- 0Dec 4, '06 by scrmblrI had a pt on a shift last week who was poked 8x. The nurses would try to start the IV and every time the vien would just instantly bruise and the nurse would say "The vien just blew" Pt came back in on my last shift with the same complaints. MD ordered an IV But I went into it thinking that I would just try once and see what happened. I put the tourny on-found lots of great "looking" viens and felt a nice fat one on the underside of her arm. I poke...get nice flash...start to advance and the vien up close to the catheter hub gets a nice little bruising around it...But the dang thing draws like a champ and flushes easily. I had my charge look at it before we put anything besides N/S in it and he said it looked great.
Any ideas on why this happened? I get the feeling that the nurses on the previous shift may have had patent IV's-but saw the bruising and d/c'd them.
- 0Dec 4, '06 by gr8greensWe actually have an "IV team", a few RN's whose job is to just start IV's! They will sometimes bruise upon insertion too......but the line is still patent. They just add "bruised on insertion" to their charting. Seems as though your co-workers had patent lines too. That poor patient!
- 0Dec 4, '06 by HappyParamedicRNsome patient's especially the elderly who are on anticoagulants and even steroids have very fragile veins and capilaries. Do not worry about bleeding/bruising around the insertion site in the skin, usually alittle direct pressure will stop it. Worry when it is at the insertion site into the vein (distal from the hub), then the IV should be removed. A trick for these patients is to use a blood pressure cuff instead of a regular turniquet as they do not bleed nearly as much and the vein doesnt form an explosive hematoma when the needle is inserted into it.
- 0Dec 4, '06 by TazziRNIf the veins "just blew" 8 different times then someone should have thought about trying it without a tourniquet. With the elderly it's not uncommon for there to be too much back pressure, so that when the vein is pierced it explodes.
In this case I agree that they didn't blow, or at least not all of them, but that the first pokers were too quick to quit.
- 0Dec 7, '06 by Victoriakemfor elderly patients with fragile skin, sometimes I don't put a tourniquet on at all, but look for the tiny flash to make sure the IV is in place. If I draw blood from the site, then I put on the tourniquet but I usually prefer to draw their blood separately to keep the IV patent.