FireEMT2009 Posted November 13, 2011 Posted November 13, 2011 You are treating a patient with constant contractures bilaterally at the elbow and wrist levels. Both of which would occuld IV sites. You need to start a line and give some fluid due to hypovolemia. I was thinking of the forearm are the upper arm/ shoulder area. Where would ya'll stick? I had a patient like this and was just getting an opinion from more experienced medics. Thanks FireEMT2009
Vorenus Posted November 13, 2011 Posted November 13, 2011 Forearm, possibly. I`d also take a look at the foot.
FireEMT2009 Posted November 13, 2011 Author Posted November 13, 2011 Forearm, possibly. I`d also take a look at the foot. I checked the foot and did not see any suitable places for venous access. I was looking at the forearm because the contractures would not occulde the IV sites.
romneyfor2012 Posted November 13, 2011 Posted November 13, 2011 It is always best to start distal and work your way in. Even with contractures, you may still find good veins in the hand, forearm and upper arm. You need to practice finding veins by feel instead of using vision, Do this: Put a tourniquet on your partner's arm, blindfold yourself with a triangle bandage or just close your eyes, and see how many veins you can find by "FEEL ONLY". Once you get good at that, you will find veins on 99% of patients that others can not find. Nurses will freak out, but i have used feet/leg veins when I had to, but then after they miss the next 3 sticks and put in a central line, they are glad i gave them something to use until the central line was in. Vein anatomy is generally the same in all people, so if you know where the veins are supposed to be, and learn to use your fingers instead of eyes, you should be great at IVs. 1
FireEMT2009 Posted November 13, 2011 Author Posted November 13, 2011 It is always best to start distal and work your way in. Even with contractures, you may still find good veins in the hand, forearm and upper arm. You need to practice finding veins by feel instead of using vision, Do this: Put a tourniquet on your partner's arm, blindfold yourself with a triangle bandage or just close your eyes, and see how many veins you can find by "FEEL ONLY". Once you get good at that, you will find veins on 99% of patients that others can not find. Nurses will freak out, but i have used feet/leg veins when I had to, but then after they miss the next 3 sticks and put in a central line, they are glad i gave them something to use until the central line was in. Vein anatomy is generally the same in all people, so if you know where the veins are supposed to be, and learn to use your fingers instead of eyes, you should be great at IVs. 99% of the time I will feel for veins more than relying on sight. Wouldn't the contractures inhibit the ability of the IV to flow due to compressing the veins?
romneyfor2012 Posted November 13, 2011 Posted November 13, 2011 Maybe a little, but if you have good circulation at the finger tips, then you have circulation.
HERBIE1 Posted November 13, 2011 Posted November 13, 2011 My initial smart ass answer is- you get the IV WHEREVER you can, but for rapid fluid replacement, obviously you need something bigger than a 24 gauge in a finger, The foot is often overlooked- and certainly not ideal, but better than nothing. A couple of other often overlooked locations are the underside of the forearms and upper arms and in a contracted patient, they may actually be easier to get at than a traditional site. Obviously EJ and IO are other options if allowed in your system.
FireEMT2009 Posted November 13, 2011 Author Posted November 13, 2011 (edited) My initial smart ass answer is- you get the IV WHEREVER you can, but for rapid fluid replacement, obviously you need something bigger than a 24 gauge in a finger, The foot is often overlooked- and certainly not ideal, but better than nothing. A couple of other often overlooked locations are the underside of the forearms and upper arms and in a contracted patient, they may actually be easier to get at than a traditional site. Obviously EJ and IO are other options if allowed in your system. EJs are allowed for traumas and codes, IOs are only for the most critical patients. That is our setups here in my area. I was thinking that the back of the arms would be a good place. I am a paramedic student in a place where we are only 5-10 minutes from a hospital so we have very short transport times. edited to make an addition to of my sentences to make it understandable. Edited November 13, 2011 by FireEMT2009
JakeEMTP Posted November 13, 2011 Posted November 13, 2011 Back of the forearm is a good place "most of the time" to find a excellent IV site. I started one the other day superior to the elbow on the right arm. Don't let your short transport times prevent you from doing patient care. Good luck in class!
nypamedic43 Posted November 13, 2011 Posted November 13, 2011 One of my favorite places to put an IV is in the side of the forearm. I call it a farmers vein. Easily accessible if you can get the arm up over the head or even next to the head. I've also put one near the ankle. Not the greatest place for it but it worked.
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