IV techniques, odd ball tricks etc.

[SANDMEDIC]

I have never heard of the bevel down trick, and not sure I would ever try it even if it was suggested. I could only imagine the pain would nearly be twice that of proper insertion.

"Stick" with the rules of proper insertion. The nurse definitely was in the right on this one.

I have used many tricks that have been suggested suck as; warm pack, gravity, and not using a tourniquet.

My question to all. Has anyone used the fancy transilluminator?

One of the most amazing things I have seen is a neonatal nurse starting an IV on a preemie (on the first attempt), simply amazing.

Great discussion.

[mrmeaner]

Never seen bevel down technique. Probably would be shot for it here. :wink:

My question to all. Has anyone used the fancy transilluminator?

One of the most amazing things I have seen is a neonatal nurse starting an IV on a preemie (on the first attempt), simply amazing.

If you mean one of a Veinlite then yes, and you can find a thread on it by doing a search for "venoscope" on the site here (I think it's the second thread in the search). Otherwise I've seen a very bright light used on the bottom of a neonate's foot that illuminated the veins on the top of the foot. I've been able to use a very bright LED flashlight on newborn to 1 month old kids with limited results.

[medic429]

and dialysis patients when sticking in fistulas.

I know this isn't a discussion about fistulas, but having worked in dialysis, I just wanted to clarify that under NO circumstances are fistula needles inserted bevel down. A long time ago, needles were inserted, bevel up, then "flipped" once inside the fistula. This is no longer accepted practice as it can A) shred the vein while flipping and if not flipped back to bevel up upon removal, would tear the hell out of peoples skin. I would asssume going in bevel down, it would do the same.

Having said that, I can't seem to think of a reason to insert bevel down. With all of the other options available-another IV site, no tourniquet, another person to do the sticking, etc. it just doesn't seem like this would be necessary and it isn't standard practice here.

[Arizonaffcep]

Unfortunately, I can't find the post I wanted to quote...had to do with "obese" people having bad veins...just personal experience, people don't look hard enough for them. I discovered this after my wife (who I had considered a hard stick because she was obese) had surgery, and lost 150 lbs, she now has "ropes" for veins. Now, obviously, they weren't small/not there and then suddenly there...and I've found (now I work in and ED FT) if I take a few extra minutes to look hard, I can usually find something sizable.

Some techniques I use: a double tourniquet...one a little more proximal to the first tourniquet (an IV tourniquet also works well for stubborn venous bleeds, place one as you would for an IV start just distal to the injury...works great!). This can help pop up veins. The biggest thing though, if time allows, is to LOOK. Look everywhere. In AZ, we can do ANY peripheral IV (an EJ is a peripheral IV) and 2 types of central lines (subclavian and IJ). I've found shoulders are a great source for veins, and I've even started (it was only a 22ga) in a very superficial vein on a quad's abd. The biggest thing is just spend an extra minute (if time/illness/injury allows) and you'll be surprised what you might find. Also, get out of the "box" with sites. If you can...feet are great (although shouldn't be used on some patients, but again, if it's all you got...and you absolutely need one). Sometimes, when I have a patient who needs an EJ, I will bend the catheter slightly (about 10-15 degrees from flat) to help with insertion...we use the INSYTE AUTOGUARD, which has a long, ungainly portion where the needle retracts by spring action. I have never needed to try this with other brands, but I don't see why it wouldn't work.

Also, if you think you are in, good flash, etc etc, but having trouble threading, you can try to float it in or you can "twist" the catheter off the needle, much like "screwing" it into the vein. Just be gentle.

[checkersfire]

THIS IS NOT A DISCUSSION ABOUT CLINICALS OR THE WAY TO GO ABOUT THEM

IV techniques

i have been told that the "bevel down" idea works for going thru valves. i have also had an older medic tell me the he has sprayed a shot of nitro on the preferred site and that will make some harder veins appear. i would be careful when and where i tried this technique, i don't think your preceptors would like it very much. as far as your clinical sites. your going to run into alot of asshole rn's, lpn's and md's along the way. you just have to bite your tongue and deal with it until you get your license. once there, you can put them in their place, but make sure your RIGHT 100% or you will completely lose respect and have a hard time almost everywere you go. it seems like everyone knows everybody in this field. your not going to get every iv, intubation in the field. so don't expect to, and ANYBODY on here who says they do is a DAMN LIAR!!!! most medics get an iv around 80-85% of the time and it seems to come in spurts, some weeks you can't miss and other weeks you won't hit even the biggest vein.

[checkersfire]

Now that I have been properly chastised by the previous post, I'll get back to the discussion, I've been researching it on the internet, lots of discussion by doctors and nurses alike in regards to the desirability of starting bevel down. Most notably on dehydrated children and dialysis patients when sticking in fistulas.

As for my esteemed whipsman in the prior post, my instructor teaches us bevel down for the type patients I first described.

As for anyone else who wants to chastise me. Just send me a PM, we all know how smart and superior you are, so you don't have to flaunt for everyone on the post.

nobody is trying to make you their whipping boy, ryder is stating facts. i have my share disagreements with some nursing staff memebers at certain er's and snf's. i am licensed and it's my ass in a sling. like he said your under their wing right now. you may not think so, but you come across here as if you have an attitude, maybe you don't mean to, maybe your expressing yourself the wrong way? i help adjunct medic students in the classroom and for some reason, alot of students especially in the 1st tier or semester seem to have an attitude problem, they have a "know it all" attitude, i've had some that would interfere with my pt care when i was doing my medic runs and the were the emt on the truck and the preceptor had to put them in their place. please take my advise, be humble, do it their way, when you graduate, you can take a chance and do what you want. when your on your own out there, it's another world and it's real humbling when your on your own the first time in the truck and don't have a preceptor there holding your hand. enjoy the experience while you can.

[checkersfire]

I have never heard of the bevel down trick, and not sure I would ever try it even if it was suggested. I could only imagine the pain would nearly be twice that of proper insertion.

"Stick" with the rules of proper insertion. The nurse definitely was in the right on this one.

I have used many tricks that have been suggested suck as; warm pack, gravity, and not using a tourniquet.

My question to all. Has anyone used the fancy transilluminator?

One of the most amazing things I have seen is a neonatal nurse starting an IV on a preemie (on the first attempt), simply amazing.

Great discussion.

i've seen it, never got to use one, the medic that has it loves it. i think there is two of them, one for adults and one for peds. i do know their somewhat expensive though.