jwraider Posted July 2, 2009 Share Posted July 2, 2009 I'm no longer a student but I wanted to ask the veterans how they proceed and are successful in starting an IV in a persons EJ vein. Any special positioning? How do you hold tension? What angle do you insert at? Do you tamponade? How do you know you're in? I had my first on my own the other night and the PT had JVD so it was as big as a finger (hard to miss). But I've noticed it's hard to hold tension and things start moving around on me. I want to find a better way to approach this that is still safe (no poking myself). -I try to lay the PT flat or with the head down if possible. -I've been holding tension to the sides of the start site with my other hand using my index and thumb in a c shape. -My angle is similar to an AC or slightly distal to one. -I haven't had to hold tamponade yet (little back flow) -It seems like it's hard to be 100% certain you are in. Is a good flash and no obvious infiltration good enough? Anyone have another method of confirmation at this site? Thanks for your advice and experience! Link to comment Share on other sites More sharing options...
HERBIE1 Posted July 2, 2009 Share Posted July 2, 2009 (edited) I'm no longer a student but I wanted to ask the veterans how they proceed and are successful in starting an IV in a persons EJ vein. Any special positioning? How do you hold tension? What angle do you insert at? Do you tamponade? How do you know you're in? I had my first on my own the other night and the PT had JVD so it was as big as a finger (hard to miss). But I've noticed it's hard to hold tension and things start moving around on me. I want to find a better way to approach this that is still safe (no poking myself). -I try to lay the PT flat or with the head down if possible. -I've been holding tension to the sides of the start site with my other hand using my index and thumb in a c shape. -My angle is similar to an AC or slightly distal to one. -I haven't had to hold tamponade yet (little back flow) -It seems like it's hard to be 100% certain you are in. Is a good flash and no obvious infiltration good enough? Anyone have another method of confirmation at this site? Thanks for your advice and experience! Sounds like you have a pretty good technique. Problem is, because of the variations of anatomy, thick necks, short necks, etc, the angle of entry will vary quite a bit. Sometimes you get a pretty good flash, other times you get nothing. Depends on the patient's underlying condition-ie a person in fluid overload will give you quite a big flow. A dehydrated little old lady in a nursing home will probably take some work to confirm your IV. Wiggle the catheter to see if it's in the vein, and hook up your IV. To secure the catheter, use an op-site membrane, loop the tubing over the ear and tape it down securely. They can be good places to have IV access because the arms and chest area tend to get crowded- cables from Pulse OX, EKG, Defib pads, CPR, etc, so an EJ can be useful. To confirm a patent line, you can also always drop the IV bag, or even aspirate a bit of blood with a syringe, but sometimes the only way you'll know for sure if it infiltrates. Also, don't use a short catheter-I'd suggest at least 1.5 inches and the largest bore you think the vein can handle- the sturdier the better. Edited July 2, 2009 by HERBIE1 Link to comment Share on other sites More sharing options...
jwraider Posted July 2, 2009 Author Share Posted July 2, 2009 Awesome thanks... the over the ear method sounds likea great idea. What do you mean by wiggle the catheter? Link to comment Share on other sites More sharing options...
p3medic Posted July 2, 2009 Share Posted July 2, 2009 Awesome thanks... the over the ear method sounds likea great idea. What do you mean by wiggle the catheter? If you have an angio that you can attach a syrninge to, use a 3cc syringe and aspirate as you advance, you will get immediate blood return as you enter the vein. The newer safety catheters don't have the ability to attach a syringe, so sometimes you get no "flash", and knowing when you are in the vein can sometimes be tricky. Link to comment Share on other sites More sharing options...
HERBIE1 Posted July 2, 2009 Share Posted July 2, 2009 (edited) Awesome thanks... the over the ear method sounds likea great idea. What do you mean by wiggle the catheter? No problem. This is one of the reasons I suggested a longer catheter. After you advance the catheter(and retract the needle), and believe you are in the vein's lumen, you gently wiggle the catheter to see if it is indeed inside the vein and not under, over, or through it. Just a secondary- and certainly not perfect- method to help confirm patency. Edited July 2, 2009 by HERBIE1 Link to comment Share on other sites More sharing options...
Jeepluv77 Posted July 3, 2009 Share Posted July 3, 2009 I love the ear idea! We're being taught "secure with tape" but no actual technique. Link to comment Share on other sites More sharing options...
HERBIE1 Posted July 3, 2009 Share Posted July 3, 2009 I love the ear idea! We're being taught "secure with tape" but no actual technique. I was never actually officially taught how to to an EJ either- I was shown that method years ago by a mentor. As for the tape, a clear op-site is almost mandatory if you have them available. It's really difficult to adequately secure an EJ with tape alone. Link to comment Share on other sites More sharing options...
JTpaintball70 Posted August 27, 2009 Share Posted August 27, 2009 I got my first two EJs on internship on traumas. As long as you can get the pt's neck turned and just hold slight pressure near the base of the neck on the EJ, it should be fairly steady and puff up a little more. At least that's how I did it. My only problem I ran into was both times I did it on the R side, and since I'm left handed it made the insertion a little tricky. Link to comment Share on other sites More sharing options...
tniuqs Posted August 27, 2009 Share Posted August 27, 2009 I was never actually officially taught how to to an EJ either- I was shown that method years ago by a mentor. As for the tape, a clear op-site is almost mandatory if you have them available. It's really difficult to adequately secure an EJ with tape alone. Cant add too much, try trandelenburg on the cot, as thats about the only thing its trandelengurg re EBM is good for these days. Sorry to disagree I HATE the opsite a very poor excuse for securement IMHO, guess I am old but a proper tape job (cross over, then the hub then opsite, and a jesus escape loop in case of a inadvertent pull ) if you are permitted, pop a suture around it takes only a minute or if the cath has "wings" 2 sutures. cheers Link to comment Share on other sites More sharing options...
HERBIE1 Posted August 27, 2009 Share Posted August 27, 2009 Cant add too much, try trandelenburg on the cot, as thats about the only thing its trandelengurg re EBM is good for these days. Sorry to disagree I HATE the opsite a very poor excuse for securement IMHO, guess I am old but a proper tape job (cross over, then the hub then opsite, and a jesus escape loop in case of a inadvertent pull ) if you are permitted, pop a suture around it takes only a minute or if the cath has "wings" 2 sutures. cheers Like I said, the OP site is not optimal and certainly not in lieu of tape. It gives the added advantage of viewing the site. Sutures? Apparently your system is a lot more progressive than ours.Obviously that's the preferred method but we certainly don't have that capability. Link to comment Share on other sites More sharing options...
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