Good luck with getting a 14 into most people's brachial artery without having a massive amount of vasospasm.

BTW, if it's not a steel needle, it shouldn't do any more damage whether you rip it out or gently remove it. IV catheters are, after all pretty darn flexible. Also, rather surprisingly, in my experience, most arterial lines bleed less than their venous counterparts upon removal.
 
usafmedic45 said:
Depends on the patient's BP. It won't flow rapidly but you should get some flow.
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It poured through there in a steady stream, not even a drip to count. His pressure was hard to stablize. LP12 was taking pressures every 5 min, if it dropped below 90 systolic I'd bolus him, the next few pressures would be up between 110 and 120/40, then back down. Most times I can get the drip rate titrated to maintain the systolic, but I couldn't on this kid....I was playing catch up all night.

usafmedic45 said:
most arterial lines bleed less than their venous counterparts upon removal.
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That's been my experience as well, a little direct pressure and it's good as new, but then, my experience is mainly with ABG acquisition, not a 14ga in an artery.

Remember though, if the IV was put into an artery thinking it was a vein, then it would be facing upstream too, not down.

He ended well though, lost his spleen but came through surgery last night with no complications.
 
usafmedic45 said:
And if you do, whatever you do, don't push epi through that line unless you want to experience the full wrath of your medical director.
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What's wrong with pushing a vasoconstrictor directly into a smooth muscle lined artery?
 
So, had my first set of pokes tonight. Missed both. First was on an older classmate known to have bad veins, but i'm blaming that miss on the instructor because she stopped me before I could advance the needle far enough to let the catheter slide easily, and then told me I missed because I didn't go far enough. This was a cephalic vein, I believe. Second was a hand vein, and while the miss was on me, my instructor didn't let me stick the vein I wanted to, and made me go for a slightly deeper one that ran into a junction (and probably a valve).

I'm thinking I might have more luck if they just stayed quiet while i'm trying to stick...we can do the CISD after i've taken the needle out of my classmate's arm.

And yes, I know i'm blaming my instructors here, but i'm going to hit all sorts of veins on Monday...that'll show em.

Any more tips on site choice and advancing the catheters?
 
Wrap a penrose or tourniquet (or whatever you like to call it) around your own arm and just spend time feeling your own veins. Switch arms, wrap one over your leg, etc. etc. Get a friend and do the same thing. If you have kids see if you can coax them into letting you do this as well. Just looking at different sites on dif types of people without ever poking them can be very educational. Good luck!
 
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