IV techniques, odd ball tricks etc.

[firedoc5]

Hey Doc, did he play for the "BULLS" as well?

sorry had too.

Naw, he got heavy and I doubt he could make it to half court. :roll:

[Ridryder 911]

The reason the bevel is up is to prevent "tearing" the skin as it punctures as well as while introducing that catheter into the lumen you make a clean entry into the vein. Now, if I was the nurse, I would have failed you as well as not following proper techniques and instruction. Get into a debate with me over such, I'll send you home and attempt to not allow you to continue clinicals at that facility anymore. We need students that want to learn not debate. Remember, you don't even have the license yet and you are telling them how to do things? Wow.. your impressive. You just demonstrated you have no regards of performing a procedure properly. Yeah, working under her license and your upset that she wants you to perform it correctly... shame on her! Your whole purpose is to learn the correct method, not some tricks of the trade that might endanger a patient or one's career.

Wonder what your institutions and instructor will feel about explaining to the patients attorney if there was the catheter shear?

I agree your main purpose may not be assisting in their duties, but as well it demonstrates team work something everyone can work upon.

R/r 911

[sirduke]

Now that I have been properly chastised by the previous post, I'll get back to the discussion, I've been researching it on the internet, lots of discussion by doctors and nurses alike in regards to the desirability of starting bevel down. Most notably on dehydrated children and dialysis patients when sticking in fistulas.

As for my esteemed whipsman in the prior post, my instructor teaches us bevel down for the type patients I first described.

As for anyone else who wants to chastise me. Just send me a PM, we all know how smart and superior you are, so you don't have to flaunt for everyone on the post.

[Ridryder 911]

You are the one that posted and flaunted it, can't stand the heat get out of the kitchen. Really, don't care what article, or poor teaching you might be receiving.. that will not hold up in court as you are judged by your curriculum, the manufacture recommendations and other professional peers. Discussion of what might and doing is another principle. One can use D50w up the rectum; but that does not mean I have to try it.

If you want to go against the manufactures suggestions and I am sure standard procedures and protocols, that is fine but work on you own license and don't criticize others that are attempting to install proper procedures to students.

Yes, we all have tricks of the trade or short cuts that have not been medically validated but they should not be taught as part of the educational process.

R/r 911

[mshow00]

The point is not to make you feel small, its so the rest of us can learn from the veterns in reguards to mistakes we make. I said we because all of us at some point have said something stupid and it has been pointed out.

Now, I was told that if you enter the IV upside down, then you sheer the skin and vein, opening the pt up to any number of complications. Or more pointedly increasing the risk. Is this not true?

[sirduke]

As I stated, there are many discussions on the internet as to the pro's and con's of bevel down vs bevel up. There seems to be no definite studies showing one superior to the other, yet the standard is bevel up. There was an article on NPR about cannulating bevel down, and several articles about it in regard to diaylsis patients fistulas, but again, no definite studies.

The current arguments for bevel down are that it leaves a flap down that actually heals faster that the flap up that the bevel up leaves. Some nurses have reported that the bevel down technique bleeds less both with injection and removal on the fistulas.

I wasn't advocating radical change in IV techniques, but rather asking about something I'd been taught, that worked, and trying to get insight from others as to why I got blasted for doing something I was taught, and that worked.

Instead, and I guess it was my fault in the way I first worded it, I get blasted from people who are not interested in discussing the issue, but rather in trying to show a "newbie" how stupid and arogant he is.

With this in mind, I guess there is no place on this site for error, either in wording or anything else.

Keep up the newbie bashing and eventually you will have only the "Seniors" here complaining about how the new generation doesn't care.

Back to the question. Have you ever heard of this technique or not.

[letmesleep]

That was an awesome display that there is no getting through to your head. Ridryder 911 has eaten me alive here before for things that I have said due to the education and experience. The good thing about the "city" that I have found since I have been on here is to maintain your cool, and have a discussion. Just because you don't agree with whats being said doesn't mean you throw your hands in the air and give up, but check the attitude at the door. It seemed as if you understood why I was disappointed by you initial post, and had humbled yourself to continue on the topic at hand, but from your last two posts it doesn't seem to be the case. Nobody is "newbie Bashing"! You have been given the same level of respect that any one of us would be given here in the "city". The opinions shared by us in regards to your behavior during a clinical were brought forth by your OP (we reacted to your words). The problem now is that your continuing to debate by trying to "slam" those of us that have an opinion about something you wrote. I, for one have no desire for you to "stop" posting here, but with that said, try to understand that you are talking to people from around the world with a TON more experience than 3 years of service and have had a direct hand in building the career choice that you have chosen, as well as, those with less than 3 years of service trying to learn.

Like I said, Rid and I have gone head to head here before and I'm sure with all due respect for Rid's opinion, it will happen again. This isn't the last time that your going to get rattled either, feel free to fight your fight, but maintain the level of respect that you expect us to give. I know that you stated that you recognized that you may not have posted correctly in your OP, but continuing to argue with those of us who share our opinion about something you wrote only shows us that you didn't and that your not willing to learn because you keep trying to divert what is being said.

[CaliMedic209]

What was the point of getting into this squabble with the nurse?? first of all.. your not going to win.. second of all.. like previously stated you are there to learn.. in the city i work in we have "that guy." He learned pretty quickly that this was obviously the wrong way to go about doing things.. check your attitude.. your a student

[Ridryder 911]

My point was to point out some things I felt was very basic points. First this technique is not new, it has been discussed and re-hashed for a couple of decades and probably will continue to do so.

What I hoped that others will learn off this that as a student you are there to learn the proper and approved way. Can one imagine as an EMT or Paramedic to have an EMS student attempt to go outside the normal scope of approved skills while on a clinical with you, and then chastise you for attempting to correct and teaching the proper method? Remembering as well, that you are a student and are allowed to work under their direct supervision, since it is their license. That any affect on care, treatment or procedures and blame will be placed upon you, not the student in which you were supposed to be supervising. Even if the so called instructors (note, not educators) are discussing this technique; this should not mean the student should attempt the technique unless approved by local EMS authority and Medical Director. I would hope most instructors would have clarified such.

Those that have read my posts, realize I am all in favor for advancing care and attempting new proven techniques. There is a place for this and its called clinical trial studies. There is NO room for cowboy medicine. This is where one is trying unproven methods of treatment. First it is illegal, and second how does one really know it does not place patients at risks?

Even in regards to reverse bevel theory. Do we really know that it is safe, or does it increase the risks of catheter shearing, laceration of the lumen of the wall, skin tear, etc. ? No one knows this unless it is scientifically studied under direct observation and under controlled studies. I feel that if this technique was so superior, then we would had read or heard about it from those that establish more cannulations than those in EMS. IV teams, ICU units, O.P. surgery units, all that routinely establish far more IV's in one hour than most EMS perform in one day. As well, there are those that do really study IV's, the techniques, the associated risks & complications that has far more education, experience, and speciality certifications than anyone on this forum in IV therapy. Surely they would had endorse this method as a normal procedure or to be used in extreme cases. IV therapy is NOT a new procedure.

Again, if I offended someone that was not the intent. The intent was to place the emphasis on the correct method of learning the procedures the correct way, knowing there is a better more way of representing yourself to the staff as a so called professional, that your role is a student while doing clinicals not to be "trying new techniques" before you have even mastered the correct methodology. I do ask, what would your schools medical director or even school liability insurance consider if they were to find out? I even doubt the instructor's would back one up or admit endorsing/teaching such technique if a complication resulted from the action.

There is always trick of the trade. Everyone does them. These should never increase or produce a risks to the patient. Until it is thoroughly proven, then it becomes is a standard procedure. Knowing the associated risks and when they are appropriate makes the difference.

R/r 911

[reaper]

Does this mean that we cannot do field vasectomy? :shock: Dang, I thought I had figured a way to beat Darwin!