Quick question about starting IV's

[TayShaun]

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CA-1 here. When starting IV's, I've been able to get a flash, thread the IV catheter, etc, but I always spill a few cc's of blood. I think it might be because I'm not sure when to take down the tourniquet.

My (elementary) question is: when do you take down the tourniquet? I've so far been taking it down right after threading the catheter.

 

[Noyac]

CA-1 here. When starting IV's, I've been able to get a flash, thread the IV catheter, etc, but I always spill a few cc's of blood. I think it might be because I'm not sure when to take down the tourniquet.

My (elementary) question is: when do you take down the tourniquet? I've so far been taking it down right after threading the catheter.

It doesn't really matter when you take down the tourniquet. What you need to do is place your thumb over the end of the catheter occluding the vein before you remove the needle. Now you can do what you want. I release the tourniquet then connect the IV tubing.

Watch the nurses.

 

[Planktonmd]

CA-1 here. When starting IV's, I've been able to get a flash, thread the IV catheter, etc, but I always spill a few cc's of blood. I think it might be because I'm not sure when to take down the tourniquet.

My (elementary) question is: when do you take down the tourniquet? I've so far been taking it down right after threading the catheter.

Thread the catheter and immediately place the fingers of your non dominant hand on the vein proximal to the insertion point and apply pressure, now take the tourniquet down with your dominant hand.

 

[Planktonmd]

I just repeated what Noyac said basically 🙂

 

[Noyac]

Plank,

I you keep doing that, people are going to think that we are the same person with two login names. We seem to be very similar. Now I'm worried about you.😎

 

[Planktonmd]

Plank,

I you keep doing that, people are going to think that we are the same person with two login names. We seem to be very similar. Now I'm worried about you.😎

😀
Let it be known that I am not Noyac and that my embarrassing skiing abilities can easily prove it.

 

[leviathan]

CA-1 here. When starting IV's, I've been able to get a flash, thread the IV catheter, etc, but I always spill a few cc's of blood. I think it might be because I'm not sure when to take down the tourniquet.

My (elementary) question is: when do you take down the tourniquet? I've so far been taking it down right after threading the catheter.

If you do end up spilling some blood, take the corner of an alcohol swab and put it into the hub of the catheter + administration set to hide your embarrassing mistake. 😉

 

[jetproppilot]

If you do end up spilling some blood, take the corner of an alcohol swab and put it into the hub of the catheter + administration set to hide your embarrassing mistake. 😉

If you wanna be real anal, in addition to what Noy/Plank et al said above, slide a 4X4 underneath so if something spills it spills on the 4X4.

 

[epidural man]

Watch the nurses.

Great advise,

I leave the needle in, which tamponades the flow, remove the turniquet, then do the trick mentioned above after removing the needle (placing a finger occluding the end of the catheter.)

You can leave the needle in if the hand is just sitting there, you can do something with both hands while the catheter/needle sit there and they won't bleed - sometimes you might need two hands (ie, the iv tubing drops, you need to grab some gauze, open your tegaderm because you forgot to, or whatever).

This works if you put in IV's like I do. I slide the catheter in the vein (so now the catheter is 2 or so mm in the vein and the needle tip is well inside the catheter, then I slide both the catheter and needle in the vein. I think most people slide the whole catheter (sliding it off the needle). When I started doing it the way I described, my IV cannulation skills improve 500%. I don't know why, it just works well for me. An attending told me to do it that way one time as a CA-1 when he was sick of watching me botch vein after vein.

 

[epidural man]

CA-1 here. When starting IV's, I've been able to get a flash, thread the IV catheter, etc, but I always spill a few cc's of blood. I think it might be because I'm not sure when to take down the tourniquet.

My (elementary) question is: when do you take down the tourniquet? I've so far been taking it down right after threading the catheter.

speaking of IV's , here is a cool youtube video of an IV cannulation using ultrasound.

[YOUTUBE]http://www.youtube.com/watch?v=WmmNlsWAP-c[/YOUTUBE]

 

[TayShaun]

Thanks for the advice! Proximal pressure and 4x4's work wonders.

 

[ozzie20]

I usually put my mouth over the iv and blow on it to push the blood back until I connect the tubing to it. Do this in front of the attending to show off what a real pro you are, not many people know this trick 🙂

 

[me454555]

Who cares if you spill a few cc's of blood, you got the iv and you lost some style points. I had one lady that bled a bit in preop b/c I couldn't get enough pressure on her ac vein. Guess what? She was ecstatic that she didn't have to get stuck again so she didn't mind the blood one bit. Like others have said, hold pressure, try the 4x4, thats all ya can do. They're just happy that its in and it don't hurt

 

[leviathan]

This works if you put in IV's like I do. I slide the catheter in the vein (so now the catheter is 2 or so mm in the vein and the needle tip is well inside the catheter, then I slide both the catheter and needle in the vein.

Interesting idea. So if the needle blows through the opposite end of the vein, the catheter in front of the needle will probably curve into the vein past the site of vessel perforation? I will have to try this in the future. The only thing I could see going wrong is catheter embolization...

 

[coprolalia]

Dudes,

With all due respect, do not put your thumb on the end of the catheter hub. Even gloved and as clean as that glove may be, you are still potentially contaminating the site. Instead, occlude the vein by putting pressure proximally on the vein where the tip of the catheter sits. This will stop all blood flow back into the catheter. Same technique works when inserting an art line.

-copro

 

[Planktonmd]

Thread the catheter and immediately place the fingers of your non dominant hand on the vein proximal to the insertion point and apply pressure, now take the tourniquet down with your dominant hand.

Dudes,

With all due respect, do not put your thumb on the end of the catheter hub. Even gloved and as clean as that glove may be, you are still potentially contaminating the site. Instead, occlude the vein by putting pressure proximally on the vein where the tip of the catheter sits. This will stop all blood flow back into the catheter. Same technique works when inserting an art line.

-copro

Correct!

 

[coprolalia]

Correct!

Yeah, I saw your initial response, but in your next breath you seemed to be agreeing with Noyac who described placing a thumb on the hub.

Line infections (even peripherals) are a real problem in the hospital. We should be doing everything to minimize them. Even a "short stay" IV shouldn't be touched and the Luer ports cleaned before injecting. I try to instruct everyone I see not to touch the insertion site after they've cleaned it, not to touch the actual catheter itself, and to use and properly place an occlussive dressing on the insertion site. It drives me crazy when I see someone do a nice job cleaning the insertion site, then immediately place their gloved (or sometimes ungloved) hand right back on it to "feel" where the vein is.

With a little practice, you can get get quite deft with never having any blood flow back using the proximal pressure technique. Also, we're anesthesiologists. A little 27g needle with about 0.1-0.2 ml 0.5% of lidocaine and a bleb distal to your target vein makes patients very happy. This is about the only thing the patient is going to remember before you take them to surgery. You may be the greatest gasser in the world, but if you struggle with the IV some patients are going to think you're a *****. Being slick with the IV insertion makes a great first impression. I can't even count anymore the number of patients who've told me "I'm a difficult stick" and a minute later have a huge smile on their face because (1) I got it in on the first try and (2) it didn't hurt.

-copro

 

[dhb]

Yeah, I saw your initial response, but in your next breath you seemed to be agreeing with Noyac who described placing a thumb on the hub.


-copro

I don't think anybody suggested occluding the hub : Noyac's word: "What you need to do is place your thumb over the end of the catheter occluding the vein"

If you happen to have blood backflow into the hub of the catheter you can lift the patients arm so that the blood flows back into the vein so that the connection of the iv tubing doesn't fill with blood.

 

[coprolalia]

I don't think anybody suggested occluding the hub : Noyac's word: "What you need to do is place your thumb over the end of the catheter occluding the vein"

My bad. I don't use my thumb. I use my fourth and fifth finger while stabilizing the catheter with my thumb, index finger, and third finger.

-copro

 

[Planktonmd]

My bad. I don't use my thumb. I use my fourth and fifth finger while stabilizing the catheter with my thumb, index finger, and third finger.

-copro

Hey, You have to remember that there are people on here who were already placing IV's when you were still in diapers.

😛

 

[coprolalia]

I hope you're not suggesting that we go back to "state of the art" late 1970's medicine. 😉

-copro

 

[Planktonmd]

I hope you're not suggesting that we go back to "state of the art" late 1970's medicine. 😉

-copro

What's wrong with the 1970's?
life was simple and people had fun.😎

 

[SleepIsGood]

another tip I do when I dont want people feeling the little prick from giving the local or anything.

I'll take a finger of my non dominant hand and stimulate another area very close to where I want to insert the angiocath (a little scratching action, nothing that penetrates skin).

This will 'distract' the pain receptors in the area. Patients wont even feel the little TB needle's prick.

Try it.

 

[milrisome]

I have the impression that intradermal injections hurt more that subdermal injections. This is partially from my own experince during TB tests and partially from watching other people do this and seeing the pained expressions on patients faces. I think that expansion of the skin is uncomfortable. So I inject deep to the skin in order to avoid this. Any thoughts?

 

[Planktonmd]

another tip I do when I dont want people feeling the little prick from giving the local or anything.

I'll take a finger of my non dominant hand and stimulate another area very close to where I want to insert the angiocath (a little scratching action, nothing that penetrates skin).

This will 'distract' the pain receptors in the area. Patients wont even feel the little TB needle's prick.

Try it.

Good idea, just make sure you don't "stimulate" an area that can cause some kind of misunderstanding.
🙂