IV Skills Help

[fiznat]

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 know it is poor practice, and I got yelled at it a few times when I was doing my ride-time and later precepting. I still do it on rare occasion though when I just can't feel anything and I need a little something extra. I don't know if it makes a tactile difference at all really, but it sure does psychologically-- and sometimes thats the difference between getting and not getting a line.

[1EMT-P]

I would encourage you to do the following 1. Find a good mentor who can give you advice and help you. 2. Review your A&P & then draw & label the veins. 3. Take a deep breath before start your IV's. & 4. Try feeling & looking at the veins before you start your IV's. GOOD LUCK!

[Dustdevil]

I know it is poor practice, and I got yelled at it a few times when I was doing my ride-time and later precepting. I still do it on rare occasion though when I just can't feel anything and I need a little something extra. I don't know if it makes a tactile difference at all really, but it sure does psychologically-- and sometimes thats the difference between getting and not getting a line.

That is my standard technique. I am not big on routine BSI, but that's an old skool, personal choice that I would certainly not suggest to others. However, it can be done almost as easily and effectively with gloves on, with a good bit of practice.

As for the "pop", I never really thought about the frequency with which it occurs. I'd venture a rough, non-scientific guess at me sensing a distinct "pop" much less than half of the time. I'm betting it is much more common with the larger gauge catheters than those 18 gauge and smaller. Regardless, I don't see a lot of value in the sign. If you are in when you feel the pop, you're going to get a flash at the same time anyhow. If you are not in, then you aren't. And, of course, there are plenty of other things that you can hit to cause a pop, so it would be unwise to quit digging just because you thought you felt a pop.

I can't recall if anybody else mentioned this yet, but one important point that is missed by many neophytes is getting the catheter and the stylet needle well into the vein before advancing the catheter over the stylet needle. Too many people seem to want to immediately start advancing the catheteter as soon as they see that flash, and they end up either outside of the vein, or else so traumatising the venous wall that it blows. Once you get that flashback, be sure to go a hair deeper into the vein before stopping to thread the catheter into place. That alone may go a long way towards raising your success rate.

[FireGuard69]

I can't recall if anybody else mentioned this yet, but one important point that is missed by many neophytes is getting the catheter and the stylet needle well into the vein before advancing the catheter over the stylet needle. Too many people seem to want to immediately start advancing the catheteter as soon as they see that flash, and they end up either outside of the vein, or else so traumatising the venous wall that it blows. Once you get that flashback, be sure to go a hair deeper into the vein before stopping to thread the catheter into place. That alone may go a long way towards raising your success rate.

Dust, thanks for that ti.

I have been getting the flash, but have just not gotten the catheter in. Hopefully, this will solve that problem... 8)

[naturegirl]

Just wanted to post a follow up to all the great helps and let anyone else who experiences this know what I did. I kept trying. One day I forgot I wasn't very good at starting lines and, well, I started a few without any problem. It built my confidence up and then I just started asking people for tips, help, pointers. Anyone in the medical field with the skill, I just asked. nurses in the ER, paramedics who train emt's. Phlebotomists, Anyone. I found out I can volunteer at the bloodbank and get better still. So for those of you new to IV's you will have problems. You'll not always get young healthy trauma patients with great veins. They'll be diabetics with crap for veins, people who have such bad veins they'll have central lines because NO ONE can get a vein. And you'll learn little tricks, like this one: If you're using an unfamiliar catheter you might accidentally be advancing the entire needle, not just the catheter because it sticks, or you forget to loosen it up before you advance it. Or another one: If you insert the catheter, and get flash and can only advance it so far, you might be stuck in a valve. Attach the saline flush and gently gently push, you might be able to float the catheter past the valve. And don't forget: Humble yourself and ask for help. It can come from the most unexpected places.

[OHMEDIC187]

As others have stated, I think we all have gone through the "I.V. slumps." The more practice you get, the better you will be at it. Alot of people have terrible veins and it makes it difficult to obtain access. One thing I will add is, keep in mind that not all veins can fit an 18 gauge. Don't be afraid to use a smaller catheter. It sounds possible that you may be using too large of a catheter at times? When I first started out, I would have some of those problems that you mention. i.e. obtaining a flash but unable to advance. Could be your catheter selections? Just a thought, maybe it'll help you.

[Dustdevil]

I just thought that it should be mentioned that all of the tips from this topic, as well as many more have been compiled into a free, downloadable guide that you can get here...

http://www.ems-safety.com/free.htm

[Classair]

I work in the ED. I have found if I hit a valve I can use a pre-filled flush (0.9% Sodium Chloride) to flush the catheter past the valve. Some times it works.

[triversbsn]

my instructor told us starting an iv is an art. Take and bio 5 pieces of spegetti, then lay it on a paper towel, and place a wet paper towel over it to maake a skin and the spegetti is your vein. now use your angio cath and try to insert it into the spegetti noodle, you be amazed at how that will help to build your skill and develop your technique

[mobey]

my instructor told us starting an iv is an art. Take and bio 5 pieces of spegetti, then lay it on a paper towel, and place a wet paper towel over it to maake a skin and the spegetti is your vein. now use your angio cath and try to insert it into the spegetti noodle, you be amazed at how that will help to build your skill and develop your technique

I may have to try that. Sounds like a good practice tool!