IV start gone bad

[lsvalliant]

I was in pre-op starting an IV on a healthy 32 year old guy getting a knee replacement. He was in the gurney HOB elevated about 60 degrees. I asked him if he needed me to lay him down and he of course said no, even though he made it clear that he hated needles. As soon as I advanced my needle in the AC he started to say "I dont feel well, I dont feel well". I reasured him and told him to take deep breaths and it would be over in a minute. Then his eyes rolled in the back of his head and he started convulsing and gasping for air. I of course screamed for my charge and he snapped out of it seconds later and said "woah, I had a dream or something". What the heck was that? Does anyone know?

[PostOpPrincess, BSN, RN]

Next time tell them to "man up and put on their big girl panties"...

My 95 hip replacement lady said that....hehe....

[EricJRN, MSN, RN]

Some abnormal movements of the extremities aren't uncommon with syncope from vasovagal reactions. There isn't a typical postictal period like you would see with seizures, but the muscle contractions can look pretty dramatic for a few seconds.

[wtbcrna, MSN, DNP, CRNA]

Young male patients vasovagal all the time when you are starting IVs(Marines seem to be the worst....), but it is nearly impossible to vasovagal and laugh at the same time. Try to get your patient talking/laughing right as you start the IV.

I always tell the same joke to my patients right before I stick them, "Don't worry this won't hurt me a bit", they laugh and I stick!

[freefalr]

i'm sorry it scared you, lsvalliant! it was not nice that that guy did that to you. :> seriously, it's -always- the young, "tough" guys. they're all chatty at first while you're starting the IV, then they get really quiet, and you look up at them, and they're ashen and vagaling. once a doc i work with was assessing breath sounds on a patient (i had left the room), and i heard her shout my name. i ran back in, and he had fainted over onto her (she's teeny, like 5') from having taken deep breaths. apparently this had happened to him before (and yep, he was a 40-something, healthy guy) during venipuncture, deep breathing, etc. we had the poor guy wear a Holter and promise to let us know if it ever happened again....we'd have him get a

Reveal monitor, i think....he was pretty embarrassed.

come to think of it, ammonia would've worked wonders! we just laid him back & made sure he wasn't coding...

wtbcrna, i love your idea of "this won't hurt me a bit")! mind if i steal it?