IV techniques, odd ball tricks etc.

[sirduke]

Recently I got into a pissing contest with a RN during a clinical rotation at the ER. I've been a EMT for 3 years, must have stuck several thousand times. I was taught, after school, by an old medic who is one of the best I've met, that with a severely dehydrated patient, or elderly person with crappy veins, that you could start the IV with the bevel down to reduce the chance of blowing the vein. I of course had to try this, and to my surprise, it worked. I have used this many times since, and the ratio of sucessful sticks on these patients has increased.

But, of course, a paramedic student is the lowest form of life in the ER, and she ripped my testicles off in front of the patient for causing them undue pain.

Has anyone else ever heard of doing this, or am I just crazy?

By the way, I got the line and she blew two attempts and gave the old lady a couple of beautiful hematomas. Even the old lady preferred my method as she only got stuck once by me.

Anyway, your thoughts and other tricks are welcome.

Rural EMS, a lifestyle not a job

[letmesleep]

Yes, I have heard of this, and in my 15 years of sticking have never once had to do this. As far as the "pissing contest" during a clinical I think it would be wise to listen to your preceptor in their house and follow their rules. If the RN who I'm sure has at least as much "sticking experience" as you, might just want things done a certain way to HER Pts. The reason I am have a bigger issue with your "pissing contest" during a clinical over your IV starting technique is due to the bad taste you will leave in the mouth of said RN. You are there to learn, and not there to "show up" your preceptors. When you get an attitude with the ER staff, well, can you guess who it is that is going to pay for it after you leave their house? The rest of us, because now we are all cocky know-it-alls.

I'm not going to sit here at my computer and tell you that you should or shouldn't do this, and by all means when you get your license feel free to use this technique to your advantage if you want, but keep in mind that your 3 years of experience are not the know all to end all, and your in somebody else house during a clinical. This particular RN may not have handled you in the most appropriate way (by ripping of your testicles in front of a Pt), but on the other hand it is NOT your place to get mouthy in your clinical sites. Ask questions, take in the info, and find another place to research the TRUE answer.

By the way Rural EMS is a job, in fact it's MY career, and welcome to the city.............

[sirduke]

Understanding how I may have sounded, I take no offense to the onslaught. Let me rephrase the statement, she and I had a disagreement as to the effectiveness and justification of my technique.

As for giving her a bad impression of EMS as a whole, she is married to the only Paramedic who isn't a complete idiot, just ask her. There are 6 counties that transport patients to this hospital, our local trauma center, we are talking about 85 medics, and she criticizes each and every one of them. So I doubt my comment had much effect at all.

That said, you are right, I'm there to learn, not change beds, clean rooms, and fetch water for patients, and get pushed to the side when it comes to treatment. I pointed this out to the nurse supervisor, got a different preceptor and eventually started swinging from nurse to nurse as patients arrived. I was invited to come work anytime, so I think I aquitted myself well.

The main point of my post was NOT to draw fire about my behavior or as you feel, lack of proper behavior during clinicals, but rather find out if anyone else has tried this technique, and perhaps hear of other tricks that would help in providing better care for my patients.

The nurse in question does in fact have some great skills, abiet a shitty attitude, which she was glad to share, and I have used in several occasions with good results.

As for the Rural EMS statement, I have mine, you got yours, Nuff Said?

[mshow00]

From one student to another, I have found that going into a clinical to work brings me great respect. I go to work, I clean rooms, get vitals/place them on a monitor, interview the pt, obtain blood/ urine (hand them the cup), and possibly start an IV. I run the collected to labs the lab, take pts to the floor when needed, I get food/water, take the pts to x-ray/CT. I do all of this because I want to earn their respect. I ask questions respectfully, take advise and offer my "limited experience" (even though one of my preceptors is younger and greener than I) to understand and find what works best (& what they will ultimately allow me to do). I have never missed anything "cool", I have had the medical control Dr. of one of my sites take me aside and personally instruct me on various things. I go in humble (or try my best too) and usually have great experiences with everyone (yes even those nurses that "hate" paramedics/paramedic students).

[sirduke]

THIS IS NOT A DISCUSSION ABOUT CLINICALS OR THE WAY TO GO ABOUT THEM

IV techniques

[Ztenec]

Interesting technique. I have never heard of this and would find it difficult as my service uses the Autoguard catheters. Which catheters are you using?

I don't normally have issues with those pt's so I'm also curious as to what the thought process of rotating the bevel would be and how it would benefit you. Also I think it would come down to comfort in your own personal technique.

The reason your getting so many responses to clinicals is because you added a whole story about a... clinical.

[defib_wizard]

The bevel down technique can be helpful especially with 16 & 14 gauge catheters. Another technique I use a lot especially on people with frail veins is to not use a tourniquet.You can lightly tamponade the vein if you need to with your opposite hand to distend it slightly. this is also how I do external jugular IV's since it poor form to tie a tourniquet around a pt's neck . LOL

[sirduke]

We use the Autoguard as well, but it works with the Jelcos as well. I have no idea why it works, just know it does. Sort of like the trick carpenters use to drive a nail in a two by four without splitting it, they can't explain it, but it works.

The old medic who taught me this couldn't explain it either, but he said he was taught that way by his instructor years ago, my current instructor was as well, but her husband who has been a medic since ambulances had stone wheels, never heard of it.

The ratio locally seems to be about fifty fifty, as to who knows about it and who never heard of it.

[defib_wizard]

It works because you don't go through the back of the vein as you advance the catheter. The bevel should be parallel to the wall of the vein after you get a flash. To start the iv you do have to use a slightly steeper angle then lower the flash end of the catheter as you slightly advance the needle into the vein. Once your in 3-4 mm then advance your catheter. it takes practice but will increase your "batting average" on your iv attempts.

Oh yeah I was once told by a carpenter to blunt the end of a nail to keep it from spitting the wood. It is because it splits the wood fibers instead of cutting them. I still don't know how it works because you use an axe or maul to split wood. :?

[sirduke]

I regularly use a heat pack to raise viens on those with deep hidden veins, brings them up wonderfully, also on unresponsive patients or the extrememly obese when you absolutly have to have a line, the underside of the wrist works great.