IV help for medic student... tamponading the angiocath?

[btowndown]

So, I am in my hospital rotations as a paramedic student. When it comes to starting IVs I have been pretty succesful at getting a patent line.

However, my problem is tamponading the vein... most of the time I end up with a huge puddle of blood. I have to use angiocaths (not butterflys) since that is what medics use in the field. And I am also using them for the blood draw....

Everything I read said something like "gentle pressure approximately where the tip of the catheter is inside the vein". It seems like I tried gentle pressure and I tried a lot of pressure, to the point where it hurts the patient a little bit.... but neither have seemed to prevent me from having the iv bleed all over. I have even tried using 4 fingers of one hand along the path of the vein... but that has not worked.

I have talked to a few of the nurses but they have not had any specific advice.

Any specific advice would be appreciated greatly!

[flightnurse2b, LPN]

i usually put a chux under the patient's arm when i'm starting a line, esp. if i'm drawing labs out of it. are you using an extender set or j-loop at the end of your IV? those are less messy then trying to draw out of a iv plug heplock.

also, sometimes when you are staring a line, esp if it is a larger bore cath, you will have a nice gush of blood before you hook your plug on and theres not much you can do about it. i try to place one finger just about a 1/8 of an inch above the insertion site (if you put pressure over the site itself you will get more blood and may kink your cath) and usually end up just needing one alcohol swipe to clean up my mess.

good luck :)

[mcknis]

I usually just use my fingers, but sometimes i'll grab a washcloth if its needed. About checking patency, I usually don't draw back, but watch my site carefully. you may not always have blood return esp if a clot has formed over the tip of the catheter

[iluvivt, BSN, RN]

1 First of all make sure your tourniquet is not too tight....make sure arterial flow is not restricted.

2. Since you are drawing blood prior to attaching your IVF or cap,you must leave the tourniquet on. So be prepared with at least a 2x2 or 4x4 until you get better at this.......also once you access your vein advance a bit and pull your needle back.......just pull it back about 1/8 an inch or so....b/c if you pull it back any farther it may be more difficult to thread and you will also start out with a mess. The needle will act as a plug until you are ready to pull it entirely out.

3. The next important thing is to make a note of the length of your catheter.If it is 1 1/4 inch YOU MUST place your fingers over the skin 1 1/4 inch from the hub (not at the hub). You must occlude the vessel BEFORE you pull the needle out of the cannula (not after). So have you 2x2 open and slide it near the hub of the catheter (after IV is successfully placed) Place fingers of your non-dominant hand over the vessel exactly at the end of the catheter (use 2-3 fingers and press moderately) NOW take out the needle with your dominant hand. If you are using the Braun product you have to hold the hub with your non-dominant hand as well. The Insyte autogard is a bit easier....after vein occludes with your fingers.....press the button with your dominant hand. It can be done bloodless.....I do it all day long....I bet you are not occluding it at the right location as this will vary based upon the length of the catheter you have placed. Try it and let me know!!!!

[btowndown]

iluvivt, thanks a ton! I am off for a week or so here, but I will let you know.

I think part of the problem is placement of my fingers for tamponading.... getting the right distance and location of the vein.

Another thing is I have been retracting the needle 90%+ of the way before I tamponade the vein.... I am worried about pushing the needle through the catheter (i.e. cath sheer) or pushing it through the vein and blowing the site....should I worry less about that???

[hypocaffeinemia, BSN, RN]

Before I remove the needle I put a folded 2x2 under the hub and then hold firm pressure above the hub and quickly put on a syringe or extension tubing. A little bit of blood always bleeds out for me, but it is caught in the 2x2 and leaves no mess as a result.