IVs and Trypanophobia

[MadMack]

How do you deal with the patients who seem unable to remain still or clench up or have a crazy sympathetic nervous reaction to seeing the IV needles?

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[Dienekes]

How do you deal with the patients who seem unable to remain still or clench up or have a crazy sympathetic nervous reaction to seeing the IV needles?

1. It's surprisingly uncommon to have a patient that has a truly serious "sympathetic nervous reaction" to a needle. I've seen a couple of people puke, a couple pass out, etc after being stuck but nothing what I would classify as "serious". Well, except for the one lady who apparently spiked her BP (which was already elevated) and burst a blood vessel in her eye.
2. If the IV isn't absolutely necessary, then don't do it. Document the patient refused and was uncooperative.
3. If it is absolutely necessary, then you just have to either talk the patient through it (which works most times) or you have the most drastic option (usually reserved for the intoxicated, the incompetent or the truly critical) of holding them down and doing it. I don't recommend this latter approach be used except in cases where the patient is in extremis because if you do it to the wrong patient, it could theoretically be considered assault.

 

[MadMack]

1. It's surprisingly uncommon to have a patient that has a truly serious "sympathetic nervous reaction" to a needle. I've seen a couple of people puke, a couple pass out, etc after being stuck but nothing what I would classify as "serious". Well, except for the one lady who apparently spiked her BP (which was already elevated) and burst a blood vessel in her eye.
2. If the IV isn't absolutely necessary, then don't do it. Document the patient refused and was uncooperative.
3. If it is absolutely necessary, then you just have to either talk the patient through it (which works most times) or you have the most drastic option (usually reserved for the intoxicated, the incompetent or the truly critical) of holding them down and doing it. I don't recommend this latter approach be used except in cases where the patient is in extremis because if you do it to the wrong patient, it could theoretically be considered assault.

It was during a clinical rotation in the ER, I was working in the fast track and the doc told me to start a saline lock and draw blood on the patient. She was fine until the I took the cover off the needle and then she started tachying out breathing went from relaxed to 20+ respirations a minute and tensing her arm up and I completely lost the vein. We talked her down a bit, and got the vein back, thought it was good to go and I went in. It was hard as hell to see the vein as she was a dark skinned Nigerian and palping a constricted vein through Nitrile gloves is well, fun.

The second I broke the skin she yelped like I'd, well, stabbed her and jerked her arm and I missed the vein. The Paramedic/RN supervising took over and took about a minute before she could get the vein which had been prominent a moment before. I'd never seen someone react a stick or even the site of a needle so adversely before, it was a shock and I was wondering if there's anyway to hit someone's veins when they shrink up like that.

That said, if a patient in her condition reacted like this I'd definitely pass on the stick, but docs orders were docs orders. I'm sure if you're experience with starting IVs its not a huge deal, but I was just poking about here to see if anyone's got some advice on hitting these sticks.

 

[24IdaFire]

Wait until they pass out from the fear, then start your line.

 

[cavalier329]

tell them you will count to 5 and do it on 1....HA

 

[jbar]

this patient sounds like a good canidate for having the IV done by a doc using a local anesthetic. I know that doesn't help you much in the field, but might a good move in the ED. Also have the pt close their eyes so they can't jump in anticipation when they see you come close with the needle. Also you can tell the patient "I'm going to have my partner hold your arm so it stays still while I start this IV, okay?" If they agree with that plan it's not assault.

 

[cavalier329]

i had a big ol state trooper once who was afraid of needles....ill never look at those guys the same again

 

[TarHeelEMT]

Hit them on the head with a brick.

 

[leviathan]

I don't recommend this latter approach be used except in cases where the patient is in extremis because if you do it to the wrong patient, it could theoretically be considered assault.

IMO that is definitely assault if the patient has a GCS of 15, understands the risks of not having the IV started, and is thus capable of refusing treatment.

 

[Blahblahologist]

When I first started as an EMT, I couldn't help but notice that all the medics in our company used approximately the same line regarding IV starts: "All right, you're going to feel a big pinch."

The first time I heard it, I thought to myself that it couldn't possibly go over well-- you're going to call it a big pinch? Why not "a little sting"? But patients seem to accept it well, maybe because it doesn't minimize their anxiety over the needle.

I'm curious what other lines people use for IV starts.

 

[leviathan]

When I first started as an EMT, I couldn't help but notice that all the medics in our company used approximately the same line regarding IV starts: "All right, you're going to feel a big pinch."

The first time I heard it, I thought to myself that it couldn't possibly go over well-- you're going to call it a big pinch? Why not "a little sting"? But patients seem to accept it well, maybe because it doesn't minimize their anxiety over the needle.

I'm curious what other lines people use for IV starts.

I usually just tell them they're going to feel a "little poke". Saying words like "big" just hypersensitize them to the relatively minor pain they're about to experience.

Whatever you do, just don't tell them they're going to feel a "big prick" (or little prick, either).

 

[TarHeelEMT]

I just say "you're going to feel a stick."

 

[greytmedic]

I usually tell them, "Don't worry, this won't hurt me a bit."

 

[ParamedicMan]

I'll warn them ahead of time, say a minute or two before I do it. Then after setting up have my partner either take a B/P, ask a question, etc and I'll fire the needle in. The only downfall is that you need to get the line right away, needless to say they're not big fans of fishing around

 

[cavalier329]

I think it all depends on why they are in your bus.

If they they are a DWI or a pedophile who for some reason ran into an officer's maglight (shi* happens) a little fishing and a big poke is the very least of what they are gonna get. I will find every way possible to make it the most painful, though still properly done, needle stick of their life.

 

[pseudoknot]

I think it all depends on why they are in your bus.

If they they are a DWI or a pedophile who for some reason ran into an officer's maglight (shi* happens) a little fishing and a big poke is the very least of what they are gonna get. I will find every way possible to make it the most painful, though still properly done, needle stick of their life.

You shouldn't be in the medical field if you think it's your role to torture patients.

 

[cavalier329]

yes, thank you for your input.

If you can't relate to what Im talking about then you have obviously not had enough experience out there. Dont act like you are better than me or that you can judge what kind of person I am.

You obviously aren't familiar with what you feel when you realized the guy on your cot just killed an entire family and hes laughing...or when the guy in cuffs had just raped a little girl.

I shouldn't be in medicine huh...ok well thats your opinion. If you don't feel a certain amount of resentment towards these people, then you arent human.

I have never done anything illegal...have I made life more uncomfortable-ABSOLUTELY. Have the doctors done it as well when I transfer them over...you better believe they did.

You are very sheltered if you think this doesnt happen among the best doctors in America. Im telling you about these from experiences in some of the best hospitals in NYC.

Its not my job to judge the patients, thats not what im trained to do. But this is what happens when your emotions take over and its just the reality of medicine. If youve never experienced it then maybe YOU arent ready to be a doctor.

 

[cavalier329]

and torture??? come on now, lets not go crazy. A needle stick resulting in pain lasting for no more than 2 seconds is not exactly torture.


Ask John Mccain what his definition of torture is.

I want you to watch your doctors and nurses next time you do a rotation in the ED. Watch how they act when they have a patient like Ive described come in. It ain't the same way they act when 88 yr old Ms. Jones comes in...ill tell you that much.

 

[pseudoknot]

I've seen plenty. I know that intentionally inflicting pain on patients is a form of torture, is unethical, unprofessional, and not something practiced by good doctors, nurses, or medics. Yes, not everyone is treated the same (although it's something to strive for) but what you are describing is well over the line.

Good luck in learning to control your emotions.

 

[cavalier329]

Come and write back to me after you have a bit more experience treating people. Am I saying its the right thing to do...no, it isnt. Does it happen with everyone in the medical field-you better believe it does.

You should certainly know about this--in fields like IR, if they dont want to deal with the patient and their hypersensitivity/curiosity they put them under general. Is that ethical? I don't think so. Does it happen? Yea, all the time.

Why isnt it ethical? Because by putting someone under your exposing them to a hell of a lot more risk for complications which could result in death. But as a medical student, you would know that.

 

[cavalier329]

In EMS, many things are done for comfort. Something as simple as pinching the tape on the pts forehead during backboarding is a common practice because it makes things a bit easier for the pt.

Have I ever put a drunk driver's life in danger by sticking him with a bigger needle than I wouldve probably used otherwise....no. Does it make me feel better, naa, it doesnt change anything. Why do people do it? Because there isnt a reason for me to want to make his life comfortable.

You stretching it pretty far by saying actions like those that I have described are unethical, torturous, and unprofessional. How so? Im following protocol, not doing anything dangerous, basically doing my job. I just didnt give him the courtesy of making things a bit more comfortable for him.

What I would consider torturous is if he told me he was severely allergic to something Im giving him and I give it anyway. Thats wrong, no one can argue. Lets not go overboard by calling me a torturer, unethical, unprofessional medic though....i mean seriously now.

Your response has led me to wonder whether you have ever actually treated another human being before and whether youve ever experienced any of the emotions associated with medicine. If I had to give an answer, I'd say you have much much much more you still need to learn.

 

[pseudoknot]

a little fishing and a big poke is the very least of what they are gonna get. I will find every way possible to make it the most painful, though still properly done, needle stick of their life.

Have I ever put a drunk driver's life in danger by sticking him with a bigger needle than I wouldve probably used otherwise....no. Does it make me feel better, naa, it doesnt change anything. Why do people do it? Because there isnt a reason for me to want to make his life comfortable.

You stretching it pretty far by saying actions like those that I have described are unethical, torturous, and unprofessional. How so? Im following protocol, not doing anything dangerous, basically doing my job. I just didnt give him the courtesy of making things a bit more comfortable for him.

What you first described was not witholding comfort (which is still unethical). It was deliberately inflicting pain. I.e., torture.

What I would consider torturous is if he told me he was severely allergic to something Im giving him and I give it anyway. Thats wrong, no one can argue.

Well, I wouldn't call that torture so much as attempted murder.

Your response has led me to wonder whether you have ever actually treated another human being before and whether youve ever experienced any of the emotions associated with medicine. If I had to give an answer, I'd say you have much much much more you still need to learn.

It's entertaining that a premed is lecturing a medical student about experience. And I'm not the one bragging about deliberately harming patients or choosing to treat some of them differently than others.

The best doctors I've seen treat all their patients with care and respect. (Just as good police officers don't beat suspects in custody, something else you seem to admire.) Can we all do that? Maybe not, but we ought to try. What disturbs me about your posts is that you affect this jaded attitude and proclaim that you're beyond having to follow ethical standards--and that you're proud of this.

 

[pseudoknot]

Perhaps I shouldn't be so disturbed by your claims about starting painful lines in NYC, since you've also stated you are an EMT-B in Virginia.

At the University of Virginia, where I am

Caviler you sound like an EMT-B is that your level of training?

yes, that is my level of training. Which would explain why it sounds that way.

My position on what you wrote is the same, regardless of your true level of training or location.

 

[leviathan]

Come and write back to me after you have a bit more experience treating people. Am I saying its the right thing to do...no, it isnt. Does it happen with everyone in the medical field-you better believe it does.

So you say you're a paramedic when you're actually an EMT-B, and you start talking to a medical student on proper treatment of criminals in your care from your more "experienced" point of view. So not only are you a dishonest person, you also think it is your place to torture people. You should tell that to the people interviewing you for medical school, I'm sure they'd love it.

 

[cavalier329]

im a NYS EMT-B in a paramedic program-so I have been in patient contact starting lines...thank you.

Yes, Im a college student in a different state.

And a medical student doesnt necessarily have more pt "experience" then an individual with 6 years in the EMS system, again, a very flawed argument you all make.

Call me what you want, a torturer, dishonest, whatever it may be. The city of New York thinks I am an excellent patient care provider, so says the awards that I have been given for many of my actions in the field.

You think otherwise, thats fine. Im telling you what goes on out there. Perhaps I misrepresented my point in the beginning, don't want to be represented as someone Im not.

Does emotion take over what is right sometimes? Yes it does. As a medical student and a future doctor you will certainly experience it, even though it is against the oath we will all hopefully take someday. We are human above anything else, and this is what Im trying to convey here. In real life, this happens.

Ive certainly held back on my temper a number of times but other times it gets the best of me. Have I ever hurt someone to the point where the term "torture" comes into question....definitely not. Should everyone be treated the same? Of course, this is a stupid question.

See what Ive seen over the past six years and maybe we can have a conversation on the same page someday. This isn't being productive anymore. Bash me for being a premed. I dont think I am smarter than anyone else out there for my experiences, but I do think I may be more experienced then some when it comes to patient care at a basic level.

You can talk your way through an "ethical decision" easily in a classroom, but get put into it for real and see how you react. No body is perfect, nor do I praise those who act unethically. They aren't my responsibility. It happens, and you will experience it. The question becomes, what will you do?

Don't underestimate me for being a premed, don't judge me either. That isn't YOUR place. I hope you recall this conversation when a perp pt. spits in your face for trying to help.

Again, call me what you wish, but you don't know me or what kind of person I am. It's too bad you have a poor image of me, but I certainly wont lose sleep over it. Your view of me doesn't hold a candle to respect my colleagues have for me as a courteous pt. care provider.

Any further correspondence with me should be made through PM because I will not respond on this post again. And if you would like to talk in even more depth about ethical decisions, I will give you my phone number and we will certainly have a nice conversation.

 

[jbar]

I know Cavalier says he won't respond to this, but I think it's a good point for others out there.

1. I don't agree with the argument that "I've been in the real world, so you can't judge me." When you join a group (ambulance service, the Army etc) you start off with your own values and ideas of how things should happen. Gradually you learn what is accepted behavior, attitudes, and views in that group and most people come to conform to some degree with these common values. Often when you've been doing a job for awhile there are things that you have come to accept as normal parts of the job that it takes an outside perspective to realize, "hey, maybe this isn't right." You really don't years of experience to be able to say that inflicting more pain than is medically needed because you don't like a patient is unethical.

2. I understand the argument that you may not go out of your way to help patients who you don't like. Okay, I'll agree with that. Sure I won't stay 20 minutes past my off time to find a pillow for the patient who just spit on me. But there is a difference between that and making an IV hurt as much as possible before you start it.

3. Any procedure caries some risks, and if you are doing it with a goal other than finishing the task safely you are doing harm. "Fishing around" with an IV cath damages tissue, increases the risk of infection, blowing the vein, delaying having a patent line etc. So you are doing harm.

4. Who are you to judge your patients? Maybe the guy arrested for DUI is really a diabetic, maybe the person accused of child molestation is innocent. You don't know and the reason why you treat patients professionally is so you don't have to find out. It's not your job. Also it's a slippery slope from causing a little more pain to maybe not giving pain meds for a fracture. Or why don't you just say you won't treat prisoners? Or certain groups you don't like? Once you get on that road where you give people different care based on who they are there is no easy stopping point.

Even though I don't think you need to match someone in experience to say they are wrong about ethics, and I don't feel the need to fluff my ego by rattling off my experiences, I'll just say that I've worked in EDs, I've worked 911 on ambulances. I'm a medical student and yeah, I have patients I don't like. So I don't think I'm talking from an ivory tower to say trying to cause more pain than needed because you disaprove of a patient is wrong. I'm not saying anyone shouldn't be in medicine, or that you are a bad care provider. I've met plenty of people who have no problem wacking a patient in the head with a radio if they are being a jerk. But I think as professionals we can hold ourselves to a higher standard.

 

[leviathan]

I know Cavalier says he won't respond to this, but I think it's a good point for others out there.

1. I don't agree with the argument that "I've been in the real world, so you can't judge me." When you join a group (ambulance service, the Army etc) you start off with your own values and ideas of how things should happen. Gradually you learn what is accepted behavior, attitudes, and views in that group and most people come to conform to some degree with these common values. Often when you've been doing a job for awhile there are things that you have come to accept as normal parts of the job that it takes an outside perspective to realize, "hey, maybe this isn't right." You really don't years of experience to be able to say that inflicting more pain than is medically needed because you don't like a patient is unethical.

2. I understand the argument that you may not go out of your way to help patients who you don't like. Okay, I'll agree with that. Sure I won't stay 20 minutes past my off time to find a pillow for the patient who just spit on me. But there is a difference between that and making an IV hurt as much as possible before you start it.

3. Any procedure caries some risks, and if you are doing it with a goal other than finishing the task safely you are doing harm. "Fishing around" with an IV cath damages tissue, increases the risk of infection, blowing the vein, delaying having a patient line etc. So you are doing harm.

4. Who are you to judge your patients? Maybe the guy arrested for DUI is really a diabetic, maybe the person accused of child molestation is innocent. You don't know and the reason why you treat patients professionally is so you don't have to find out. It's not your job. Also it's a slippery slope for causing a little more pain to maybe not giving pain meds for a fracture. Or why don't you just say you won't treat prisoners? Or certain groups you don't like? Once you get on that road where you give people different care based on who they are there is not easy stopping.

Even though I don't think you need to match someone in experience to say they are wrong about ethics, and I don't feel the need to fluff my ego by rattling off my experiences, I'll just say that I've worked in EDs, I've worked 911 on ambulances. I'm a medical student and yeah, I have patients I don't like. So I don't think I'm talking from an ivory tower to say trying to cause more pain than needed because you disaprove of a patient is wrong. I'm not saying anyone shouldn't be in medicine, or that you are a bad care provider. I've met plenty of people who have no problem wacking a patient in the head with a radio if they are being a jerk. But I think as professionals we can hold ourselves to a higher standard.

Let me say that I've been working in EDs for the last nine years, and was a full time EMT on a 911 ambulance for almost two years so

Well said, jbar. The fact of the matter is people like cavalier shouldn't be working in health care if they cannot maintain professionalism and feel it is necessary to intentionally inflict pain upon patients they dislike. I wonder how many of those awards the state would revoke from you if they found out the things you are admitting to doing while under partial anonymity online.

 

[jbar]

]

Ive certainly held back on my temper a number of times but other times it gets the best of me. Have I ever hurt someone to the point where the term "torture" comes into question....definitely not. Should everyone be treated the same? Of course, this is a stupid question.

I don't think it's a stupid question given the number of people I've met who think that it's okay to inflict pain on someone based on who they are or what they've done. And when that happens the right response is "hey, I messed up. How can I keep my feelings in check next time so I don't do this again?" Rather than saying "they deserved a tough stick because they are a scumbag."

People lose control. People make mistakes. But I think what really tells about someone is how they respond after those situations and grow from them, rather than try to justify them and validate the situation so it happens again.

 

[jbar]

Well said, jbar. The fact of the matter is people like cavalier shouldn't be working in health care if they cannot maintain professionalism and feel it is necessary to intentionally inflict pain upon patients they dislike. I wonder how many of those awards the state would revoke from you if they found out the things you are admitting to doing while under partial anonymity online.

Thanks. Though I would like to make a plea in general to stay away from the whole "this person shouldn't be in medicine/go to med school/would be a bad doctor." I know that sometimes there are people we feel that way about based on some small post they've made, but once that gets thrown out there the discussion tends to sort of break down. It's like the SDN version of Godwin's law.

I know I'm not a mod, but it just makes me sad when interesting threads die because things get personal.

 

[leviathan]

Thanks. Though I would like to make a plea in general to stay away from the whole "this person shouldn't be in medicine/go to med school/would be a bad doctor."

I agree, perhaps that was a bit too harsh. My point was that this kind of behaviour shouldn't be practiced by anyone in any health care profession (doctor, EMT, paramedic, nurse or otherwise). My last post was stating that if he can learn to overcome his anger/control issues, then there isn't a problem.

 

[jbar]

I agree, perhaps that was a bit too harsh. My point was that this kind of behaviour shouldn't be practiced by anyone in any health care profession (doctor, EMT, paramedic, nurse or otherwise). My last post was stating that if he can learn to overcome his anger/control issues, then there isn't a problem.

Cool, yeah. I'm 100% behind that. When I was with the ambulance service they (I wasn't in the room) had someone come into an interview and start talking about "Motorola therapy." It became clear that he meant nailing the pt with the radio. Man, it's bad enough when people think that stuff in private, but I can't believe someone thought it was funny/ok enough to say in an interview.

 

[cavalier329]

I said I wasn't going to respond, but I want to thank jbar for his post. Very well said.

While Ive never done any significant harm to any patient, I will certainly consider what was said next time I run into a difficult situation.

I dont believe I have an anger issue and I think many conclusions were hastily made by me and others based on a post which wasn't meant to have much value.

What I want the underlying value of my post to be, if nothing else, is that we are all human. Humans make mistakes out there when emotions are high. Control them the best you can and think rationally. Whether we all become doctors, PA's, nurses, EMT's or some other medical professional, we will certainly be placed in a situation where our ethics come into question. Some times we lose control, sometimes we handle it with grace.

Will we always be right? I wish that was the case, but its not...do the best you can when handling with the less than thankful individuals we encounter while trying to lend a helping hand.

 

[leviathan]

I said I wasn't going to respond, but I want to thank jbar for his post. Very well said.

While Ive never done any significant harm to any patient, I will certainly consider what was said next time I run into a difficult situation.

I dont believe I have an anger issue and I think many conclusions were hastily made by me and others based on a post which wasn't meant to have much value.

What I want the underlying value of my post to be, if nothing else, is that we are all human. Humans make mistakes out there when emotions are high. Control them the best you can and think rationally. Whether we all become doctors, PA's, nurses, EMT's or some other medical professional, we will certainly be placed in a situation where our ethics come into question. Some times we lose control, sometimes we handle it with grace.

Will we always be right? I wish that was the case, but its not...do the best you can when handling with the less than thankful individuals we encounter while trying to lend a helping hand.

Glad we can keep this thread positive and a learning experience for everyone then. Yes, we do all make mistakes, and that's OK as long as we learn from them. It was only a week ago that I dealt with an intoxicated patient who had caused a high-speed MVA with a family in the other car. I certainly did not go out of my way to give him A+++ patient care, but I did the job I've been trained to do and no more, no less. Had anyone in the other car been seriously injured, I can see how it would have been hard to remain civil, but that's our job to remain professional.

 

[NiteOwl]

Don't tell them "it won't hurt". I used to have a terrible needle phobia and that pissed me off so much when I heard that lie.

If they don't really need the IV, then don't bother with it. Just say "oh, you don't want an IV?" and when they say "no" you can document that they didn't want it. It is assault if you do something against the patients wishes (in most cases anyway. If they have a severe head injury that is making them combative then you need to go ahead and start one). IMO, if a patient just has a possible closed fracture, or something like that doesn't exactly warrant an IV, or isn't life threatening, then don't give it. The hospital probably won't even start one over something like that.

Some people don't have the kind of phobia that makes then pass out. I never passed out, I just freak out, had severe panic attacks, and would almost be combative at the mention of me getting stuck. People like that, you should just explain why they should get the IV, but they can choose against it if they wish. Then there are the people who faint, that kind of makes it easier, just stick them while they are out.

 

[MadMack]

I appreciate the replies, and some of the answers were general information that I was already pretty familiar with. Talked it over with a couple of the lead instructors 30+ years a piece in EMS and ER work and the Doc I work for, they all agreed that a patient like the woman who went tachy on me are a stick that I should have passed off to a Doc, PA or ARNP who had ordered the line or tried to get orders for topical lidocaine; as well as talking them down like the Medic/RN and I did.

Again, I appreciate the feedback.

 

[NiteOwl]

I appreciate the replies, and some of the answers were general information that I was already pretty familiar with. Talked it over with a couple of the lead instructors 30+ years a piece in EMS and ER work and the Doc I work for, they all agreed that a patient like the woman who went tachy on me are a stick that I should have passed off to a Doc, PA or ARNP who had ordered the line or tried to get orders for topical lidocaine; as well as talking them down like the Medic/RN and I did.

Again, I appreciate the feedback.

Topical lidocaine works wonders! I have a tube of EMLA cream I use for when I have blood drawn (I'm still a bit uneasy about being stuck. I don't mind sticking others or watching things being done with a needle, just as long as it isn't happening to me), and I can't even feel the needle. The drawback to it is that you have to leave it on for an hour for it to be effective. So its not bad if its for a scheduled procedure or test or if the needlestick can wait for an hour. Doesn't work if there is an immediate need. I have seen people inject lidocaine before starting an IV, but I don't get the point of doing that. You still get stuck for the lidocaine and it burns.

 

[MedicFL]

Even though it is not in protocol I do use the lidocaine jelly from the NPA's to numb the region but it is rare.. I don't think they you all need to jump down caviler's throat. I have seen many many times in the ambulance and the ED people put in 14g IV's when an 18 or 20g was all that was needed. I have seen everyone from Doctors to nurses to techs doing this type of behavior. I will say however it is much more rare to see a DR. doing it. I think if you want to be a DR you need to be the one that sets an example and shows how the rest of the staff needs to behave. Caviler if you do become a Dr please leave this type of behavior on the street and don't bring it with you..

 

[MadMack]

Topical lidocaine works wonders! I have a tube of EMLA cream I use for when I have blood drawn (I'm still a bit uneasy about being stuck. I don't mind sticking others or watching things being done with a needle, just as long as it isn't happening to me), and I can't even feel the needle. The drawback to it is that you have to leave it on for an hour for it to be effective. So its not bad if its for a scheduled procedure or test or if the needlestick can wait for an hour. Doesn't work if there is an immediate need. I have seen people inject lidocaine before starting an IV, but I don't get the point of doing that. You still get stuck for the lidocaine and it burns.

I heard about Lidocaine injections as well, doesn't make a tremendous amount of sense honestly, for the same reasons you mention, the only time we really use it to lessen the pain from a line is when we start an IO. The drilling actually doesn't hurt all that much, so I've been told, but its apparently amazingly painful when you start flowing the line. Running the lidocaine and letting it take effect before we run the meds tends to do a tremendous amount for alleviating the pain experienced by the patient.

 

[MadMack]

Even though it is not in protocol I do use the lidocaine jelly from the NPA's to numb the region but it is rare.. I don't think they you all need to jump down caviler's throat. I have seen many many times in the ambulance and the ED people put in 14g IV's when an 18 or 20g was all that was needed. I have seen everyone from Doctors to nurses to techs doing this type of behavior. I will say however it is much more rare to see a DR. doing it. I think if you want to be a DR you need to be the one that sets an example and shows how the rest of the staff needs to behave. Caviler if you do become a Dr please leave this type of behavior on the street and don't bring it with you..

Using a 14g cath when massive fluid resuscitation isn't indicated or foreseen in the immediate future is the kind of thing thats going to get a citizen complaint filed with your Department or Agency; which could lead to all kinds of fun for your career. Seriously, look at that needle, its like looking at a sharpened coffee straw. We can sit here and argue about how no one is breaking any rules by using a catheter that big when its not indicated.

Really it all comes down to ethics, you either have them or you don't. Cav, you're a medic student, probably working out of Brady's "Essentials of Paramedic Care" or Mosby's equivalent; go reread chapter one, particularly the part dealing with ethics in prehospital care. You can't cite "experience in the field" because I can cite people that've been working in the field for decades more than you have, and I can safely say that none of them would ever condone inflicting additional pain upon a patient unless it was absolutely necessary to save their life.

Its stated pretty clearly right here.

Its already hard enough to get respect as a medical professional working as a Medic, you should know that, especially if you spent six years working as a basic. I don't want to beat a dead horse, but I think its important that people who see this forum and read these posts realize that the kind of behavior you described is NOT accepted or encouraged by the medical community. If you would condone that behavior or participate in it then you don't belong in EMS community; we answer the call no matter who calls and we will do our damnedest to save our patient, regardless of who they are or what they've done.

 

[jbar]

Adding to the discussion about proper care is the impact even talking about abusing patients can have on public perception. This is from a news report investigating the use of Versed to sedate prisoners.

"The side effect raises the question of a person being able to defend themselves in court if they can't remember what happened.

"If they would've said I'd done anything after that shot, hey, I couldn't have argued that fact. I don't remember," Beasley said.Kalodimos reported that while doing research for this report, she found a post on a paramedics Internet chat site that said, "One good thing about Versed is that the patient won't remember how he got that footprint on his chest."

http://www.wsmv.com/news/16844880/detail.html#-

Not good.

 

[MedicJ]

tell them you will count to 5 and do it on 1....HA

TITCR.

Or learn to do it while they are moving.

 

[pseudoknot]

TITCR.

I didn't know what that meant, so I had to look it up in the Urban Dictionary. They had this to say:

Those who use this term are generally of high intelligence, but completely overly occupied with the nuances of the admissions process. Most need to get a life and stop wasting their youth posting on anonymous admissions related boards.

 

[NiteOwl]

Good Lord! I saw someone get stuck with a 14g needle last week. That looks horrible. I'm not sure why they did it. There was a high level of suspicion that he was on drugs (very disoriented, blood sugar was normal-so that wan't the cause, confusion, pinpoint pupils, heart rate 160). But we weren't sure what was going on with him-he spoke very little English, mostly spoke Korean, so it was hard to get any answers about what was going on from him. But still, that crap looked like it hurt! Sharpened coffee straw is a good description, I said it was like the ink tube inside of a bic pen.

 

[jkelly2]

Ooh I've got one.

The other night we had a call for multiple syncopal episodes. The pt's BP was low-low probably due to dehydration. My partner told the pt that he wanted to start an IV so we can give her some fluids to make her feel better. "I'm not good with needles" she says. "My eyes roll back and I foam at the mouth." We blew it off and my partner prepped the site. I decided I would talk to her through it. Well, my partner gets into a hand vein but the pt is clenching and moving around, so the vessel blows. Meanwhile, the pt is screaming at my partner, "You're mean. . . you can't do this job. I hate you. You're fired. Are you married? You shouldn't be."
My partner decides he'll hit another vein en route, so I took off my gloves and head to the door. As I turned my head, I saw that the rate on the monitor dropped from 65 to 45 to 25 to 0. You might call it a sinus pause but it sure felt like asystole! Lucky for me, the pt rolled her head back, exposing the carotid. But I felt nothing. We probably had a long 15 seconds of this, meanwhile our eyes are big as dinner plates. Then she started some seizure-like activity and gets a rate back up to the 60s. While she was out, my partner cannulated another vessel and we started with the fluids. I've never gotten a Tubex of Valium prepped that fast! It all ended spontaneously but at that point, my partner decided that I would stay in the back with him and someone else would drive us. The pt was fine after that. . .until she told us how glad she was that her mean personality wasn't with her.
Next time I hear that someone's not good with needles, I'll know better.

 

[MacBook]

How do you deal with the patients who seem unable to remain still or clench up or have a crazy sympathetic nervous reaction to seeing the IV needles?

I have never had issues starting my lines. Many patients I have picked up have had some form of anxiety or fear of the situation as a whole, but have never had a problem to the point where I was unable to start a line.

There have been a few calls where kiddies get scared and start crying but even then with the distracted help of mom or dad I've been able to start what I needed.

 

[jbar]

Good Lord! I saw someone get stuck with a 14g needle last week. That looks horrible. I'm not sure why they did it. There was a high level of suspicion that he was on drugs (very disoriented, blood sugar was normal-so that wan't the cause, confusion, pinpoint pupils, heart rate 160). But we weren't sure what was going on with him-he spoke very little English, mostly spoke Korean, so it was hard to get any answers about what was going on from him. But still, that crap looked like it hurt! Sharpened coffee straw is a good description, I said it was like the ink tube inside of a bic pen.

It's good to remember that there is a reason we carry 14ga needles. A sick patient who is unstable should get the largest IV that you reasonably think their veins can take. Clearly you don't try a 14ga on a 15yo girl with little veins, but it is totally reasonable to start 14ga lines on a guy who is tachy and disoriented. I think what some people on this board are upset by is starting large bore IVs to inflict more discomfort than is medically nessecery. Chest tubes hurt too but sometimes people need them.

 

[MacBook]

are you kidding? I can always make it legitimate reason to start a 16g in someone who pisses me off. If they have enough time to think ahead of the discomfort calling an ambulance might cause...they might not be that sick after all

 

[deleted92121]

I won't lie and say that I have never purposely chosen a slightly bigger IV to start in some very unruly and disruptive Pts.

HOWEVER. . .

I have never and will never purposely miss an IV in order to have the Pt feel a more of a pinch. There is a difference between not selecting a comfort measure (20g in a sewer pipe opposed to a more appropriately sized 16g) and willingly causing pain with the purpose of revenge or what have you. In fact, putting the 16g in a sewer pipe is much more correct than the 20g, as I previously mentioned. We choose to follow some protocols more stringently with certain Pts (example: IVs).

Just b/c this is the way EMS (I can't speak for any other portion of the medical field) doesn't mean we are not caring and compassionate healthcare providers. If that child rapist needed immediate medical care, I would provide it the same as if it were my own family member. End of story.

dxu