IV Tricks

[ffemt8978]

Do you have any tricks of the trade when starting an IV?

I'm aware of bending the catheter using the cap (not recommended or allowed), and of rotating the bevel 180 degrees when sticking an elderly person. I would like to hear any others that you have used, seen, or heard about.

[Firechic]

rotating the bevel 180 degrees when sticking an elderly person.
I haven't heard of this one.....what's the reasoning behind that??
Just curious :blink:

[croaker260]

[rotating the bevel 180 degrees when sticking an elderly person]

This used to be taught with doing EJ's too. The theory is that by rotating the needle, the angle of the bevel is reversed, making it less likely to lacerate the other side of a small vein and blow the IV. I have also heard this used with Ped IV's. I have tried it, and have noticed no appreciable difference one way or the other, so Im not sure how much of it is the medical equilivent of an urban myth, how much of it was applicable with the oldet style needles, or if it really makes a big difference.

[ffemt8978]

I've noticed that I'm less likely to blow the IV on an elderly person with thin vein walls and thin skin when I rotate the bevel. Urban legend or not, it does seem to work in those elderly patients with almost no fat or muscle mass, and the paper thin skin.

[rescuecpt]

bending the catheter

Huh? Never heard of this... doesnt sound, um, i dunno, like a good idea?

I know we were even told not to loosen the catheter (because we might get shear...) but I always very carefully roate the base of the catheter so that I can advance it easier once it's in the patient.

The other night I was on a call with a former RN (35 years experience). She had her first ALS call without a preceptor (even though I was there). She got a line, and the guy was a bleeder.... as blood started trickling out she said "Oh!" and just stared at it... I hooked up the line, opened it up, and took off the turniquet. She got a look on her face like "duh, I knew that".

It's almost a little comforting to know that even someone with so much experience can have a duh moment once in a while.

[shorthairedpunk]

Two rumor has its that I havent tried are to use provodine/iodine on your african americans, supposedly it will be darker near a vessel, and another is for the deep ones, to turn off your lights and place a maglite to the skin, suposedly the deep vessel will be a dark line.

Tried and true for those with rolling veins is to come at them from the side rather than above

sticks in a moving rig: rest you wrist on their arm and their arm on your leg, that way you move with the patient.

[medic03]

don't need any tricks, I never miss :rolleyes: :lol: :D :P B)

[GFD940]

The best tounequet I have found is a BP cuff. It works better than any rubber ones and you're putting it on their arm anyway.

Also, to avoid "blood letting" be sure to place your thumb where the tip of the catheter is. My partners tend to place pressure just below the hub and end up with a puddle on the floor

[rescuecpt]

Originally posted by medic03@Feb 19 2005, 12:58 AM
don't need any tricks, I never miss :rolleyes: :lol: :D :P B)
You would have been so proud of me today - I got a great line on a trauma pt in ENpt... No one thought there was anything there and I sunk an 18 on the first try - must have had a great teacher (wink, wink) ;) .

[medic03]

Originally posted by rescuecpt+Feb 19 2005, 11:28 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (rescuecpt @ Feb 19 2005, 11:28 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-medic03@Feb 19 2005, 12:58 AM
don't need any tricks, I never miss :rolleyes: :lol: :D :P B)
You would have been so proud of me today - I got a great line on a trauma pt in ENpt... No one thought there was anything there and I sunk an 18 on the first try - must have had a great teacher (wink, wink) ;) . [/b][/quote]
good for you! you can stick me anythime erika..... :P

[rescuecpt]

Originally posted by medic03@Feb 20 2005, 09:10 PM
you can stick me anythime erika..... :P
Shouldn't it be the other way around? :o

[medic03]

Originally posted by rescuecpt+Feb 20 2005, 09:31 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (rescuecpt @ Feb 20 2005, 09:31 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-medic03@Feb 20 2005, 09:10 PM
you can stick me anythime erika..... :P
Shouldn't it be the other way around? :o [/b][/quote]
i knew I liked you for a reason :D

[ECC]

We used to bend the catheter into a hockey stick shape to get into Junkie's veins. Another trick is to use the old BDR (Blood Divining Rod) as my old partner Floyd used to say. Make a paece sign with your fingers...hold it over where you think there is a vein...you will know if you are doing it right! :D

[Phridae]

Originally posted by ECC@May 12 2005, 05:20 PM
We used to bend the catheter into a hockey stick shape to get into Junkie's veins. Another trick is to use the old BDR (Blood Divining Rod) as my old partner Floyd used to say. Make a paece sign with your fingers...hold it over where you think there is a vein...you will know if you are doing it right!:censored: :D
I just dont get what bending a catheter is going to do.

[ma2va92]

Originally posted by Phridae+May 14 2005, 01:37 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (Phridae @ May 14 2005, 01:37 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-ECC@May 12 2005, 05:20 PM
We used to bend the catheter into a hockey stick shape to get into Junkie's veins. Another trick is to use the old BDR (Blood Divining Rod) as my old partner Floyd used to say. Make a paece sign with your fingers...hold it over where you think there is a vein...you will know if you are doing it right!:censored: :D
I just dont get what bending a catheter is going to do. [/b][/quote]
now we do the hocky stick shape for a ET tube .. for to start a line.... I think i would feel like i was closing up a turkey

I just check with the pt. befor we leave there house.. please make sure you bring your veins with you ... knowing were veins should be has always helped... the one I like most is the side of the forarm.. thumb side.. just a hair above the wrist... even the old and paper skin let me in....

[ECC]

Originally posted by Phridae+May 14 2005, 01:37 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (Phridae @ May 14 2005, 01:37 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-ECC@May 12 2005, 05:20 PM
We used to bend the catheter into a hockey stick shape to get into Junkie's veins. Another trick is to use the old BDR (Blood Divining Rod) as my old partner Floyd used to say. Make a paece sign with your fingers...hold it over where you think there is a vein...you will know if you are doing it right!:censored: :D
I just dont get what bending a catheter is going to do. [/b][/quote]
1)Bend catheter

2) Pick a side of the vein you are comfortable with (left or right)

3) stick needle in lateral to vein and UNDER!

4) stick vein from the soft non-sclerotic side.

;)

[rescuecpt]

Maybe I'm just dumb, but if you bend the cath, you bend the needle, right? then how do you not get catheter shear when you retract the needle? Am I not seeing something?

[TTLWHKR]

When all else fails.. Blame the driver!

[Jon]

Originally posted by TTLWHKR@May 16 2005, 01:19 PM
When all else fails.. Blame the driver!
:lol:

[ECC]

Originally posted by rescuecpt@May 15 2005, 10:08 PM
Maybe I'm just dumb, but if you bend the cath, you bend the needle, right? then how do you not get catheter shear when you retract the needle? Am I not seeing something?
It is doubtful that the material used to make the catheter has changed much in a few years...I have never ever had a problem with this technique and shearing a catheter...it simply did not place that much stress on the catheter material to cause it to shear. I am not saying to put an acute angle in there...make it look like a hockey stick mebbe 120 degrees or so. I would imagine that trying an acute angle (boomerang anyone?) may cause catheter shear...but if you do it right...there should not be any problem...

And no, Cap... AEMT III's are not dumb...a little slow mebbe but certainly not dumb.

Disclaimer: This is a Ghettomedic procedure...not to be tried to alleviate your boredom but to get the line on a junkie who is in arrest and there aint no other way you are gonna get the meds in! ;)

[Jon]

Originally posted by ECC+May 16 2005, 08:34 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (ECC @ May 16 2005, 08:34 PM)</td></tr><tr><td id='QUOTE'> Originally posted by rescuecpt@May 15 2005, 10:08 PM
Maybe I'm just dumb, but if you bend the cath, you bend the needle, right?:censored: then how do you not get catheter shear when you retract the needle?:censored: Am I not seeing something?
It is doubtful that the material used to make the catheter has changed much in a few years...I have never ever had a problem with this technique and shearing a catheter...it simply did not place that much stress on the catheter material to cause it to shear. I am not saying to put an acute angle in there...make it look like a hockey stick mebbe 120 degrees or so. I would imagine that trying an acute angle (boomerang anyone?) may cause catheter shear...but if you do it right...there should not be any problem...

And no, Cap... AEMT III's are not dumb...a little slow mebbe but certainly not dumb.[/b]

I would think you only have to worry about shear if it is put back on, otherwise it wouldn't matter if you only took the cath. off once in the vein.


<!--QuoteBegin-ECC@May 16 2005, 08:34 PM
Disclaimer: This is a Ghettomedic procedure...not to be tried to alleviate your boredom but to get the line on a junkie who is in arrest and there aint no other way you are gonna get the meds in! ;) [/quote]

Ok.... where can I get that cert? - Maybe with it I can work for Philly's Medic 8 - they are in the "badlands" and have shirts that label their firehouse (Eng, B/C, Ladder, Medic) "the Narcan Task Force" (Hack on the PD's Narcotic Task Force)

Jon

[ECC]

Originally posted by MedicStudentJon+May 16 2005, 08:40 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (MedicStudentJon @ May 16 2005, 08:40 PM)</td></tr><tr><td id='QUOTE'> Originally posted by ECC@May 16 2005, 08:34 PM
<!--QuoteBegin-rescuecpt@May 15 2005, 10:08 PM
Maybe I'm just dumb, but if you bend the cath, you bend the needle, right?:censored: then how do you not get catheter shear when you retract the needle?:censored: Am I not seeing something?
It is doubtful that the material used to make the catheter has changed much in a few years...I have never ever had a problem with this technique and shearing a catheter...it simply did not place that much stress on the catheter material to cause it to shear. I am not saying to put an acute angle in there...make it look like a hockey stick mebbe 120 degrees or so. I would imagine that trying an acute angle (boomerang anyone?) may cause catheter shear...but if you do it right...there should not be any problem...

And no, Cap... AEMT III's are not dumb...a little slow mebbe but certainly not dumb.

Disclaimer: This is a Ghettomedic procedure...not to be tried to alleviate your boredom but to get the line on a junkie who is in arrest and there aint no other way you are gonna get the meds in! ;)
I would think you only have to worry about shear if it is put back on, otherwise it wouldn't matter if you only took the cath. off once in the vein. [/b][/quote]
EXACTLY!

[ECC]

Originally posted by MedicStudentJon+May 16 2005, 08:40 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (MedicStudentJon @ May 16 2005, 08:40 PM)</td></tr><tr><td id='QUOTE'> Originally posted by ECC@May 16 2005, 08:34 PM
Originally posted by rescuecpt@May 15 2005, 10:08 PM
Maybe I'm just dumb, but if you bend the cath, you bend the needle, right?:censored: then how do you not get catheter shear when you retract the needle?:censored: Am I not seeing something?
It is doubtful that the material used to make the catheter has changed much in a few years...I have never ever had a problem with this technique and shearing a catheter...it simply did not place that much stress on the catheter material to cause it to shear. I am not saying to put an acute angle in there...make it look like a hockey stick mebbe 120 degrees or so. I would imagine that trying an acute angle (boomerang anyone?) may cause catheter shear...but if you do it right...there should not be any problem...

And no, Cap... AEMT III's are not dumb...a little slow mebbe but certainly not dumb.

I would think you only have to worry about shear if it is put back on, otherwise it wouldn't matter if you only took the cath. off once in the vein.


<!--QuoteBegin-ECC@May 16 2005, 08:34 PM
Disclaimer: This is a Ghettomedic procedure...not to be tried to alleviate your boredom:censored: but to get the line on a junkie who is in arrest and there aint no other way you are gonna get the meds in!:censored: ;)

Ok.... where can I get that cert? - Maybe with it I can work for Philly's Medic 8 - they are in the "badlands" and have shirts that label their firehouse (Eng, B/C, Ladder, Medic) "the Narcan Task Force" (Hack on the PD's Narcotic Task Force)

Jon [/b][/quote]
If you work the ghetto, the Ghettomedic cert will be conferred upon you by your much senior partner! ;)

[rescuecpt]

EMTAl rides the ghetto sled... ;) I've seen pictures of the corner he posts on... not pretty.

[ECC]

No more ghetto sleds for me...I am done with that! No need to be running 13+ ALS calls every 8 hours. I am not as young as I look ;)

[Jon]

Originally posted by rescuecpt@May 17 2005, 01:39 PM
EMTAl rides the ghetto sled... ;) I've seen pictures of the corner he posts on... not pretty.
I'm sorry... I just LOVE his signature.... espicially since everyone and their brother likes to "talk FDNY" here... the County Field Svcs. department put a memo out about 2 years ago that anyone calling for a "bus" would be asked how many passengers they needed it for..... copy direct, k?

[emtal233]

Originally posted by rescuecpt@May 17 2005, 01:39 PM
EMTAl rides the ghetto sled... ;) I've seen pictures of the corner he posts on... not pretty.
Just another day in good ol' day in Queens.... :D

[ECC]

Originally posted by emtal233+May 18 2005, 01:16 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (emtal233 @ May 18 2005, 01:16 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt@May 17 2005, 01:39 PM
EMTAl rides the ghetto sled... ;) I've seen pictures of the corner he posts on... not pretty.
Just another day in good ol' day in Queens.... :D [/b][/quote]
When did Queens get a Ghetto? ;)

[rescuecpt]

Originally posted by ECC+May 18 2005, 01:32 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (ECC @ May 18 2005, 01:32 AM)</td></tr><tr><td id='QUOTE'> Originally posted by emtal233@May 18 2005, 01:16 AM
<!--QuoteBegin-rescuecpt@May 17 2005, 01:39 PM
EMTAl rides the ghetto sled...:censored: ;):censored: I've seen pictures of the corner he posts on... not pretty.
Just another day in good ol' day in Queens.... :D
When did Queens get a Ghetto? ;) [/b][/quote]
:lol: LOL :lol:

[daemonicusxx]

Originally posted by TTLWHKR@May 16 2005, 01:19 PM
When all else fails.. Blame the driver!
amen

[Flight-LP]

If distal peripheral access fails or is not feasible, go EJ. Our system also has protocols for femoral and subclavian as a last resort.......................

[Stevo]

i like to draw palpable viens with a betadine stick...

[Jon]

Originally posted by Flight-LP@Jul 2 2005, 10:09 PM
If distal peripheral access fails or is not feasible, go EJ. Our system also has protocols for femoral and subclavian as a last resort.......................
That's cool... Ive ridden along with a resident, who carries a 10-blade and a HUGE 14ga long for subclavians....

[rescuecpt]

When all else fails... stick by anatomy, easiest place is between the knuckles. :)

[911 DJ]

Wanna play sewing machine?.... :o