Watched a midline-omg. Always like that?

[FuturePN]

I'm in my second term of clinicals as an LPN student. We are based at subacute right now. Last night we had the opportunity to watch a midline get placed by an IV access nurse.

I will start by saying that almost nothing makes me squeamish. I've been in the medical field as an MA for about 8 years now and there's nothing I won't watch/help with/look up to learn more about.

Last night was rough.

The patient had bad veins (hence the midline for abx) She has a dialysis port in the other arm.

The IV access nurse seemed nice enough and was willing to let us watch which i was of course super grateful for. she draped the patient and had us gown up.

all was well until she had difficulty getting in the vein (using ultrasound guidance) which i totally understand... that poor woman's veins were rolling all over the place. But the nurse was getting obviously irritated and embarassed (i'm sure 4 students watching were not helping)

so she kept the tourniquet on the for the entire time. it was at least 20 minutes, probably somewhere around 25 minute mark. that made me uncomfortable.

then after searching for a while she pulled out the (giant) needle as she could not find the vein and decided to try again, USING THE SAME NEEDLE. after she put it down on an (admitedly sterile) piece of gauze for a minute. now i know i'm not a nurse yet, but i imagine if you can't use a needle twice for a blood draw when you miss the vein that you probably shouldn't with a needle like that either. AND when she pulled the needle out she didn't apply pressure so there was blood everywhere.

ok.... whatever. so she goes in again and it takes her a few minutes but she finally finds the vein. this is the part that freaked me out. the patient is silently crying (she was a trooper but definitely nervous... had her head turned the entire time and was definitely just trying to find a happy place) and we're all thinking the worst part is over. then without any warning the nurse shoves, and i mean SHOOOOOOOOOOVES the guidewire up her arm. like in the videos where you watch people having lipo.... THAT kind of agression. no warning to the patient, no telling her what she's doing, just SHOVING. over and over again. and the woman is now crying out in pain, and sobbing, and i swear to you i can see the catheter being jerked around under her skin in her upper arm because this nurse is being so rough. and she's not holding the site down at the same time so the needle/catheter is flopping around EVERYWHERE and blood is just running all over the drapes. I swear i clutched onto the girl next to me like i was watching a horror movie and my stomach just sank. WE were talking to the patient and telling her she was doing great, etc and the nurse didn't say a word. Finally after another big shove the patient cried out and all the nurse said was "I told you you didnt have to agree to this" !!!!!!!!!!!!!!!!!!!!. it was so so so bizarre.

at this point she started to dress the wound.... the patient already had a hematoma that was about silver dollar size and was growing, and the nurse said she was on heparin so that is to be expected (although i honestly dont think her technique helped)

the four of us were exchanging horrified looks and left ASAP.

a couple of minutes later i happened to be alone with my instructor so i told her my concerns and she was very upset that she had not used a different needle, but otherwise did not seem too concerned with what i reported.

so i guess my question is.... is it always this violent?? as soon as i got home i looked up the procedure and read up about it as much as i could, and it didn't seem that this was the norm. everything i read suggested that the pain/discomfort should really only be from the needle itself and not the catheter as it is "guided" or "slowly advanced" in. (neither of which were the case)

I'm just not sure if I am right to be horrified as this was a breach in procedure or if this is the norm and i need to toughen up should i ever watch it again.

for what it's worth i did go and check on the patient (even though she wasnt ours) right before I left and she seemed ok. she was getting her abx. I'll be curious when we come in tonight to see how the site is looking.