Best ER Tricks what it meant is like putting two tourniquet to get the IV

brainkandy87 · Feb 12, 2012

Always ask an IV drug abuser where their vein is.

Yep. I'm always straight up with them. I don't care what anyone does, I'm here to take care of them. Managing their life choices is not my job and I let them know that. I nearly always get them to open up and be honest with me about where they access, what gauge they use, etc. I always let them know that they need to stop, but if not, they're always going to end up back here for infections, etc, and to at least leave us their EJ's so we can take care of them when we need to help them.

One good trick for IV's that you get blood return on but can't thread (and it works really great with scarred veins from drug users, older people, basically anyone that has had a lot of needles in their arm) is using a vacutainer holder and a vacutainer tube. Basically, you attach the holder to a saline lock (the blue clave) and attach the whole thing to your IV hub. Use a vacutainer tube to draw blood. The suction created from the tube will open the vein up and allow you to slide the cath in fairly easily. I use this trick all the time, especially when starting a large bore IV with a long catheter.

Editorial Team / Moderator · Feb 12, 2012

Not a nurse yet, but I'm an ER Tech and I have seen a doc use the bp cuff in replace of a tourniquet when the pt was a hard stick.

Yep, this works. You pump up the BP cuff until the radial pulse goes away, and leave it right there. I learned that from a guy who was a total ace with IVs.

MKEdoc09 · Feb 13, 2012

I often ask the Pre-hospital guys what they do, we have it easy in the ER. Good lighting, beds, more people, etc. They aren't so lucky, often getting large bore IV's in the dark, or in a moving ambulance.

Simple tricks, like using BP cuffs as tourniquets, or pressure bags, hot packs over veins, cutting a hole in a large bio-bag, and putting in over thier hed, so the patient has a large target, using nebulizer masks to make EtCo2 compatable, all came from our Paramedics. They can actually be a pretty good resource when it comes to "tips and tricks."

MKEdoc09 · Feb 13, 2012

Another one that a medic friend gave me. - He took a retractable badge holder, we all have them for our nametags, and put a pair of EMS shears on it. I now do the same thing, I keep the shears in the back pocket of my scrubs, but I don't lose them, because they are always attached to my waistband via the badge holder.

**canoehead, BSN, RN** · Feb 13, 2012

Yep, this works. You pump up the BP cuff until the radial pulse goes away, and leave it right there. I learned that from a guy who was a total ace with IVs.

If you lose the radial pulse you've lost arterial flow. You want to stop venous return but keep the arterial flow so the veins get bigger, and easier to stick. So pump up to above the diastolic pressure.

CrashED · Feb 14, 2012

make sure you bring in the size 24 french catheter as an example of what garden hose...I mean catheter you are going to use to obtain that urine sample!

Nataayy · Mar 15, 2012

My very first job was at a poor small rural hospital that could not afford anything. It was amazing that we could afford to stay open. Well working at that hospital taught me how to work with nothing. Here are my tricks

1) Eye wash station? Thats for rich folks. Take a 500 bag of NS and a piggyback tubing, use that rolling clamp to control the flow.

2) Have a unresponsive/lethargic patient thats blood sugar is low, no IV and the refrige only has sugar free pudding. Wipe the icing off the cake left from lunch and place in cheek. And keep a tube of writing icing in your locker.

3) Have a hard stick or small veins, rub a dab of intro paste over the desired IV vein.

4) Always have a small flashlight in you locker, never know when you will need it. A 300lb pt that needs a Foley or when the hospital get hit by lighting. (yes it's happened, with no back up generator)

5) If some how the plastic hoop on the nitro drip bottle is "magically" gone get a zip lock bag and cut a whole in the bottom corner and tread the line through and hang the bottle by the bag.

6) Need to elevate legs and take pressure off of the heels but don't have anymore pillows; pull the bottom side rails up and loop a sheet though the rails and tie it tight. Spread the sheet out where it is supporting the calfs.

Guest219794 · Mar 19, 2012

Regarding BP cuff for IVs: If you use a Phillips monitor, check the BP settings- there is likely a tourniquette setting. Does it automaticlly.

A tip if you need vented tubing for anything in a bottle- No vented tubing, use regular tubing, and stick an 18 g needle through the rubber stopper.

allnurses Guide · Mar 19, 2012

When breaking the neck of an ampule, put the needle cap cover over it and bend, the top of the ampule will get caught in the cap and no broken glass near your fingers.

Our monitors have a setting for blood draws on the automatic BP cuff, will hold it automatically partway between the systolic and diastolic.

If your gravity flow IV is running slowly, bend over the tubing twice (about 8 inches above the site) and give a quick twist; gives a mini flush/push and helps open a line trying to clot off.

BostonTerrierLover, BSN, RN · Mar 19, 2012

BOSTON's FAVORITE TIPs and USELESS KNOWLEDGE!!!!

I used to sit on bags for the transfers to a trauma center via ambulance, it warmed the fluids, and created pressure. You can also use a blood pressure cuff around the bag for pressure delivery also.

I use a red paper over my LED maglite to make veins stick out in bad sticks, it will fade arteries, and darken viens. (OH TURN THE FLOURESCENT LIGHT OFF!

Baby powder in your socks helps your feet not feel so claustrophobic over the 12 hour shift.

In patient's with uncontrolled vomiting, get them to yawn, I read this in a Neurology Book, it can reset the pathway in the brain that PAIN NAUSEA AND TEMPERATURE TRAVEL ON.

Run water if your patient has trouble urinating.

The Vagus Nerve Trigger can stop Hiccups.

In a picture, if only one eye is red, that could be a sign of a tumor.

Squeezing the skin between the THUMB and POINTER FINGER helps migraines tremendously. (PINCH, HOLD, AND MASSAGE)

Chewing gum will make you read and chart faster.

A 5 minute Rigourous Scalp Massage can release as many endorphins as MORPHINE 5mg!!!!!!!!!!!!

If assessing for a stroke, shine the light in one eye, USE A DIVIDER TO KEEP LIGHT OUT OF THE OTHER, it should STILL RESPOND.

Blowing up a baloon helps prevent ATELECTASIS, (BEWARE OF LATEX ALLERGY, and POLICY/PROCEDURE)

When you become aware of your breathing, and conscious takes over subconscious, YOUR spO2 generally falls by 2-5%

An aspirin 325mg crushed and put in a car batteries water supply will give you a charge to start.

(SAVED MY TAIL IN ALASKA)!!!!!!!!!

Where shoes that make a noise so if your Psych, or Psych Emergency Room Pts are doing something stupid, they will hear you coming and behave. I KNEW A NURSE THAT WORE HIGH HEELS FOR THIS PURPOSE!!!!!!!!

A condom and a 18 gauge IV catheter placed in the last intercostal space for a collapsed lung in the field.

Those prepackaged fingernail polish removers are great for permanent marks on skin, temp tattoos, and even blood stains on your scrubs.

When doing a accu-check, get the pt. to make 5 fists first, also helps decrease pain from stick.

DISCLAIMER: TRY THIS JUNK AT YOUR OWN RISK!!!!!!!!!!!

brainkandy87 · Mar 21, 2012

The ASA + battery combo is one of my favorites. I'm surprised this hasn't been on Breaking Bad.

AnnieOaklyRN, BSN, RN, EMT-P · Nov 13, 2014

IV access in critical situations shouldn't be that much of a problem anymore with the EZ-IO. Takes seconds to put in and you can infuse anything that can go through a normal IV. May need a pressure bag or BP cuff to get wide open flow...

HPRN