Getting the hard IV's.

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Granola EMT

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So I've been an Advanced for about 8 months now, and I feel like I should be getting some of the harder IV's. I know it's a combo of technique, skill, and luck, but Im wondering if anyone has tips/tricks that work to help get the harder IV's . Mostly dehydrated pt's with nothing in the veins, I guess?

I have a few tricks up my sleeve that have worked, but wouldn't mind learning a few more...
 
If they taught you to go in at a 45 then drop down once you got flash throw that out the window. Low and slow especially on old people (don't know why they say slow, if you go fast it hurts less.) Another trick I use is rather than pulling the skin back like we were taught I grab under their arm and pull their skin to the sides to keep it tight, I have better luck popping veins up that way and keeping them from rolling. Not sure maybe that's been proven to be a bad idea and someone else will correct me but so far it's been working with no complaints from patients.

I'm still learning myself so I hope others can come in and toss in their 2 cents. I think there was a thread about this a while ago if you feel like searching but I'm kind of lazy tonight.
 
Have you tried a roller tourniquet?

The other thing I suggest is getting the IV you can get, and once you get some fluid in them, get the IV you want. If that means putting a 24 in, then put a 24 in. It will take a while, but you will get some fluid in, and then you can try for a bigger one.
 
I had some issues not long ago with my IV's. After months of having an extrememly high success rate i started missing multiple cannula's.

Myself i often find that the whole 45 degree pop then drop approach just does not work. I prefer a much shallower approach around 10-15 degrees. The other problem i have had is that the overwhelming majority of the time i had no problem locating and puncturing a vein but i would go thorugh the other side of the damn thing. As for anchoring i dont really have a system, theree so many variations of skin types and thickness that i just use whatever seems to work best at the time.

I have cheated once with someone i was trying to place 14g in. I put a 24g in the back of their hand, pulled a tournequet on realy tight then pushed 20-30ml saline which made her cephalic an AC pop up nicely

Good luck bro!
 
Thanks! good feedback! Im normally very proficient, but you always want to be better I guess. Some people just don't pack good veins I guess...
Funny, after posting this last night, we went on a code and the guy had been down approx 10 min W/O CPR. No veins... I tried an AC... Nothing... So we put in an EZ-IO. Zipped that in gave a round of epi/atropine, and after 250cc of NS I got the other AC. Nothing special, but a little ironic...

Ya the whole 45* thing IS crap! EZ-IO's are great, though. Second time I've used it on a code, and gotten an IV after administering NS. It's amazing what a little fluid can do...

Has anyone tried using a hot pack to get veins to pop up, on, say pt's that have been exposed to cold/down a little while/dehydrated, etc?

I always forget to try it, but I guess it works?
 
The thing about IV's is that what works for one situation won't necessarily work for every situation. Sometimes you have to LET the vein show up. It takes time. Also, if you can't feel it, don't stick it.
 
Fishing is okay sometimes, I guess... I would rather feel it and not see it, then see it, and not feel it. At least you know there is something in there...

Has anyone tried the hot pack thing?
 
Granola EMT said:
Fishing is okay sometimes, I guess... I would rather feel it and not see it, then see it, and not feel it. At least you know there is something in there...

Has anyone tried the hot pack thing?
Click to expand...

Even with fishing you want to know where the fish are.
 
Granola EMT said:
Fishing is okay sometimes, I guess... I would rather feel it and not see it, then see it, and not feel it. At least you know there is something in there...

Has anyone tried the hot pack thing?
Click to expand...

Fishing hurts. And you run the risk of doing some damage to the tissue or the patient.
 
Of course it hurts... Thats why it's not nice.

There is a difference between "fishing for the vein" (okay sometimes) ( not conscious/really need it/think its there) and digging around in someone's arm/hand/whatever, with a needle hoping to find something blindly....
 
Last night had a critical patient, needed an IV big time. I couldn't find anything, paramedic I was riding with couldn't see or feel anything but took a shot at the AC. After that he looked at me and said never do what I did, I knew anatomically it was there but couldn't feel it. He got it but not something I'm hoping to have to do ever.
 
Best way to get good at IV's is to close your eyes and find your site. Learn to go by feel not sight. Practice that way.
 
medic417 said:
Best way to get good at IV's is to close your eyes and find your site. Learn to go by feel not sight. Practice that way.
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DING DING DING!!

Close your eyes, and feel. It might freak the pts out but use your other senses besides sight.
 
BLSBoy said:
DING DING DING!!

Close your eyes, and feel. It might freak the pts out but use your other senses besides sight.
Click to expand...

And if you lower your head like your looking intently they will not even be able to see that your eyes are closed.
 
Sasha said:
What!? You mean don't go fishing around in someone's arm for a vein?

Blasphemy.
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As I'm sure you're joking, no. One should know their anatomy well enough to already know where the veins are. Plus, one should also be able to feel even some of the deep ones because they tend to not get used for IV's very often.

Granola EMT said:
Fishing is okay sometimes, I guess... I would rather feel it and not see it, then see it, and not feel it. At least you know there is something in there...

Has anyone tried the hot pack thing?
Click to expand...

"Fishing for veins" tells me that you might not have been trained as well as you probably should have been. It takes assessment. It takes patience. It takes knowledge of anatomy. It takes feeling of your pt's anatomy. It takes critical thinking of the situation. In short, it takes a skilled clinician.
 
MSDeltaFlt said:
"Fishing for veins" tells me that you might not have been trained as well as you probably should have been. It takes assessment. It takes patience. It takes knowledge of anatomy. It takes feeling of your pt's anatomy. It takes critical thinking of the situation. In short, it takes a skilled clinician.
Click to expand...

Sooo..... don't poke and hope? :P
 
For the tough ones I usually have them hold their arm as far below the heart as possible to encourage filling. Also quite a bit of massaging with an alcohol prep seems to help them pop up as you tend to force the valves closed in a given vein. Give it plenty of time.

Don't be afraid to start the IV from the floor of the truck, rather than the bench.
 
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As I'm sure you're joking,
Click to expand...

I was joking :]

Don't be afraid to start the IV from the floor of the truck, rather than the bench.
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I prefer to start them while kneeling on the floor between the stretcher and the bench. Maybe it's just me, but it feels more steady.
 
Sasha said:
I prefer to start them while kneeling on the floor between the stretcher and the bench. Maybe it's just me, but it feels more steady.
Click to expand...

It seems to, always trashes the knees on my pants though...
 
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