IV tips and tricks - page 23
Hi all, I am starting to compile a list of tips and tricks concerning starting venipuncture. The goal is to share experiences and tricks of the trade. Tips e.g. on how to find that elusive "best... Read More
Apr 13, '11I disagree with those who say 22g are useless you can bolus fluids through a 22g 2500ml/hr as well as blood, in very dehydrated people, elderly and even trauma patient we can and do put in 22g.
Jun 24, '11I came across this expensive tourniquet with a weird design. The 'bridge' is designed not to restrict the flow of blood out of the specific vein you are about to cannulate or venepuncture. Seem's to go against the whole idea of a tourniquet. Do you think it would help?
Jul 24, '11my instructor said to never be the hero! don't try to go for a vein if you are not 100% sure you can get it. always look around, don't go for the first vein you see! and if you are asked for help by someone, don't try the vein they didn't succeed in. find one that you know you can get.
also, when doing hand draws, a lot of times it is easier if you get down on one knee. it is a better angle
Jul 24, '11Quote from thanatosthis has been discussed ad nauseam. try a search.
Why even add this? If you're not interested or think its been discussed too much, just move along.
Jul 25, '11I'm feeling lazy today, so it may heve been said in the preceding 28 pages:
lots of folks get tourniquet crazy. Remember, for our purposes, we are inhibiting venous, not arterial flow. If youze cuts off da artery, youze ain't improvin' da feel of da vein. (Best mobster voice, there)
SkinnyLatte is also correct, if you can train in the "feel", not so much the visualization, it is much easier. i describe it like a warm Vienna sausage, tho' "spongy" is certainly accurate.
MedicUK, I think you have found a stellar solution in search of a problem, combined with superlative marketing! As of today, it runs about $59 USD. Daaaaaang. I rather doubt the hospital is going to buy me one, much less a gross, unless they get to rivet it to my palm...
Jul 25, '11So Rob, I just want to clarify...you think this torniquet will theoretically help? I'm still confused because it will squeeze all the superficial veins apart from the one under the 'bridge'. And I don't think it will stop the arterial flow, because those vessels are much deeper (right?).
Jul 25, '11Quote from MedicUKAplologies- I was too verbose. I really doubt that it would be effective. It is an oxymorominc device- you must be able to see the vessel to "bridge"; if you are already well-visualized, why are you using the $$ device?So Rob, I just want to clarify...you think this torniquet will theoretically help? I'm still confused because it will squeeze all the superficial veins apart from the one under the 'bridge'. And I don't think it will stop the arterial flow, because those vessels are much deeper (right?).
Of course, if you are able to visualize that vessel, you are probably also able to palpate it fairly well, using a $0.08 tourniquet. Yet again, it is rather difficult to justify the $60 tourniquet.
In the case of compromised, sclerotic, or scoraited valves, the bridge will actually work against you, as it will not prevent regurg.
Edit to add: proper tourniquet technique results in a tourniquet that has not rolled upon itself to form a ribbon around the patient's arm. Even with morbidly obese patients, the band should be fairly wide/flat, resulting in good venous compression.
Rule of thumb- your patient should not complain of pain, pressure, dicoloration, etc., in under 3 minutes (the amount of time generally recognized as appropriate to complete diagnostic phlebotomy w/o specimen compromise).
Apr 4, '12First, I owe everyone here a big THANK YOU- especially Daytonite (RIP). I was up until midnite reading these IV tips, and lo and behold this AM I had to start an IV in a 40 y/o pt who is on HD and has HORRIBLE veins- one of our best IV gurus on nights had to stick her 5 times last nite to get a 24g in that was buh-bye by 0900 when she needed Dilaudid. I used a handful of these tips (nitro paste is my new hero!!!) and got one on the FIRST TRY that lasted until I left tonite. My pt said thanks as well for saving her from a likely pincushion fate.