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Timmy

IVC Placement

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I'm with the others. I like the forearm for two reasons. It doesn't occlude when they bend their arms plus it's way easier to secure than the ACs in my opinion. Particularly on elderly/allergic patients where you may not want to use tape.

Also, on traumas, or any patient really that I need two IVs or that I think that I'm going to be busy on, I try and put them both in the right forearm/AC. This is maybe not a good practice for some reason that I can't see..but it keeps the lines opposite the bench seat where I can see them but don't have to manage them while I'm doing other things.

I'm also with Island in using the feet. I'm not sure why people seem to avoid them, I go to them pretty quick on patients with poor availability of access. They're normally easy to secure, don't easily occlude with movement, and as above, keep the lines out of the way if I'm busy. They're a good option I think with the exception of diabetics, where the resulting wound will not be easily monitored by care providers.

Dwayne

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AC is pretty solid bet imo. In a true emergency situation with a critical patient, I've never seen anyone complain about placement of IV's. They should be happy we've taken care of everything for them. True the arm can bend impeding flow, I've placed a board like we do with peds to stop the bending.

That being said, I do follow the start low and go high, force of habit I guess. 18g is my standard goto for most patients, large bore =14 if I can.

EJ is a great spot for large bore IVs, especially on an unresponsive trauma.

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I think perhaps one of the issues with using the "vein of shame" is not that you have placed an IV in it, it's that we have placed an IV in it when there are just as good alternatives lower down, sorta shows we didn't really have a proper look

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Thanks for the feedback everyone, appreciated.

I’m extremely new to cannulation, my second IV ever was the other day on this patient who was in sever anaphylaxis which rebounded for 2 hours, he was semi conscious and dropped his BP so I just went for the 2 biggest veins I could find.

Live and learn I guess, I’ll know for next time! Thanks.

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Thanks for the feedback everyone, appreciated.

I’m extremely new to cannulation, my second IV ever was the other day on this patient who was in sever anaphylaxis which rebounded for 2 hours, he was semi conscious and dropped his BP so I just went for the 2 biggest veins I could find.

Live and learn I guess, I’ll know for next time! Thanks.

Dude! Talk about trial by fire!

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sorta shows we didn't really have a proper look

I disagree. The more proximal the better. It's closer to where the fluids and drugs need to go (adenocard, anyone?), and the closer your IV is to the trunk of the body the less the catheter moves around when the patient flails. There is no such thing as the "vein of shame" in an emergency.

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I disagree. The more proximal the better. It's closer to where the fluids and drugs need to go (adenocard, anyone?), and the closer your IV is to the trunk of the body the less the catheter moves around when the patient flails. There is no such thing as the "vein of shame" in an emergency.

Fiz I have to agree with you if you really need a line then AC is way closer to the heart for meds, starting lines in feet is not good for any med delivery and plus patients kick, my personal experience is a PITA line especially with decreased perfusion pathology or the blue hair crowd. Again, personally I believe this gas passer was just a tosser s/he had 2 lines and push come to shove could infuse blood (not positive of underlying pathology here but circling the drain is something I understand ) and with an introducer could have rethreaded a larger bore if needed in OR or get a shlep Resident MD to do it for him.

On the other side of the fence if Timmy did not have 2 patient lines this primadona gas passer would have been pissed off more.

cheers

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I disagree. The more proximal the better. It's closer to where the fluids and drugs need to go (adenocard, anyone?), and the closer your IV is to the trunk of the body the less the catheter moves around when the patient flails. There is no such thing as the "vein of shame" in an emergency.

Dont get me wrong, i do agree with your statement, but thats a pretty specific answer to a generally broad topic.

My "didn't really have a proper look" is more about those people who jam every IV into the cube without looking in the forearms, so it certainly can become a vein of shame.

Having said that, i dont run infusions, so my priorities may be a tad different.

Edited by BushyFromOz

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Thanks for the feedback everyone, appreciated.

I’m extremely new to cannulation, my second IV ever was the other day on this patient who was in sever anaphylaxis which rebounded for 2 hours, he was semi conscious and dropped his BP so I just went for the 2 biggest veins I could find.

Live and learn I guess, I’ll know for next time! Thanks.

That seems to be the way the jist of this conversation has turned. Sometimes you have time to sit back and evaluate things a bit to see where is the best place to stick.

Other times, like what you've just described, you go with what you can get.

Strong work.

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