Constant Vein Blowing?

[JVoEDrn]

Hi all!

I am an IV nurse, seeking some advice. Earlier in the year I posted of a patient I had difficulty sticking who comes to me weekly for their IVs at our clinic. Well the issue dissipated when I found areally great vein and we've been using it for the last 10 or so visits. Its a deep vein, but unlike his other ones its not a roller and its big, takes a 21g easily, a very giving vein.

Well, 2 weeks ago, it infiltrated during the push. Great blood return, about half way through the pt begins c/o burning, I checked for return, nothing. That day I stuck him one more time, got a great flash (as always) and then upon pushing the fluids in (slow - bc he has a tendency to blow easily) it infiltrates, my back up - an IV certified ND came in, gave it 5 more shots and had the same issue- great flash and upond fluids, it would infiltrate. He gave his arms a rest the following week and came in today. I tried old faithful in the RAC and I would get a flash, but upon drawing back to pull some blood into the syringe I was pushing, there was no further return, we use 21/23g butterflies for pushes and blood draws.

Today there were a total of SEVEN sticks (all per patients request bc I give my self a 3 stick rule)....and all had GOOD flash! I took everything slow, I treated each and every vein like a baby...and they ALL blew...

Ok, if this is the only patient of mine this happens too isn't it safe to say its him? Ok, if it is him....why and what can he do, what can I do??

Thanks in advance everyone!

Jenny

What about the IO route?

IO for elective vitamin infusions O.o?

Word-for-word, I said the same thing just before scrolling to your post.

Honestly, this naturopathic clinic seems pretty shady if they're hawking weekly IV vitamin infusions for 'wellness.'

[MichelleRN32]

If it blows when you are going in first, then you have too much pressure on the tourniquet for the type of vein.

If it blows while you are infusing, then you have a couple of other reasons : you are pushing with pressure, you have nipped the inner lumen to begin with (in case he is dehydrated, it would be easy to do). If the patient already has scar tissue on that one vein, then I would imagine the only solution being going in blindly and hoping for the best!

i hope this helps!

[CrunchRN, ADN, RN]

Does malpractice insurance cover this practice area?

[OCNRN63, RN]

If he's just choosing that for his own good and he doesn't mind all the pokes then its his problem.

But if he minds the pokes, explain that most people can get their vitamins and minerals naturally and that this is an extreme way to get his nutrition. This could all be avoided if he ate better...unless he has medical issues which in that case maybe you could convince his primary MD to give an order to place a PICC.

The problem is he's chewing up his veins. Then when he needs medical care he won't have anything left.

[OCNRN63, RN]

What about the IO route?

Intraosseous for complimentary medicine? Are you kidding?

[OCNRN63, RN]

What is IV certified ND? Who giving the meds if there is NO MD order?

​Naturopath, as in, not an MD or DO.

[Wrench Party]

Hmmm...I would think the risk of continuously starting IVs in someone (infiltration, infection, blown veins for when he does have an emergency) would far outweigh the potential benefits to this patient, especially if he has no conventonially documented medical conditions.

If he has trouble swallowing pills because a lot of those vitamin pills look like they're more for livestock, could he take it

in a liquid form instead? Or take it in a form that could be absorbed through oral mucosa, bypassing the GI route?

I also wonder if high concentrations of electrolytes in the vascular space such as in the Myer's cocktail is a good thing, especially

if being used to treat certain conditions where the patient may already have fluid and electrolyte imbalances.

[Anna Flaxis, BSN, RN]

I think the problem may lie in your choice of intravenous catheter. What have you tried so far?

[wooh, BSN, RN]

Intraosseous for complimentary medicine? Are you kidding?

Is it really any more ridiculous than the IV? Once you get into ridiculous, why not go all out with it? Imagine the joy he'd get from having calcium injected directly into his bones!

He'd better hope these cocktails work, because he's screwed someday when he gets sick and NEEDS an IV.

[Anna Flaxis, BSN, RN]

I live in a part of the country where the use of CAM modalities is common. While I personally would not choose the Myer Cocktail for myself (and I have migraines, which is one of the things it is used for), I completely respect the patient's autonomy and right to choose this treatment for himself. Whether it is effective is questionable, but as I understand it, it's pretty safe other than the risks associated with intravenous therapy.

If the person ends up in a life threatening situation where they need IV access in order to prevent death, providers don't always go to the IO or the central line first, without trying a peripheral several times. This could result in delay in treatment.

I agree that this is an issue that should be discussed with this patient; that he could be doing irreparable harm to his vascular system with this therapy, and that this could impede rapid life saving treatment in the future should he find himself in that situation. He needs to be informed of the risks so he can weigh the risks and benefits for himself and make his own decision. He needs to decide whether the benefits he feels he is experiencing from this treatment are worth the risk of delayed life saving treatment further down the road. I think you have an ethical obligation to at least discuss this with him, or if you are not comfortable, then the ND needs to do it.

[OCNRN63, RN]

Is it really any more ridiculous than the IV? Once you get into ridiculous, why not go all out with it? Imagine the joy he'd get from having calcium injected directly into his bones!

He'd better hope these cocktails work, because he's screwed someday when he gets sick and NEEDS an IV.

You're right, and I am bowed by your awesomeness. We haven't discussed an IJ or maybe even a cut-down. Heck, let's go whole hog and slap in a central line. ( Why does this smilie look drunk? He's tipsy!)

[CrunchRN, ADN, RN]

I have no issue with the patient making an informed choice, but i would really worry about my liablility down the line from doing invasive procedures on someone for non-medically necessary reasons. If he needs chemo down the line and they say your veins are a miss do you think he or his family may sue?