Thursday, November 19, 2009

Difficult IV Access Trick

Ok, they call you because they can't get an IV in someone. You think, What the hell? They couldn't do it, and I just started so somehow they think I can?

I suck at IVs, I sucked at them for a long, long time. Lately, it's been going better. One day it just suddenly got a lot easier.

But for the truly hard stick - here's my favorite tip. Get a towel and run it under hot water (not too hot to burn, but hottish).

Put the hot part of the towel on the place you want to stick - antecubital, hand, whatever. Leave it there for a few minutes.

This causes vasodilation - often a good vein will pop up, and if not, a bad vein will still be easier to stick.

It has the added benefit of calming things down a little. The patient has been stuck probably several times by an increasingly irritated nurse, and is probably increasingly irritated himself...the time that the towel sits there gives a little break for everyone to relax.

And - when really screwed - you can get a tiny IV from pediatrics. Unless you are in a serious resuscitation situation, it's probably fine. If people bitch about this, tell them that smaller IVs allow better blood flow around the cannula and are less likely to get infected.

69 comments:

Silvia said...

...or you can always get warmers from phlebotomy if they stock it on the floors. It could avoid a wet mess on the patient's bed. But I do LOVE this idea. Hope to one day use it :)

XE said...

This is going to be the best blog ever. (I love learning things that integrate the theory we're doing at school with real life situations). Thanks for the link Sara!

Kelly said...

Or fill a glove with warm water and tie the top like a balloon. Stays warmer for longer than a towel and doesn't make the patient or bed damp (unless the glove bursts!).

medstudentitis said...

I use a blanket from the blanket warmer! (usually from post=partum)

DHS said...

For the truly hard stick, borrow an ultrasound machine. Learn how to use this when you do your ED term (for Australian interns).

Dr Michael Anderson said...

Good trick, though I found the biggest tip with tricky IVs is to have patience. If it's difficult, sometimes it takes 20mins to get in. Give yourself time and do not be rushed

Michael (anaesthetic registrar)

Albinoblackbear said...

I warm up 50mL or 100mL saline bags in the microwave for about 20 sec. Then I kling wrap them to the patient--that way if you get called away the pt isn't sitting there wrapped in wet cold blankets (then you really have a bugger of a time getting the line in).

And I agree with Michael--*time* and patience is essential. (Two things I don't always have in the ED). :)

Great blog!

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