IV Skills Help

[futuremedic35]

Tell me about that. If I used the protectIV/protect IV plus, I am fine. If I use the Introcan or the "B&D push button" cathlons, I find it harder. I guess it's all what you get used to!

[tinman694]

We use the B&D's and they work fine....

If you get into the situation where you know its gonna blow (especially elderly and diabetics) skip the tourn---That is something I have known for almost 20 years and it hasn't failed yet---

My luck is always getting the 800 pound 80 year old diabetic chain smoker with no vascular system and getting bitc%ed at because YOURE HURTING ME.

then the rest of the guys start the razzing---and it gets out of control--

Stick'em hard, stick'em quick and find something else to worry about.

[Dustdevil]

One of the most common problems and solutions that I see is that a lot of people are never taught to correctly use their sense of touch. The basic training in IV technique seems to usually focus on visualising your vein, then going for it, without first using your fingers to get the lay of the land. Developing your ability to use your tactile senses to evaluate your stick sites is probably the most positive thing one can do to improve his skills. Veins that look good don't always feel good, and vice versa. Don't let visualisation give you a false sense of confidence, because it frequently will. Always make palpation your primary decision maker.

Of course, like anything, that takes a lot of practice to make it come together for you. You're going to have to take some risks at a time when you are looking for a sure thing. It's a tough thing to make yourself do. But for the next while, ignore your first instinct. Feel around for veins that are not so obvious, but have good size, and a nice, spongy firmness. Sometimes you may not actually see them at all, but don't worry about it. Locate them. Visualise their path, then go for it. I think you will see your success rate rise, because those veins are generally more stable (less roll) and less delicate than their superficial counterparts.

And, of course, USE THE FORCE!! :wink:

[DwayneEMTP]

Dust's post reminds me of something that I seem to have discovered.

Working construction, my hands are pretty tough. I've driven many crazy when they have located a vein via palp, placed my hand on it, yet what was obvious to them seems nonexistant to me!

I've found that it's easier for me to press a little harder, feel for the "divot" (A little concave, that I believe is the bottom of the vein instead of the top), and then back the pressure of to get a feel for the 'quality' of the vein.

It doesn't seem to require such a gentle touch at first, as when pressing harder you can feel yourself 'stumble' across the veins, and then back the pressure off to decide if it has the qualities you like before committing to it.

Again, I must state that this makes my technique sound much more elegant than it really is. I get a general idea of location, and then go for it. Normally the above steps are applied with heavier patients, or sticks that I have a low level of confidence for success.

From the start I made the whole process much more difficult that it needed to be...

Good luck!

Dwayne

[scparamedic98]

Another thing I'd like to add to what these guys/gals are saying. While you're performing the sticks feel for the "pop" once you enter the vein. I found that when I was first starting with IV's, that I would actually feel the "pop" of the needle entering the vein. I find myself now not focusing on the flash chamber at all until I feel that flash. Just like you've been told on here, just find your vein and perform the stick, the more you do it the more you'll get the feel for the little things you may not notice right away.

[buckeyedoc]

I precept student and new medics all the time. IV's are a skill that everyone is very timid with in the beginning. Why? Glad you asked. Patients are normally awake and can feel the stick. We're aggressive w/ intubations because the patient is gorked and don't realize what we're doing. Every patient is different with regards to IV's. What I've seen a lot of people do is "go by the book". IIRC, it says to start at a 45 degree angle. That works great of IV dummy arms. Hit the hole the other guy left you and you're in and the "vein" is always the same depth. Attempt the IV at a shallower angle. Say 15-20 degrees. That will help to eliminate going the through the back of the vein. You have to be more aggressive with the 35 year old chain-smoking truck driver because his skin will be thicker and tougher than the 85 year old grandma. Everyone has their "trick" for hitting IV's. Find yours. It's as simple as that.

[HellsBells]

Its funny that scparamedic98 refers to feeling the "pop" of the vein, because I very rarely experience that sensation when starting a line. I really have to go on sight, seeing the blood actually flow into the flash chamber.

[James_ffemt]

How many of you use a are finger to feel for the vein. I have worked with a lot of older medics that will take the tip of their glove and tear it off so they can feel better. To me, not good BSI practice. I even have seen nurses at the ER do this or not use gloves at all. What's your thoughts?

[buckeyedoc]

How many of you use a are finger to feel for the vein. I have worked with a lot of older medics that will take the tip of their glove and tear it off so they can feel better. To me, not good BSI practice. I even have seen nurses at the ER do this or not use gloves at all. What's your thoughts?

I usually tear the tip of the glove off of my left index finger. I have big hands and can finish the IV without that finger. That's just the way I am.

[DwayneEMTP]

Its funny that scparamedic98 refers to feeling the "pop" of the vein, because I very rarely experience that sensation when starting a line. I really have to go on sight, seeing the blood actually flow into the flash chamber.

I know what you mean. I'm no veteran of course, but in 150 or so sticks, I've never felt the "pop".

But, as I stated earlier in this thread, I don't have the finest touch, so I'd imagine I'm simply missing it...

Dwayne