Constant Vein Blowing?

  1. 0
    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
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  4. 42 Comments so far...

  5. 17
    My goodness, this patient needs a midline, a PICC or a port - STAT. Have these been considered?
    brownbook, PMFB-RN, Quit Floating Me, and 14 others like this.
  6. 0
    The problem, is that I work at an alternative medicine clinic administering complimentary medicine. So with that being said, this particular patient is recieving 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 doesnt 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 strssful for me being the nurse that pokes him so many darn times!!!
  7. 1
    Is he dry? Perhaps you should suggest lots of water prior to the visits?
    sserrn likes this.
  8. 2
    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.
  9. 6
    If he feels that benefits him somehow then more power to him, although physiologically there's no reason to believe he can't get the same end result by taking magnesium, calcium, etc PO. The bioavailability and absorption is different so it may take more of a PO dose to get a dose-equivalent IV dose. But in the end if something makes you feel better, whether actual or perceived, then it does serve some purpose.

    One thing to be careful of however is that the same principles that prevent a port being placed apply to you as well. A port isn't indicated for IV access in a patient who doesn't have an indication that is 'legitimate', since that would be performing an invasive procedure unnecessarily, keep in mind you're also starting IV's for a purpose that has no legitimate purpose and adverse events related to this could threaten your license much more than if there was a generally recognized indication.
    IowaKaren, PMFB-RN, NurseDirtyBird, and 3 others like this.
  10. 1
    Quote from MunoRN
    If he feels that benefits him somehow then more power to him, although physiologically there's no reason to believe he can't get the same end result by taking magnesium, calcium, etc PO. The bioavailability and absorption is different so it may take more of a PO dose to get a dose-equivalent IV dose. But in the end if something makes you feel better, whether actual or perceived, then it does serve some purpose.

    One thing to be careful of however is that the same principles that prevent a port being placed apply to you as well. A port isn't indicated for IV access in a patient who doesn't have an indication that is 'legitimate', since that would be performing an invasive procedure unnecessarily, keep in mind you're also starting IV's for a purpose that has no legitimate purpose and adverse events related to this could threaten your license much more than if there was a generally recognized indication.
    Exactly. Just seems odd that you would choose to take vitamins/ minerals IV when humans have been getting them naturally from their diet for thousands of years.
    SoldierNurse22 likes this.
  11. 6
    It is a growing medical problem -- patients whose habitus, anatomy, medical and social histories and/or disease processes mean they have very poor venous access. You may recall recent state execution attempts hampered by venous access issues which were widely covered in the media.

    I personally would probably not participate in continuing to stick this individual, if his access is already that poor. I continually teach my patients who get regular blood draws or infusions that the problem with repeatedly accessing the "go-to" vein is that it WILL eventually sclerose ... and then what do you have? On that fateful day when the patient becomes hypotensive, hypoxic, dysrhythmic, suffers trauma or some other EMERGENCY ... to have compromised their chance of successful resuscitation by sclerosing accessible veins without good reason is just not something I'm comfortable with.
    wooh, sserrn, VickyRN, and 3 others like this.
  12. 0
    What about the IO route?
  13. 6
    Quote from runnergirl86
    What about the IO route?
    IO for elective vitamin infusions O.o?
    klone, canoehead, One1, and 3 others like this.


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