Fishing for IVs

[DesertMedic66]

So a recent call made me start to think about IV starts.

How many of you "fish" for an IV? For those who have not heard that term before it means you don't see or feel a vein so you insert a cath and just hope you get a vein.

Does it change fore you depending on the patients age or condition?

The story behind this question was a pretty standard 16 month old febrile seizure. The fire medic could not find a vein after only checking the left AC so he went fishing and caught nothing.

For myself I was taught never to fish for a vein during medic internship and I still don't. If I don't feel or see a vein I will move on and check other areas. I may then decide not to do an IV or depending on patient condition I'll just go to IO.

 

[Chewy20]

Agree, sounds like a waste of time to me. If you absolutely need an IV but can not find anything, just go IO. Pt at that point needs fluids or meds, no need to try and fish for something you probably wont catch.

 

[Flying]

Why would one do anything based on a gamble? We can do better than that.

 

[DesertMedic66]

Why would one do anything based on a gamble? We can do better than that.

Welcome to EMS in SoCal...

 

[jwk]

Your medic ought to learn some more pediatric techniques - saphenous veins are pretty easy in little kiddos.

 

[DesertMedic66]

Your medic ought to learn some more pediatric techniques - saphenous veins are pretty easy in little kiddos.

Wasn't my medic. I'm the medic on the ambulance haha. After he missed I looked and got a 24G in her right AC.

I will usually check the ACs first and then go straight to the saphenous.

 

[Angel]

Sometimes I'll "fish"...usually I get it, other times I don't. Not getting doesn't mean I'm going to go directly to an io though. EJ is always an option.

 

[Tigger]

When I say fishing it usually means that I have a vein in mind but I am struggling to get it.

If you're just rooting around with blind squirrel finding a nut philosophy, maybe don't.

 

[DesertMedic66]

Sometimes I'll "fish"...usually I get it, other times I don't. Not getting doesn't mean I'm going to go directly to an io though. EJ is always an option.

I won't go directly to IO. I'll check all the other sites, then move up to EJ, then IO if absolutely needed.

 

[STXmedic]

On occasion with someone who needs an IV, I've started one where a vein should be. I'm probably about 50% successful on those. These are usually on rather obese patients. Like others have said, I'm not at all opposed to an EJ. I won't claim to be stellar at pediatric IVs, though... They get drills if they're that bad off.

 

[Akulahawk]

If I'm having to fish for a vein, it means that I can feel (or even see) a vein that's right there and I didn't hit it during the initial stick. For me, it usually means that the patient's veins roll around more than I expected them to. I'm about 50% on those. I only spend a minute or two with those before I move on to a different site.

 

[COmedic17]

The only time I "fish" for a vein I can't feel/see is if I see scars over it...so I know something is under there. Usually in obese patients or patients who recently gained a lot of weight.

 

[Carlos Danger]

I don't believe in doing it at all. Making a few careful movements to try to enter a vein that you know is there, but just can't see or feel? Sure. Blindly stabbing into the tissue over and over in the hopes that you'll get lucky? No way. I'd smack the crap out of someone I saw doing that to my 16 month old.

You either NEED access, or you don't. If you NEED it, stop screwing around and place an IO. If you don't really NEED it, then just stop, and drive to the hospital.

Multiple IV attempts are painful, can potentially result in serious complications, and probably 90% of prehospital IV's are just for show.

 

[dalmain]

I don't fish for veins..I have to see it or feel it to attempt it.

 

[Knightinwhitesatin]

That call doesn't even need an iv.

 

[DesertMedic66]

That call doesn't even need an iv.

I normally agree, however the hospital we were going to be transporting to and the doctor that was on duty like us to get a line on febrile seizures if possible.

 

[cannonball88]

A couple of useful things to remember here:

1. There is a difference between "fishing" and using your experience and instinct to attempt accessing a vein. For example, in placing a central line, physicians do not palpate or visualize anything other than the anatomical landmarks. Why? Because they have sufficient knowledge of anatomy to know that if they poke "here" there will subsequently be a vein "there." The same is true for peripheral veins.
2. Consider whether you really NEED the IV or if you're simply doing it because you "should." Those who got to this thread first covered this well, I won't beat a dead horse.
3. Move up the "ladder" sooner rather than later. If they do indeed need that access and a peripheral is going to be difficult, consider moving straight to an external jugular or even IO line. With new equipment such as the EZ-IO drill, they are being considered less and less "invasive" and more akin to your peripheral line.

Hope this helps a little!

 

[Jason]

I don't believe in doing it at all. Making a few careful movements to try to enter a vein that you know is there, but just can't see or feel? Sure. Blindly stabbing into the tissue over and over in the hopes that you'll get lucky? No way. I'd smack the crap out of someone I saw doing that to my 16 month old.

You either NEED access, or you don't. If you NEED it, stop screwing around and place an IO. If you don't really NEED it, then just stop, and drive to the hospital.

Multiple IV attempts are painful, can potentially result in serious complications, and probably 90% of prehospital IV's are just for show.

I agree with Remi.
Normally ... I try to find two places that I'm pretty sure or ok with. Pick one I think I can get in one attempt. No fishing or blind sticking. If the access is NEEDED and a peripheral is not happening, then time to move on and up ... EJ or IO.

 

[EMSComeLately]

I'm so glad this thread got started. I've been doing pretty well with IV starts (in clinicals) but have been too nervous about going for what I've heard is called an "anatomical stick."

 

[Gurby]

http://www.cnci.co.uk/site/library/casestudies/Nerve_damage_from_cannula.html
http://goldberghirshlaw.com/nerve-damage-from-iv/