dialysis patients and iv access

[Eydawn]

You can find it. Can you get patent access with it? Not always. It's always dependent on the individual patient. For example, I just ran a call for end stage liver disease where the Pt had a power-port... tried 2 different peripherals (with my medic assisting and watching like a hawk) and couldn't get either. Neither could he.

*shrugs*

Wendy

CO EMT-B

[DartmouthDave]

Hello,

Is a power-port a PICC line? Or, is it a Portacath?

At my old job we were setting things up for PCP and ACP to be able to use PICC lines and Portacath (with gripper needles) if patients had them.

Saves digging around for an IV when odds are the central line would be used once the patient arrives at the hospital.

Cheers

[Camulos]

wrong, wrong, wrong ---------- know your vein anatomy, you will find a vein

There is nothing wrong with accessing it if you absolutely have to, but too many medics assume dialysis means no veins, which is not always true. I would say I was able to atleast put a 22ga in 95% of the dialysis patients I transported.

"Wrong, wrong, wrong" and "There is nothing wrong" Is that a contradiction???? LOL

I do however understand your main contention that far too many medics / doctors / nurses etc believe they will not get a cannula in a dialysis pt even before they have tried. Whatever happened to the power of positive thought people?

My next questions -

1) Would you be happy with a 22G IVC in a trauma pt?

2) If not why not? Hint - a simple equation or law here will suffice

3) Alternatives?

4) Methods of insertion and possible insertion sites?

Don't ask much do I? :roll:

Looking forward to the responses.

Stay safe,

Curse :evil:

[mrmeaner]

1) Would you be happy with a 22G IVC in a trauma pt? No.

2) If not why not? Hint - a simple equation or law here will suffice I don't like to have the receiving doctor's foot in any of my orifaces.

3) Alternatives? EJ, Fast1, or EZ IO.

4) Methods of insertion and possible insertion sites? See #3 as applicable.

[Camulos]

2) If not why not? Hint - a simple equation or law here will suffice I don't like to have the receiving doctor's foot in any of my orifaces.

LOL

Not the equation or law I had in mind but it did however did give me a good laugh. So what is the law I am thinking of?

Stay safe,

Curse :twisted: I thought a laughing evil was more appropriate this time!!

[vs-eh?]

We can access PICC, Hickman, Portacath, etc... in critically ill patients. Remembering how to access them on the other hand when you've done it zero times and after a ten minute CME is another matter entirely

If you have exhausted all peripheral sites (including EJ, saphenous, etc...), oh well...

We don't use adult IO's so...

[Camulos]

Come on guys and gals. Why is a 22G IVC not ideal in the trauma pt. Remember I'm after the law!!

Another hint : This law also explains the primary reason why a CVC is not indicated in the initial management of the trauma pt.

Stay safe,

Curse :evil:

[crotchitymedic1986]

We had a nephrologists give us an inservice on this topic years ago, but i do not remember all the correct points to do before you stick. The one thing you can do is look at the site itself, as there will be an obvious place that the dialysis nurses have been sticking. I remember that they either use the ladder technique or the button-hook technque. THose who use the ladder, move the injection site upwards ever so often, so that one spot does not get worn out. The other theory is to use the button-hook technique, where you use the same spot over and over, so that you can move up later (tomato tomoto). Either way, you should be able to clearly see the spot that is presently being used. Do try to be as sterile as you can, and use betadine and alcohol to clean the site.

[mrmeaner]

Come on guys and gals. Why is a 22G IVC not ideal in the trauma pt. Remember I'm after the law!!

Dude, the foot in ass thing is a law!!

But seriously, I don't know what law you are referring to.

[Just Plain Ruff]

how about the hagen formula

The larger the catheter the more fluid that can go thru the cath into the body.

a 22 ga will give x amount while a 14ga will give a lot more.

I'm not sure of the actual formula numbers.