Theoretical Argument

[bbbrammer]

Protocols aside, how about debating a theory. IV medications are pushed through an IV directly into a vein. No brainer. Then why is it not considered to be a possibility to push IV meds directly into a vein using a needle/syringe combination without having an actual catheder placed? Say you have a pt. that for some reason has veins that blow everytime you try to cannulate, but not when you stick. Say you can't get an catheder to cannulate, but you do have a vein that you could use if you were just going to draw blood. Theoretically, could you not draw the med up in a syringe, do a venipunture, then administer the med?

Disclaimer:

This is a theoretical discussion only. I have NO intentions what-so-ever of trying this, and absolutely DO NOT recommend anyone else trying it.

[AZCEP]

I think the major downside to "mainlining" would be the corrosive nature of many of the medications. Extravasate and the surrounding tissue dies. Using the IV fluid to dilute the concentration is very useful for some meds that are commonly used.

In theory, sure you could. You'd just have to ensure the site was clean, the concentration was dilute enough to not need any further dilution, and the pH of the med is near neutral.

[OVeractiveBrain]

When intravenous medications were first being pushed, no one cannulated anything. When heroin uesers shoot up, they dont cannulate. Of course you COULD do direct injections into a vein. But as AZCEP said, with an actual cannulation you have additional access should repeat medications be required, you can run a line to dilute and apply forward pressure, etc.

I have a tough time believing that you could get a syringe needle into a vein and not blow out the other side but you cant get a 24G catheter to slide in. Granted the length of the needle might be different, but if youre choosing your site well enough, it shouldnt matter. If a patient's veins are so fragile that a soft tipped catheter causes them to blow, chances are the pressure from your pushing the medication will cause it to blow too.

[Redcell19512]

When I was 16 I had enoscopy done on my colon and at a later date my stomach. When they did my colon I got a hep trap. But for the stomach the GI doc injected the "sleepy medicine" directly into the vein. This was 18 years ago mind you. Today I would assume nobody has a procedure done under sedation without an IV site of some type.

My partner and I happened to be at the ER when one of those drive up and drop off heroine ODs came in. I watched a nurse main line narcan. Besides those two incidents I've not seen it done anywhere else.

[Ridryder 911]

I have "mainlined" Valium for seizing patients and sedatives such as Ativan for agitated to calm them down, then establish the line afterwards. As other pointed out there are complications to everything, such as lacerating the vein and if the med is caustic causing phlebitis and scaring of the vein.

R/r 911

[paramedicmike]

When I was in paramedic school I remember having a discussion along the same lines with an ER RN during one of my clinical days. She mentioned that mainlining would be so much easier in certain circumstances, but that it was illegal to do.

I don't remember much more of the conversation. And I haven't done any research into this prior to my posting here. But legal scope of practive issues may come into play here, too.

Just a thought.

-be safe

[pyroknight]

If you do not need the IV access, most of the drugs we carry can also be administered IM. I can hit a muscle a lot easier than a vein! 8)

[FormerEMSLT297]

In NYC this was referred to as "hot shotting a vein",,, and along with all the previous complications in doing this, one of the other problems was that after you give the med, what if you need to give another or more..? keep hotshotting, till you run out of vein???????????

I heard of old time medics, who used to hot shot narcan to heroin O.D.'s and then let them go their merry way,, now other than the fact that the narcan wears off a lot faster than the narcotic, and then the patient crashes (again) The reasons this was done seems to be for pure laziness..... ( I never did it, none of my partners never did it,, but It was taught in medic basic school as a GREAT BIG NO NO.)

Between the introduction of adult I.O, and the use of all arm, leg and if necessary E-J lines, I would have to estimate that you can only truely not start a line in a very small percentage of patients.....

I just don't think it is worth the risk..... now some meds can be given I.M. and that may be a stop gap until you can get a line, or if you can't, but it just doesn't sound like good medicine to me....

Former

[croaker260]

BTW: In most drug circles, "hot shot" means an especially powerful, often fatal overdose of medication, not just that it was IV.

The biggist problem is , of course, if you have an untoward effect of the medication, then a key component of treating that effect (IV access) does not exist. Not that you have it when you IM medications, but some situations call for a little common sense, and sometimes IM or IN is a better route if no IV access is available than Main line-ing something.

This was a key factor in the idea of mainlining narcan going bye bye..although i heardof this being done in the new england area (wont mention where mind you) as late as 1995, with at least one incident resulted in a cardiac arrest...and with no IV access...bad news and MAJOR loss of kewl points.

The proper use of narcan with and with out IV access is another adventure and discussion altogether.

[Dustdevil]

I too have mainlined Valium for seizures.

Only other time I have mainlined was Benadryl for extrapyrimidal reactions, because it works so quickly and certainly that you know there is no necessary followup.

Not that I am recommending the practice, but I don't see where it would be illegal. Maybe some particular state's Nurse Practice Act says so? :?