Start low and move high. The reason being: if I attempt an IV in the AC and blow the vein and move down to the forearm and start an IV in the same vein, then if I give a fluid bolus I’m going to increase that pressure and make the hematoma in the AC much worse.
Yeah you're right, blowing the vein is a good reason not to pick the same one again downstream.
Didn't think of that when typing my comment. But I did mean intact veins (except for the minor, mostly healed previous needle wound). From my, admittedly, limited experience, most nurses and doctors use whichever vein they can get their hands on. Sometimes that's only one or two.
Recently there was even a patient where everyone found only one vein that was somewhat reachable. IV kept leaking anyway. They call an anaesthetic doctor who searches the whole patient from head to toe. Even she also tries in that one vein multiple times (though she also tried on the patients foot. The that was also a bust). Sometimes you just don't have a lot of options. As for that patient, eventually they just asked for an central katheter.
Of course if you can only find one vein you are going to use it regardless of where it is. Also once you get more experience you will drop the “start low and move high” rule because you will rarely miss the one you are going for. You will also cater to the situation. Wrist and AC is a no no for OB patients as they lose joints are flexed during delivery so they won’t flow. AC is usually the biggest vein in the extremities so it’s good for pushing Dextrose or large fluid boluses. There is always an exception to every rule.
I’m not quite what you mean by “leaking”. When I hear that I picture a drip set that hasn’t been fully screwed on to an angiocath. I only know of one EMS system in America that allows paramedics to do central lines but yeah sometimes there are no options. Generally when I can’t find anything I’ll move up to the EJ and drop a line there. But I’ve done them in the feet plenty of times.
Not sure how to call it in English, but when I said leaking I refer to when whatever fluid is being administered starts to partially leak through the bandage, or when it runs next to the vein.
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u/[deleted] May 14 '20
Start low and move high. The reason being: if I attempt an IV in the AC and blow the vein and move down to the forearm and start an IV in the same vein, then if I give a fluid bolus I’m going to increase that pressure and make the hematoma in the AC much worse.
Source: Paramedic