Trouble with Ivs

[NYMedic828]

Why are the EJs discouraged? Possibility of an embolus? Only been trough internship with no job yet but I started one almost every shift on people with terrible vasculature

I wouldn't say anyone discourages them here but we really only use them on a patient in extremis or in arrest. On a patient in arrest, doesn't really matter just get the access in as timely a manner possible (which it's almost always faster to use an IO) but for a living patient you do run risks by using an EJ. The main factor in my eyes if just the dangers of making a mistake in that region where you can easily spike an artery instead of a vein. I advise against EJs while moving but Im not a cowboy like some people.

Some providers here work single provider and the cop (CPR trained only) will drive the ambulance so they always try to get an EJ so they can run the entire arrest from the head. (Meds/airway)



Back to the ET tube securement, the only time I have had a properly inserted tube displace is when an EMT or firefighter forcibly pulled it out of place. Never has patient movement messed up my tube. Don't we all use capnography? It's pretty obvious when the tube is out of place if your waveform goes from 40mmHg to 0...

 

[Shishkabob]

EJs aren't frowned upon here, but it's always entertaining to see a nurses face when you walk in with one. (Even the local L1 trauma doesn't allow their nurses to do them anymore).


Although it IS considered a peripheral access point just like an AC or hand, it conjures up more serious thoughts. If I've run out of the usual suspects, something is needed, but haven't justified an IO, I'll do an EJ.

 

[TransportJockey]

EJs aren't frowned upon here, but it's always entertaining to see a nurses face when you walk in with one. (Even the local L1 trauma doesn't allow their nurses to do them anymore).


Although it IS considered a peripheral access point just like an AC or hand, it conjures up more serious thoughts. If I've run out of the usual suspects, something is needed, but haven't justified an IO, I'll do an EJ.

The hospitals here consider them 'central access' so the RNs, even at the state L1 TC, are always freaked when I roll in with someone with one

 

[VFlutter]

The hospitals here consider them 'central access' so the RNs, even at the state L1 TC, are always freaked when I roll in with someone with one

I hate that. According to the INS and AVA an EJ is a peripheral line due to the fact that it does not break the intrathoracic cavity at point of entry and the tip does not enter the SVC. If we have any drips that require central lines we can not use EJs.(unless it is a PICC). I think IJs are considered acceptable.

 

[Thricenotrice]

On the topic of EJ's... I never ended up liking them. Much more difficult than an arm or foot, roll like crazy. But sometimes the only option from what I could see (didn't have IO's)

 

[TransportJockey]

I hate that. According to the INS and AVA an EJ is a peripheral line due to the fact that it does not break the intrathoracic cavity at point of entry and the tip does not enter the SVC. If we have any drips that require central lines we can not use EJs.(unless it is a PICC). I think IJs are considered acceptable.

I know. They just call it that I think because they don't want their nurses to start an EJ in the ER or on the floor. And their nurses are allowed to start 'all peripheral intravenous lines'.

 

[jwk]

It's funny, I hear a lot of "911" medics state the c-collar method as gospel, but most CCT medics/nurses (the people who move intubated patients all the time) don't do this yet don't seem to displace tubes all that often....

Those of us who put in ETT's every day tape them in. That includes cases where the patient is in a lateral or prone position for many hours. The C-collar idea, frankly, is one of the more pointless things I've heard on this board.

I worked in a level 1 trauma center ER and all we used to secure tubes (in non c-spine precaution patients) was string. Can't think of the name of the string/tie we used for some reason but it looks like shoe lace kind of. We would move people from the bed to the CT machine then back to the bed and up to the ICU bed... never needed a c-collar to keep the tube secure.

You're probably thinking of umbilical tape. It's made by the suture manufacturers, so it comes in the same type of sterile package that regular suture material comes in. The problem with tying in a tube is that in order to actually secure the tube, you have to pull the tape tight, which actually compresses the lumen of the tube - not really desirable. And if you don't tie it tightly around the tube, it's worthless because it will slip.

The commercial tube holders (as pictured in a previous post) are fine, and that's what our respiratory therapists change to as soon as our ventilated post-op patients hit the ICU. More than once, they've pulled out the tube when untaping it and putting the fancy device on.

 

[Shishkabob]

The hospitals here consider them 'central access' so the RNs, even at the state L1 TC, are always freaked when I roll in with someone with one

I love doing things that freak nurses out who think it's physician level only... EJs, conscious sedation, RSI with 300mcg of Fent (Yup, nurse freaked out about that level of Fent... on a patient I gave Roc and Etomidate to... while I was bagging them...)

 

[VFlutter]

I know. They just call it that I think because they don't want their nurses to start an EJ in the ER or on the floor. And their nurses are allowed to start 'all peripheral intravenous lines'.

We are allowed to start them but no one ever does. The PA will usually do it. If we have a new kindney failure patient who may need dialysis they sometimes go for a EJ until they decide were they are going to out the AVF.