This is a reminder that even the expert on IV access can fail sometimes. The important action is to remember is to know how you fail and what to do next. Thanks for sharing this video. Also, I've never tried ('cuz of unknowning) leaving the failed catheter in while attempting another IV on the same area.
Sometimes when i realize i went throught the posterior wall of the vein with the catheter i try to slowly pull it back until the point of the catheter is in the vein again and i see blood flowing, and then go forward to insert the rest of the catheter. It doesn't always work and sometimes leaves a bit of hematoma but it can be successful and it's nice to not have to puncture the patient's skin again
Alternatively if you have a wire laying around you can insert a wire into the catheter when you’ve pulled it back enough, and then advance the catheter over the wire. We sometimes have wires by themselves in sterile packaging in our access carts.
Thank you for sharing your experience that sure I will keep in mind when faced with difficulty visualising the veins. One thing I would suggest to that end is to wrap a warm damp surgical swab (in babies) or mop (in adults) around the area for a few minutes. That helps to dilate veins too.
Try to use BP cuff for few bp readings, it will pump veins with blood nicely, then squiz hand gently from upper to lower part, apply tourniquet once, then remove and let veins to fill up with the blood and apply again. Tighten the skin with your two fingers to secure veins from movements and to be more prominent and visible. Hope it will help🙏🏻😍 Big Thanks Doctor for amazing videos, advices and tips❤I downloaded the app and its amazing, sharing with all collegues💖
I could tell you were going to have punctured the posterior vein wall, Two additional tips: First) "crack" the seal at the needle hub y rotating the catheter around the hub. This prevents hanging up the catheter when you want to advance. Second: As soon as there is flashback. pull the needle back inside the catheter. If there is blood return up the catheter, it's tip is in the lumen. Once in that position, you can gently advance with the needle still just inside the catheter, but not leading the advance so the sharp tip will injure the vein. If things hang up, use a straight spring guide wire through the catheter gently through the vein, and advance the catheter. Thanks for these great tips.
I've been using this technique recently when I get flash but can't get the catheter in. I go right for the second try. Today I had one that was a good but tricky vein for some reason, and after the first 18g failed, I got the second 18g in about a cm proximal. Leaving the first one in kept me from having to find another location.
Hi dear Dr.Hadzic, it's very interesting what you do. As you says, if we retire the fail cathether, it will come a hematoma because of the elastic band, and it's a very inconvenient to get off the band. So i'm agree with your procedure and I think it's very wise. What do i do?, well the use of eco for periféricas veins for non invasive procedures it's correct but it's very unconvenient , it's easier to cateterice a radial artery than a little vein because of it's fragility, we need to be more skillfull. I'll try inicially your way for a small vein, and previously apply topic emla over the posible veins to take. Including the external yugular vein, that it's very helpfull and non invasive. Hope this little tip would be usefull. Greetings.
Much to my dismay, I was often called upon to start a difficult IV. You could easily tell it was going to be difficult because there was ample evidence that someone had attempted multiple times.
La cara interna de la extremidad superior cerca de la articulación con la mano en un área muy dolorosa al igual que la zona radial. Es menos doloroso el dorso de la mano. Es un detalle a tener en cuenta para dar comodidad al paciente al advertírselo. The inner face of the upper limb near the joint with the hand in a very painful area as well as the radial area. The back of the hand is less painful. It is a detail to take into account to give comfort to the patient when warning him.
I work in an ER and don't have access to esmark bandages; Can I use an ace wrap instead? If so, would you recommend a 4" or 6"? Thank you for your videos! Bending the needles has helped tremendously in my PIV access attempts where I need to access a small, superficial vein and need a very shallow angle of attack.
Try to use BP cuff for few bp readings, it will pump veins with blood nicely, then squiz hand gently from upper to lower part, apply tourniquet once, then remove and let veins to fill up with the blood and apply again. Tighten the skin with your two fingers to secure veins from movements and to be more prominent and visible. Hope it will help🙏🏻😍
Esmark bandages not always available so putting the limb in gravity dependent position and do manual exsaguination works well .. Alternatively using blood pressure cuff with venipuncture mode also does the job most of the times
@@nysoravideo Seriously I never faced problem of BP cuff deflation .. May be luckily I secure IV before deflation of cuff .. Anyways thanks for highlighting the valid point ..
I like to use inflation of BP cuff few times before insertion, its pumping the veins nicely and with the help of gravity works most of the time😍 Huge Thanks Doctor for the amazing channel and tips💖💜💖Great Job👍🏻🙏🏻
This is a reminder that even the expert on IV access can fail sometimes. The important action is to remember is to know how you fail and what to do next.
Thanks for sharing this video. Also, I've never tried ('cuz of unknowning) leaving the failed catheter in while attempting another IV on the same area.
Sometimes when i realize i went throught the posterior wall of the vein with the catheter i try to slowly pull it back until the point of the catheter is in the vein again and i see blood flowing, and then go forward to insert the rest of the catheter. It doesn't always work and sometimes leaves a bit of hematoma but it can be successful and it's nice to not have to puncture the patient's skin again
Alternatively if you have a wire laying around you can insert a wire into the catheter when you’ve pulled it back enough, and then advance the catheter over the wire. We sometimes have wires by themselves in sterile packaging in our access carts.
Great TIP! Greetings and thanks for watching! And - do YOU Agree/ What do YOU do?
Thank you for sharing your experience that sure I will keep in mind when faced with difficulty visualising the veins. One thing I would suggest to that end is to wrap a warm damp surgical swab (in babies) or mop (in adults) around the area for a few minutes. That helps to dilate veins too.
Try to use BP cuff for few bp readings, it will pump veins with blood nicely, then squiz hand gently from upper to lower part, apply tourniquet once, then remove and let veins to fill up with the blood and apply again. Tighten the skin with your two fingers to secure veins from movements and to be more prominent and visible. Hope it will help🙏🏻😍
Big Thanks Doctor for amazing videos, advices and tips❤I downloaded the app and its amazing, sharing with all collegues💖
I could tell you were going to have punctured the posterior vein wall, Two additional tips: First) "crack" the seal at the needle hub y rotating the catheter around the hub. This prevents hanging
up the catheter when you want to advance. Second: As soon as there is flashback. pull the needle back inside the catheter. If there is blood return up the catheter, it's tip is in the lumen. Once in that position, you can gently advance with the needle still just inside the catheter, but not leading the advance so the sharp tip will injure the vein. If things hang up, use a straight spring guide wire through the catheter gently through the vein, and advance the catheter. Thanks for these great tips.
Greetings and thanks for watching! These are GREAT POINTS. Will use/teach them.
I've been using this technique recently when I get flash but can't get the catheter in. I go right for the second try. Today I had one that was a good but tricky vein for some reason, and after the first 18g failed, I got the second 18g in about a cm proximal. Leaving the first one in kept me from having to find another location.
Thank you for sharing your experiences. Did it work?
@@nysoravideo Yes, thank you!
Good point, to much practical. Thanks so much
Glad it was helpful! Greetings and thanks for watching! And - do YOU Agree/ What do YOU do?
Hi dear Dr.Hadzic, it's very interesting what you do. As you says, if we retire the fail cathether, it will come a hematoma because of the elastic band, and it's a very inconvenient to get off the band. So i'm agree with your procedure and I think it's very wise.
What do i do?, well the use of eco for periféricas veins for non invasive procedures it's correct but it's very unconvenient , it's easier to cateterice a radial artery than a little vein because of it's fragility, we need to be more skillfull.
I'll try inicially your way for a small vein, and previously apply topic emla over the posible veins to take. Including the external yugular vein, that it's very helpfull and non invasive.
Hope this little tip would be usefull. Greetings.
Thanks for posting this!
Most welcome!
Much to my dismay, I was often called upon to start a difficult IV. You could easily tell it was going to be difficult because there was ample evidence that someone had attempted multiple times.
La cara interna de la extremidad superior cerca de la articulación con la mano en un área muy dolorosa al igual que la zona radial. Es menos doloroso el dorso de la mano. Es un detalle a tener en cuenta para dar comodidad al paciente al advertírselo.
The inner face of the upper limb near the joint with the hand in a very painful area as well as the radial area. The back of the hand is less painful. It is a detail to take into account to give comfort to the patient when warning him.
how long do you leave the failed catheter?
Good question. Once the new IV is taped, remove and compress for 1 min. Greetings and thanks for watching! And - do YOU Agree/ What do YOU do?
How to decrease the pain of iv canulation ??😊
Use emla cream. Apply some possible veins and wait for 15 ir more minutes. It's very helpfull
Great tip
Isn't that place a bit dangerous to get an IV? Because of the nerves
How that, For The baby or Child...
Super
Thanks. Greetings and thanks for watching! And - do YOU Agree/ What do YOU do?
Refer to interventional radiologist
I work in an ER and don't have access to esmark bandages; Can I use an ace wrap instead? If so, would you recommend a 4" or 6"?
Thank you for your videos! Bending the needles has helped tremendously in my PIV access attempts where I need to access a small, superficial vein and need a very shallow angle of attack.
Yes. You can use ACE wrap!
Use a warm compress (you can put warm water in clean glove)
Try to use BP cuff for few bp readings, it will pump veins with blood nicely, then squiz hand gently from upper to lower part, apply tourniquet once, then remove and let veins to fill up with the blood and apply again. Tighten the skin with your two fingers to secure veins from movements and to be more prominent and visible. Hope it will help🙏🏻😍
Esmark bandages not always available so putting the limb in gravity dependent position and do manual exsaguination works well ..
Alternatively using blood pressure cuff with venipuncture mode also does the job most of the times
Agree! Greetings and thanks for watching! Is that what you do all the time? Sometimes the BPP cuff deflates sooner.
@@nysoravideo Seriously I never faced problem of BP cuff deflation .. May be luckily I secure IV before deflation of cuff .. Anyways thanks for highlighting the valid point ..
I like to use inflation of BP cuff few times before insertion, its pumping the veins nicely and with the help of gravity works most of the time😍 Huge Thanks Doctor for the amazing channel and tips💖💜💖Great Job👍🏻🙏🏻
Surely you meant too FAR rather than too fast?
Going too fast resulted in too far. Can't rush when accessible veins are at a premium.
YES! Greetings and thanks for watching! And - do YOU Agree/ What do YOU do?