EMT-I---IV sticks [Archive] - Glock Talk

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kjg26
04-21-2007, 14:46
We are about a week into our thrid and final quarter of EMT-I training. we got to do IV sticks today. it was a really intersting experience. Several in the class are deathly afraid of needles. Two went into histarics. Overall really had a good day, got to do two sucesful sticks. Just thought i'd share!

Skintop911
04-21-2007, 15:54
Be sure to try sticking folks that don't have the garden hoses for veins. You'll also want to try those sticks in the back of a bus in motion.

breech
04-21-2007, 17:44
Ah.. I remember those days. I actually blew my training partner's vein. She wasn't happy but I got a kick out of it. :animlol: She was a good friend of mine.
Starting an IV hauling ass down a bumpy road is fun. Sometimes you don't have those "hey, give me a sec" moments in EMS.
Have fun and WATCH that needle.

kjg26
04-21-2007, 18:24
her veins were not good by any means. Mine on the other hand are garden hoses. First day of class my instructor shook my hand and said,"oooo can i poke you? i could get you with a 14g from across the room" i thought it was pretty funny. I've got 6 or so ride alongs in may, can't wait!

breech
04-21-2007, 22:23
Man I haven't poked anyone with a 14 in years. Usually everyone I provide care to gets an 18.

jmshady
04-22-2007, 07:25
Originally posted by breech
Man I haven't poked anyone with a 14 in years. Usually everyone I provide care to gets an 18.

LOL come work with me it is rare that anything smaller than an 18 is started by me. This month I have started 8 14ga and 6 16ga.

kjg26

Get as much time just doing sticks as you can. Experience is the best teacher. the classmate and the 89 year old renal failure pt is a huge difference. There are days I could not hit an IV on the first attempt for anything. Those are the times experience comes into play. Pick your vein and stick it, don't piss around thinking about it. If you have doubts it is never a bad idea to let your partner attempt. You will miss, that is a fact. Everyone misses now and again. Do not let it get you down.

kjg26
04-22-2007, 07:46
luckly my previous job included starting IVs on dogs and cats, so i'm pretty comfortable sticking people. I think if i can hit a dog/cat vein through hair i should be good to go as far as MOST people go. Or at least have some experience under my belt

Lynn D
04-22-2007, 09:43
Re: sticks. If your agency/school allows, see if you can spend some "lab and line" time in your local ED. As a new RN in an ED unit, several of us were given this task when we were "extra". Did loads for my ability to get into difficult veins or non-existent ones.

Otherwise, get all the practice you can. My advice? Two-fold. Choose your site carefully, and be patient. Sometimes it takes a bit longer for the vein to "come up" than we might want. Waiting usually brings the reward of the "flash" we're looking for.

Best of luck to ya.

gruntmedik
04-22-2007, 11:56
Good advice so far. Start low, then work your way up the arm if need be. Make sure you release the tourniquet before you remove the needle--makes much less a mess. :supergrin: And keep track of the needle---Do NOT stick it in the bench seat!!! If all else fails, and you can't see anything to stick, remember the anatomy--stick where the vein should be.

hotpig
04-22-2007, 14:26
I used to require my students to start a IV and do a blood draw on me before I let them loose on the general public. After teaching a class a year for few years I realised that I was a idiot.;)

gruntmedik
04-23-2007, 10:58
Originally posted by hotpig
I used to require my students to start a IV and do a blood draw on me before I let them loose on the general public. After teaching a class a year for few years I realised that I was a idiot.;)

Honest, officer, those aren't track marks. :animlol: :rofl: :animlol: :rofl:

DaleGribble
04-23-2007, 18:12
Originally posted by gruntmedik
If all else fails, and you can't see anything to stick, remember the anatomy--stick where the vein should be.

Best advice yet that no one ever gave me.

For the first month I was doing IV's in a moving ambulance every single pt had awesome veins and I had a 100% stick ratio so naturally I thought I was hot **** right out of the gate. Then the real world slapped me in the face and my percentages fell hard.

After two monhs of sub 50% IV rates I finally figured out on my own that if I looked to see where my veins are I can probably find the same one on my pt. It's worked pretty damn good so far, especially on AC's.

demaster
04-25-2007, 17:17
I also agree with most of what the people say. Just a side note, start from fingers up because if the patient is going to be admitted or have to have surgery, they will pull your line and start a new one. Reason being "its not a stirle environment".

I have started numerous lines, but my patients always warranted a line. Always cover your ass and know your protocols.

Good luck, and make sure you feel the vain before you stick it .

hotpig
04-25-2007, 17:22
I often close my eyes while checking for veins. It helps we to focus on the feel rather than look for the blue.

Lynn D
04-26-2007, 19:46
Originally posted by hotpig
I often close my eyes while checking for veins. It helps we to focus on the feel rather than look for the blue.

+1

I do it also...helps me trust whats really there. 'Cause the good ones aren't always the visible ones!

D25
04-27-2007, 16:01
+1 on checking for veins without looking.

And remember, while holding a 14g just above someones arm, say, "Now your gonna' feel a little pinch.";)

mylt1
05-02-2007, 11:50
here lately i havent been able to start a line while setting still. i have to be going 80 down a bumpy ass highway in our monster medic to get a line started. my normal stick is just a 20g unless its trauma or CVA they get 18 or larger in the AC. the joys of our protocols, "provider discretion".

Lynn D
05-03-2007, 20:03
Not to hijack....

Today at work:

#20 in R FA of lady with "bad veins"....
#20 in L FA of LOL with fractured hip, and a "blind" foley in same
#20 in s/p Liver transplant with a PICC that was infected and needed out.....

Phew! I'm tired.

BTW, liver guy had an AC that was almost horizontal. I wasn't sure, but kept the faith, and was rewarded!

Sludge
05-03-2007, 20:12
for some of your harder to stick patients... put your constricting band above the AC and then a second one mid fore arm.... I will also swab area with an alchol prep to get the "moist skin shine" going on... it sometimes help locate veins that are hidden, once you have found one, clean and prep the area again...

mylt1
05-03-2007, 21:29
LYNN D i had a hispanic male having a TIA last week and his AC was parallel with the joint. i think that was the first AC i have ever had that was running the wrong way. this guy had nothing in his left arm but i could see that AC even in the dark.

WIMPY
05-04-2007, 00:54
I am an "old paramedic" & emergency room rn. Just remember that a 22 ga iv may not be sexy but they are your best friend.

RLDS45S
05-04-2007, 04:06
Now ain't that truth!Originally posted by WIMPY
I am an "old paramedic" & emergency room rn. Just remember that a 22 ga iv may not be sexy but they are your best friend.

One vendor used to make a 12g with a heparinized syringe attatched, they were sweet. 14 and 16 in the back of the hand!

Simple words in protocols:
Ensure Airway
Obtain IV access

TxFire
05-04-2007, 21:38
I agree with everything said. I will second that a 22g is better than no line.

My favorite phrase is: "You re going to feel a series of sticks." :rofl:

Dean
05-05-2007, 01:11
Pull over and stop for the stick.
Tape it down.
Then "Ga' head."

Why risk bringing AIDS home and having to tell your wife, "I'm so sorry, Honey! I must have got it a few months ago through my thumb!"?
'you know what I mean?

:drillsgt:

RLDS45S
05-07-2007, 10:04
Well, let us just say that kids can humble a person right quick!
I was fortunate to go 2 years as emt-p before being faced with having to stick an EJ, then it seemed like I encountered way too many....opportunities...

There were days when my partner and myself could not buy an IV!

I tell you one thing, learning on the run has paid dividends in palpating veins now.....

kjg26
05-11-2007, 22:47
ok well i'm 5/10 now. got 1 for 2 in class, 1 for 1 on the truck and 3 for 7 at The hospital. Seems like it was easier bumpin down the road. Oddly i got most of the harder patients at the hospital. Got two older ppl with crappy veins and this rather large woman. I dunno. i know practice is all i can do. the close your eyes and feel helped with the two older people.

Parmaboy
05-22-2007, 19:01
IVs in the wonderful City of Cleveland.

I largely start 20ga IVs... Only reason to go bigger than 20 imo is for D50 admin and traumas/ other blood loss situations.

I love an 18 for d50. and I love 14s for traumas, Especially an EJ those are my favorite.

I think my friend is gonna have to say a lot of hail Marys though. He stuck a 16ga in a priest who just had a syncopal episode, and was CA+O with no life threats lol.

for you new guys just remember, 1 successful 22 or 24ga is 1000x better than a blown 18ga. Dont be a wimp like some people, when they need a big IV.... GO BIG OR GO HOME!

Unfortunately my success rate is not too great, there are a lot of poor people here who take terrible care of themselves and have terrible veins.

On a funny note of doing IVs, I had a drug addict try to grab the needle from me and start it himself lol

gruntmedik
05-22-2007, 22:20
Back when I was still working the streets, I had an elderly pedestrian struck by a truck. Poor old gentleman had crap for veins, certainly nothing that would take a 16 or a 14. So.....I presented him to the trauma team with 5 18's. Was able to get his pressure in the low 90's, so I didn't feel too bad. The look on the faces of the trauma team was priceless. :supergrin:


Somethin is better than nothin. :thumbsup:

D25
05-23-2007, 21:53
Originally posted by gruntmedik
Back when I was still working the streets, I had an elderly pedestrian struck by a truck. Poor old gentleman had crap for veins, certainly nothing that would take a 16 or a 14. So.....I presented him to the trauma team with 5 18's. Was able to get his pressure in the low 90's, so I didn't feel too bad. The look on the faces of the trauma team was priceless. :supergrin:


Somethin is better than nothin. :thumbsup:

:bowdown: :thumbsup: