Did I stick a tendon?

[GaJenRN]

I'm a new grad in the ER without much experience starting IVs. Of course everybody gets them in the ER, but most people that come in have really bad things I've noticed. So this lady comes in and I can't find anything on her except for some very small veins in her wrist. She tells me that this is normally where the nurse has to start an IV on her. So I preceded to stick her with a 22g and it went in the vein because I could see it go through but I didn't get blood return and as soon as it got in she screamed and said that it hurt unusually bad. I immediate pulled it out and when I did a very small amount of clear liquid came out. She's very used to getting stuck so I know I hit something else with the vein. Do you guys think it was a tendon? I swear I'm never going in the wrist again unless someone is unconscious!

[NurseCard, ADN]

I don't know the answer... But I will say, after 13 years as an RN, in varying specialties, I am still terrible at sticking people... I've noticed that when I stick people in their hand anywhere, more often than not it seems to ignite cries of pain, not heard when I stick in the lower arm or AC. I HATE having to stick someone in the hand.

Working in the ER, you are gonna get better... Don't worry! :)

[Anna Flaxis, BSN, RN]

It sounds to me like you hit the median nerve which caused the patient's pain, and the clear fluid could have been lymph fluid.

I would highly recommend avoiding the wrist area for IV starts due to the risk of nerve damage.

[iluvivt, BSN, RN]

You should avoid the volar wrist and the wrist area just above the wrist for a full five inches.These areas have the highest potential for nerve damage and chronic pain syndromes from any damage. In desperation I have used them with extreme caution and a small cannula when the benefit outweighed the risk.I will look for a long while and/or use my US before I get desperate enough to go there.The volar wrist is also a very painful area when stuck so it is no suprise it hurt.You probably went too deep and hit something.Did the pt complain of any electric like shooting pain?