Quote from lilbiskit78
Hi everyone! I was practicing IV on my husband this afternoon (I know, he's a good husband!), and saw something weird. I inserted the catheter, got flashback, and threaded the catheter all the way in (I used one of those push button catheters where you push the button & needle retracts). Anyway, I left the catheter in his hand for a few, just admiring my work, and it was fine. When I took the catheter out, his hand swelled up. Is it possible to blow out the vein when removing the catheter? Or did I somehow blow it before then, like I said, it didn't swell until I removed the cath?? I have never seen this before. Any ideas? Thanks!
I used to teach this IV catheter, which is called an InSyte AutoGuard, made by BD. Yes, as others have stated, you probably "blew" the vein with the stylet upon cannulation, but the catheter itself tamponaded the resulting hole in the vein wall.
Here are a couple of tricks to avoid blowing the vein again, that you may or may not have been taught:
---Before you start, hold onto the catheter hub where it attaches to the clear flash chamber (just above the button.) You will see a slight notch there. BE CAREFUL NOT TO PRESS THE BUTTON!!!
---With the opposite hand, grasp the clear flash chamber at its base, and twist it--NOT THE CATHETER ITSELF
-- to the right, a full circle, (360 degrees) until you hear a slight "click." You have brought it all the way back where you started, to that "notch." (The notch is just above the button; again, be careful not to press the button.)
We taught this step by saying "take it for a spin. " This action will loosen the heat seal between the catheter and the stylet, and allow the catheter to "glide" off the stylet easier. If you neglect this step, the catheter may feel "sticky" when you attempt to advance it off the stylet, and may cause you to inadvertently "blow" the vein when you struggle with it.
---Here is the most important step: Remember, your approach should be LOW AND SLOW.
---Place your thumb and index finger on the little "grooves" on the side of the flash chamber (created for that very reason.)
---Angle the catheter, bevel up, at approximately 15 to 30 degrees above the skin.
---Stick, (just enough to get the catheter tip in) stop, lower the catheter almost flush with the skin.
---As IAG's stylet is sharper than some of the other brands, and thus cannulation less traumatic, you will not feel a POP as you enter the vein as you do with some other brands--that "pop" with other brands is trauma to the vein from a stylet that is not sharp enough.
---It may take a bit longer than some other brands to see the flash in the chamber--but if you have successfully accessed the vein, it will appear. Be patient.
---Now ADVANCE THE ENTIRE UNIT
--not just the catheter--approximately 1/8".
---This is important with ANY IV catheter, to make sure a good portion of the actual catheter is in the vein--not just the tip of the stylet.
---Go ahead and thread your catheter off the stylet.
---Push the button, stabilize your catheter, put digital pressure above your tourniquet, (this will cut down on "back-bleeding") and pull your tourniquet. ----Dress IV site according to institutional policy.
FYI: the 22s and 24s have a "divet" cut into the tip of the stylet, which allow you to see a drop of blood IN THE CATHETER before you see it as a flashback in the chamber.
Another FYI: One of the most common reasons for the complaint of "I got a flash, but the catheter won't thread" is failure to advance the entire unit another 1/8" into the vein before threading the catheter off the stylet--it means that only the tip of the stylet is in the vein, and not the tip of catheter itself.