June 15, 2010

Can I Poke You With My Needle?

IVs. Generally one of the most used physical skills a Paramedic does on a regular basis. Medics tend to pride themselves on their IV ability--- I mean who else in the healthcare field can start an IV upside down in a car wreck, or while bumping down the highway in the back of a rig? None from what I can tell.


All other healthcare professionals tend to have a much more controlled environment when starting IVs. Nice, well lit, white wash room, with a patient sitting there, all the IV supplied laid out, and all the help you could ever want or need in the form of every other person in the hospital.



Back in my Medic clinicals, I was nailing IVs left and right. I seriously only missed at most, 1 or 2 a day out of 20 attempts. The ones I DID miss, I had the luxury of having much more skilled people at the hospital that I could pass the buck off to.



Yet, somehow, in my practice as a lone Paramedic, I haven't been able to hit a thing. I'm probably getting 1 out of every 3 or 4 lines actually started. There are some patients where I can't even get a line in. I have an EMT partner, so he's unable to help.


Take yesterday for example. I had a chest pain patient with T-wave inversion on V2 and V3, pain dull and radiating to L arm 9/10. Obviously I wanted an IV, so we load her up and bring her to the rig. I look at the left arm, and found an ok AC... just barely there, but I was going to go for it. Poke it in, no flash. Work it for a little bit (which I hate doing, but I hate poking again all that much more) still no flash. Pull it out and the patient starts letting loose all the blood that I wanted in the flash chamber, on to my ambulance floor. Darnit. Well, atleast I knew I was IN the vein at some point, just didn't know why I wasn't getting a flash. So I switch to the right arm. Try the AC there after finding nothing on the hand... no flash again.

I hate giving Nitro without an IV, but I had to, as she was still in pain.



I don't know what it is. Maybe it IS just because I'm in an ambulance instead of a hospital. Maybe it's because I'm just unlucky lately. Or maybe it's because I'm psyching myself out being the only person able to get an IV. But I need to definitely start working on being able to get a majority of IVs again.


I have a long ways to go before I'm the ace at IVs like Paramedics are expected to be.



So, on to you guys (the whole 2 I have right now :P ), do you have any special ways you like to do IVs? Special equipment? Vein you go for? Angiocath size?

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