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

[jadelpn, LPN, EMT-B]

I have commented on this before, however, I am sure it is facility based--however, we are going against our policy to infuse or push anything through a butterfly needle. With the constant use of one vein and the use of a needle as opposed to a plastic catheter, one jar and the needle goes right through the vein. Is there a reason that a regular old IV is just not put in?

And in most emergency situations, an IO is introduced if it becomes clear an IV won't go in the first time. But I do agree that you have the ethical obligation to discuss this with the patient in your education.

This therapy has been a lifesaver for people with migranes. And can be a viable option for people who have lots of ER visits for an intractable migrane and not having to rely on narcotic pain relief. And for those who can not take or have no relief from the other presciption medications for migrane headaches.

Alternative therapies for pain control or wellness maitenence for a chronic condition can be questionable. However, if it works for the patient of chronic pain, all the better for them. However, I would review and perhaps look to revise infusion methods. And depending on a primary MD's thoughts on chronic pain control, perhaps a port could be something discussed. It is of course patient dependent, and dependent on the diagnosis for which this treatment is to be keeping under control.

[PMFB-RN, RN]

The problem, is that I work at an alternative medicine clinic administering complimentary medicine. So with that being said, this particular patient is receiving these pushes by choice....its a mag push, better known as a meyers cocktail. So a port and picc are extreme for him in particular bc he doesn't have a diagnosis for this push, hes just choosing this for his own well being. ;/ My thoughts would be to obviously find a better way to introduce vitamins and such into your body... especially if I'm not "ordered" by a doctor to have it.... hes so willing, to get these pokes and it certainly stressful for me being the nurse that pokes him so many darn times!!!

*** I can hardly believe that a nurse would take part in such "treatments". We will see how much his well being benefits when one day he has a REAL medical issue and paramedics and nurses are unable to obtain IV access needed to save his life.

[Anna Flaxis, BSN, RN]

It's a fact of life that CAM is becoming part of the health care landscape, like it or not. I think as health care providers, we have an obligation to provide factual information with which our patients can make their own decisions. I think in this case, the patient believes he is benefitting from this therapy, and the Myer's Cocktail apparently has a good safety profile. Rather than judging this patient's choices about his own body, he should be informed of the potential consequences, i.e. poor venous access in the event of an emergent, life threatening situation, and allowed to make his own choice.

I agree, the problem might very well be the use of the butterfly set for IV push, which is why I asked what equipment has already been tried.

I wish the OP would come back and answer.

[CrunchRN, ADN, RN]

I think CAM is fine. Well some of it. However, it is not accepted as the usual and proper and meets standard of care so i would be very afraid to be involved in this aspect of it legally.

I'm of the very strong opinion that invasive CAM therapies like IV pushes should be managed and ordered by integrative medicine MD/DO types.

It seems a bit of an oxymoron for a naturopath to be 'ordering' pushes of IV compounds.

[Altra, BSN, RN]

I'm of the very strong opinion that invasive CAM therapies like IV pushes should be managed and ordered by integrative medicine MD/DO types.

It seems a bit of an oxymoron for a naturopath to be 'ordering' pushes of IV compounds.

Thank you. Invasive procedures is the line in the sand, IMO, for CAM therapies.

[Emergency RN]

Having worked for years on an IV Team, I'm reluctant to favor one particular site repeatedly over many venipunctures. In drug abusers' parlance, we refer to this as creating tracks, as such veins become useless over time from scarring. The vein doesn't care that it's being used for a clinically legitimate purpose; all it sees is the constant cutting and it will scar accordingly. That is why site rotation is so important, especially for someone with known access issues. I also agree with the other respondents vis a vis the use of an in-dwelling venous catheter over the butterfly injection technique. An IV catheter is much more stable (isn't prone to shifting or continued unintended venous injury) and more importantly, can provide immediate secure access if the patient has an untoward response during any procedure. This isn't only because of allergic reaction as I've seen patients vagal for even the simplest of things. Additionally, having a running IV line attenuates the irritation of the infusion because it dilutes whatever solute one needs to give.

But, given that this is occurring in a office practice situation, I certainly understand the monetary constraints; IV lines, catheters, and fluids all cost money. Some doctors may not want the expense and prefer to do it on the cheap. Additionally I would decline to participate in an IO insertion for this patient; IO's should be strictly reserved for lift saving emergencies where immediate access is critical to the survival of a patient. To puncture someone's bone marrow just because we can, for the purpose of delivery of a non clinically proven substance, IMHO, would dangerously flirt with malpractice.

In difficult access cases, I've always found that either transcutaneous illumination, or if available, ultrasound, to be the most helpful non-invasive adjuncts in obtaining reliable venous access. Obviously, given the known condition of the OP's patient's veins, it may be worthwhile to reconsider the overall risks versus benefits of IV versus the PO route.

[Anna Flaxis, BSN, RN]

I'm of the very strong opinion that invasive CAM therapies like IV pushes should be managed and ordered by integrative medicine MD/DO types.

It seems a bit of an oxymoron for a naturopath to be 'ordering' pushes of IV compounds.

NDs can and do order "injectable nutrients" by IV route. I would imagine this varies from state to state, but in California it is legal.

[brownbook]

*** I can hardly believe that a nurse would take part in such "treatments". We will see how much his well being benefits when one day he has a REAL medical issue and paramedics and nurses are unable to obtain IV access needed to save his life.

I think CAM is suck treatment. Okay, if the patient says they feel better....I won't argue, as long as they have seen a MD and are sure their symptoms are not something serious.

Ha Ha, did you intentionally write suck treatment or was it a typo, I love it!

I think CAM is suck treatment. Okay, if the patient says they feel better....I won't argue, as long as they have seen a MD and are sure their symptoms are not something serious.

Well, as long as you're bringing up typos...

I work at an alternative medicine clinic administering complimentary medicine.

It was all I could do not to point out that I'm sure this treatment is not complimentary but in fact rather pricey... and likely (hopefully) out-of-pocket.

[wooh, BSN, RN]

Well, as long as you're bringing up typos...

It was all I could do not to point out that I'm sure this treatment is not complimentary but in fact rather pricey... and likely (hopefully) out-of-pocket.

I figured while the veins were blowing, he was being told things like, "What beautiful eyes you have! And you have such a kind disposition. And excellent taste in clothes!"

[Anna Flaxis, BSN, RN]

You guys crack me up!