IVC Placement

[BushyFromOz]

Fair enough Bushy!

Fist bump?

fist bump.... wanna beer?

[rock_shoes]

Fiz I have to agree with you if you really need a line then AC is way closer to the heart for meds, starting lines in feet is not good for any med delivery and plus patients kick, my personal experience is a PITA line especially with decreased perfusion pathology or the blue hair crowd. Again, personally I believe this gas passer was just a tosser s/he had 2 lines and push come to shove could infuse blood (not positive of underlying pathology here but circling the drain is something I understand ) and with an introducer could have rethreaded a larger bore if needed in OR or get a shlep Resident MD to do it for him.

On the other side of the fence if Timmy did not have 2 patient lines this primadona gas passer would have been pissed off more.

cheers

Meh. Unless It's that rare occasion where the drug in question has an extremely short half-life I don't think being a foot or so closer to the patient's heart is going to make much of a difference. A patent large bore line is a patent large bore line (not that an 18 is really large bore. It's exactly medium by most standards.). I'm with Squint on him being a bit of a primadonna.

Personally I avoid the AC's if I can because it saves fights with the lab-techs. Apparently the AC is god's gift to lab-techs and any other who should dare defile it's sanctity with a 16 guage piece of teflon should be struck down by Thor's Mighty Hammer. Who the hell died and made them ruler of all vascular access? Of course I do risk the lab's scourn on occasion. If a patient needs access like yesterday it's whatever I can get as soon as I can get it. When patient care takes priority lab can huff and puff all they want. I'm not a pig.

[crotchitymedic1986]

I agree rock, you have to think about what is best for the patient long term, and not what is most convenient for you. I also agree that foot and leg veins are way underused, when I worked for a pediatric facility we started IVs in the foot all the time. There is a myth about increased infection, sort of like taking a B/P on the same side of a mastectomy will certainly lead to death. Some rumors dont like to die.

[Just Plain Ruff]

I agree rock, you have to think about what is best for the patient long term, and not what is most convenient for you. I also agree that foot and leg veins are way underused, when I worked for a pediatric facility we started IVs in the foot all the time. There is a myth about increased infection, sort of like taking a B/P on the same side of a mastectomy will certainly lead to death. Some rumors dont like to die.

Actually the rumor I heard about the foot and leg veins in adults, especially elderly is that the added fluids running through the lower extremities, especially the tib/fib area was that "OH MAH GAWD" you might make a blood clot break off and where would you be then.

I started foot lines in kids (babies a lot), as well as scalp veins. I have started lines in the big blue veins of one woman's breast, she had no veins in her arms or legs due to ahem - heroin abuse and meth injections.

I have started EJ's, IJ's (only on cadavers), veins on Ahnold Shwarzeneger look alikes in their biceps and thighs. I've dropped numerous IO's on babies, adults, kids and the like.

so getting the iv is paramount, where it's at is not. If the patient needs the IV then get the damn iv where you can and screw those who get pissed at where you placed it.

Case in point, had a 75% burn from a meth lab explosion. I got the ivs in the AC space, through the burn, well because there was no place except her back that wasn't burned. Got to the burn center and this bitch of a ER nurse got mad at where I put my iv's and yanked em and then went to try to put hers up higher in the arms. She couldn't get the iv due to the burns and the anesthetist came in and proceeded to scream where are the iv's, "I was told there were IV"s where are the Fin iv's?" The nurse went on to tell him that they were trying to get them and the medic didn't have one started. I was in the room. The anesthetist looked at me and I said "I had two good iv's but she yanked them to start her own". Two other nurses backed me up. The anethetist then proceeded to kick her out of the room and he started a central line. To this day that nurse still hates me.

So get the line if it has to be gotten.

[Vorenus]

Actually the rumor I heard about the foot and leg veins in adults, especially elderly is that the added fluids running through the lower extremities, especially the tib/fib area was that "OH MAH GAWD" you might make a blood clot break off and where would you be then.

Hm... never considered that, sounds kinda logical on the one side, though kinda overprotective on the other side.

I can`t imagine that the bit of added fluid would make such a difference in the risk of a clot getting loose... Any literature on that one? Couldn`t find one in a quick search.

I started lines in the foot veins too, though only if I couldn`t find any usable material at the upper extremities.

Hm... never considered that, sounds kinda logical on the one side, though kinda overprotective on the other side.

I can`t imagine that the bit of added fluid would make such a difference in the risk of a clot getting loose... Any literature on that one? Couldn`t find any in a quick search.

I started lines in the foot veins too, though only if I couldn`t find any usable material at the upper extremities.

Sorry for the screwed up post, can`t really edit posts with the old computer at work.

[zippyRN]

i'd echo everything Jake and Bushy said

avoid over joints whenever possible , they make the line positional, easily dislodged and just don't quite seem to work as well

ruff was right to point out that biceps are an often under utilised site on people where you struggle with conventional sites

Edited August 22, 2011 by zippyRN

[usalsfyre]

A/Cs are fine, anyone who says different is being picky, and the folks arguing about "messing up" distal sites need to go look at a chart of collateral circulation. I pefer forearms when I can get them, but if I need a line RIGHT NOW you can bet I'm looking at the A/C.

How do the folks who advocate lower extremity lines feel about introducing a wound into the lower extremeities of diabetics?

[BushyFromOz]

How do the folks who advocate lower extremity lines feel about introducing a wound into the lower extremeities of diabetics?

About as much as i like seeing proximal veins blown first when people are going to be getting dextrose

[usalsfyre]

About as much as i like seeing proximal veins blown first when people are going to be getting dextrose

If we'd get away from 50 freaking percent dextrose it wouldn't be nearly as big of a deal...but until that day arrives...we should be avoiding the blown proximal veins AND the lower extremities.

[BushyFromOz]

If we'd get away from 50 freaking percent dextrose it wouldn't be nearly as big of a deal...but until that day arrives...we should be avoiding the blown proximal veins AND the lower extremities.

PR it is!