Resticking same pt w/ same needle? (Venipuncture)

[anbuitachi]

So in class they always teach you to switch needles with every attempt at sticking the patient. But in the hospital I'm seeing often times people use use the same needle to restick if they missed the vein. Anyone else seeing this too, and how important is it to actually switch needles every time (I'm guessing its just to prevent a very small chance of infection)?

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[Smurfette]

People will usually stick a patient multiple times with the same needle until they get into the vein. I've never seen someone change needles with every stick.

 

[Winged Scapula]

Me either.

 

[Instatewaiter]

Agreed. If you sterilize the skin before you stick, that risk of infection is pretty small.

 

[bobow98]

Sometimes if you're REALLY taking a long time, or if you kind of hit a vein and got some flash, you can clot the butterfly off. This would take a while probably, but that might be one indication for actually switching the butterfly. But I always hit on the first attempt. 😉

The trick really is to raise bed to comfortable height for your back and take your time. Don't worry about who's watching you. Much more impressive to take 2 minutes and hit on first stick than to stick 3 times in 1.5 minutes.

 

[Bacchus]

So in class they always teach you to switch needles with every attempt at sticking the patient. But in the hospital I'm seeing often times people use use the same needle to restick if they missed the vein. Anyone else seeing this too, and how important is it to actually switch needles every time (I'm guessing its just to prevent a very small chance of infection)?

I was taught the same way, but in practice never did it that way. The only time I switched a needle was if I had extremely poor flow and couldn't fill a tube, then I'd switch to a larger (lesser #) gauge.

 

[mvenus929]

So in phlebotomy, I would change needles if I got any blood flow, because the chance of he blood clotting within the needle before I could get another setup was high. I would also change needles if I caused bleeding when I accidentally came out of the skin, because I would hold pressure and didn't want an exposed needle out while I was focused on that.

In IV needles, I've seen people use the same needle multiple times, but it's not a practice I agree with.

 

[Sublimazing]

You should change your needles because they dull out even after one stick...and if you blew it so bad the first time that you had to withdraw...you might as well grab a new needle and optimize conditions for yourself

 

[ulikedaggers]

A lot of the "clinical skills" we learn in pre-clinical years are not realistic.. For example palpating the radial pulse while taking someone's BP to make sure that you compressed the brachial artery enough.

 

[SouthernSurgeon]

A lot of the "clinical skills" we learn in pre-clinical years are not realistic.. For example palpating the radial pulse while taking someone's BP to make sure that you compressed the brachial artery enough.

Or you know...just taking a blood pressure at all

I'm pretty sure the last time I did that was the med student free clinic...

 

[alpinism]

Wut

I've never heard of anyone using a new angiocath for each venipuncture attempt on the same patient…

You use a new one for each patient so you don't spread blood borne infections (HIV/Hep/etc…)

 

[Raryn]

Or you know...just taking a blood pressure at all

I'm pretty sure the last time I did that was the med student free clinic...

I've taken a manual maybe 4 times during the first half of intern year.

That said, if there was any doctor who *couldn't* take a blood pressure, I'd be pretty hesitant regarding any of their other skills. BP measurement is a lot more useful than a number of physical exam maneuvers I've long since forgotten.

 

[ulikedaggers]

Or you know...just taking a blood pressure at all

I'm pretty sure the last time I did that was the med student free clinic...

Haha good point.

 

[Bacchus]

I've taken a manual maybe 4 times during the first half of intern year.

That said, if there was any doctor who *couldn't* take a blood pressure, I'd be pretty hesitant regarding any of their other skills. BP measurement is a lot more useful than a number of physical exam maneuvers I've long since forgotten.

One of the neurohospitalists here does them regularly because he doesn't trust the nursing staff to take orthostatics.

 

[mvenus929]

Or you know...just taking a blood pressure at all

I'm pretty sure the last time I did that was the med student free clinic...

One of my medicine preceptors did all his own vitals. Blood pressure, weight, pulse... all were done within his 15 minute visit as part of the physical exam.

 

[Kaustikos]

One of the neurohospitalists here does them regularly because he doesn't trust the nursing staff to take orthostatics.

I kinda did that once... I was examining this girl in clinic who looked dehydrated. I checked the file and the nurse wrote normal pulse/pressure. I checked the pulse and she was 120s.... So I went ahead and checked her bp - 95/70... I didn't trust my judgement so I asked the doc to check. Sure enough - she was definitely not normal pulse/pressure. lol


But forreal - I've used the same needle on the same patient. Academic medicine doesn't equal clinical/real medicine.

 

[Rendar5]

Or you know...just taking a blood pressure at all

I'm pretty sure the last time I did that was the med student free clinic...

...I actually had to do that yesterday. couldn't get a BP on a severely hypotensive pt, RN couldn't hear pulse sounds, machine wouldn't pick it up, so I had to get the BP over palp read...first time in 5 years I actually had to do that mind you...