Hi..I just started at a Rheumatology office for infusions. I have never worked infusions before, and the infusion clinic uses the Nexiva IV. I used to work Pre/Post at a hospital and then a GI clinic, and we used regukar IV'S which we could float the IV'S catheter in very quickly and easily if we hit a valve/obstruction.
Does anyone have experience with Nexiva? It's quite frustrating to hit a valve with this catheter. Can you still try to float the catheter in by priming the tubing with NS or will that prevent flashback in the chamber?
I have some experience with the Nexiva. No, you can not float the catheter in with saline. I hate them.
Frankly, neither do I!! I am stuck with them at my new job. I could finagle IV'S into almost any vein until these guys, and I have watched their videos and read forums on common IV mistakes made with them. They simply aren't as adaptable as regular IV's in my opinion (can't float them)..and for a good enough percentage of IV starts, you encounter a valve and in that situation, it's not always the best option to push the IV past the valve. Then you have to re-stick the pt.
Interestingly enough, my facility is studying whether these IV starts are more likely to infiltrate than other types. Apparently the ICU nurses were noticing a trend and so now we chart which type of IV start kit we use (some floors have alternatives) to try and track it.
We use BD Nexivas and BD Autoguards, nurses can choose which one to use but are encouraged to use the Nexivas on the adult side. The ultrasound trained nurses can also use the B. Braun Introcan as well but risk managment decided that none of the other nurses can use them.
I strongly detest the Nexiva, I don't have a problem with valves but I hate how hard it is to advance the catheter off of the needle. If you have blood advance down the extension you can still float them in, but it is certainly more difficult than with our other angiocaths. Our pediatric units have basically abandoned them on 24, rarely use the 22, and only really consider it when they were going to place a 20 because of this.
The one thing I do like about the nexiva is that I feel more comfortable about blood exposure. Also if they could make a 16 or 14 in would much improve my ability to keep blood off of the floor.
I know this isn't probably approved technique, but when using any other IV besides Nexiva, I would take a 4x4 or 2x2 and once the IV is in, I would place it under the port so that any blood that leaked out would drain on and get absorbed by that when pulling the needle out. It was quite nice. I wish they made a pad like this for IV starts that was similar to a pantiliner for women, but just a 4x4 instead. They could make it in awsome bright or dark colors, like Coban.
Try this...Take the flashplug off the end of the catheter BEFORE you attempt the IV.....draw up 3 mls of NS in a 6 ml syringe from a 10 ml NS pre-fill and attach it to the extension tubing where you removed the flashplug.....start the IV and if you feel the need to float it you have the NS already attached and can do so......the
extension tubing does not readily fill on this product so you may have to pull back and fill with blood before you float (thus the 3 mls in a 6 ml syringe)
I have seen nurses float IVS in but not once have I ever had to do it as I find it messy and easy to lose my chance at the access. Assess very carefully prior to venipuncture and feel for valves or look for the characteristic bulges (not always easy or possible) then carefully perform venipuncture just above the valve or well enough below it. What you are most likely encountering is a sclerotic vein or section of one or you you are running into a slight turn or curve of the vein. Many of these problems can be dealt with prior to venipuncture with careful choice of where you are going to enter the vein and by straightening the vein out during the venipuncture with good skin traction techniques and some other techniques that I have invented out of sheer necessity. If you do run into an area of sclerosis or narrowing and you are STILL getting a blood return and you are certain you are still in the vein you can try to advance through it. It often works and you can feel a crunching sensations as you pass through it. These veins will have a thick wall that you can feel before venipuncture but they may be all you have to try so you got for it
Most of our pts are long time steroid users and have autoimmune issues. I always assess for possible valves etc. It's not always possible to detect a valve prior to IV insertion, and we try to avoid the AC if possible, which is usually the easiest spot for a lot of pt's.
I had considered attaching NS flush to the end, however I was not sure if that would make the Nexiva lose its vacuum? Does it? I used to do that all the time with regular IV'S before working pre/post where we simply attached the free flowing IV fluids and the IV floated in quite easily if you hit a valve. I am not sure how floating an IV was messy? I never had any messes with IV starts or floating them except when I was new to it all.
I generally never tried to go through valves if the vein wasn't visible long enough for the catheter to fit, because floating it was successful 99% of the time wheras attempting to go through valve in a vein that wasnt fully visible was unlikely to be successful. On the other hand, If the vein was long and visible, yes I would just go through the valve. Unfortunately, the vast majority of our infusion patients are not those types of candidates.
Nexiva is at a disadvantage with that, although it is easier to do blood draws with them.
Last edit by sameasalways on Oct 11
: Reason: spelling
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