Resources of peripheral IVs
Does anyone have additional resources learn Peripheral IV insertion
I like these...
I would make a couple of recommendations….. first take and use two tourniquets at once and tie them in a square knot… then I slide it over the patients hand and when finished cut it off with scissors…. this does a couple of things… makes a big thick vein, allows me to get the tourniquet tight enough so that it causes discomfort in the patient… if it’s too loose then i put a tongue depressor into the tourniquet and twist the rubber like a military tourniquet to get it super tight and very high on the patient…. almost to the deltoid. Also since I will be using lots of gel it will prevent the problem of scanning up on the arm and getting gel on the traditionally tied tourney and it falling apart.
I tell students… think of it like a peach… it has to be plump and super ripe. A thought is I don’t know what this does to lactic acid, K+ levels or cell counts.
make sure the bevel is up.. the tip reflects sound and will make it pop… also with bevel up the needle won’t slide over the top of the vessel, the sharpest point is toward the vessel.
Use beam steering and manual beam steering…. the needle will be most echogenic running parallel to the transducer, therefore use lots of gel and the ski-slop technique to maintain contact with the skin and gel while becoming parallel to the needle.
consider the BD Mid line… the wire inside the needle is more echogenic… only use the 10 cm catheter… bonus they are good for longer (4 wks if i’m not mistaken)
Teach the mapping technique… use a sharpie (alcohol content make them aseptic) and mark off and dot on the vessel proximally and to the same thing 3-4 cm distally… connect the two. Show the students that by following that line keeps the vessel in the middle of the screen when “running up and down the vessel”. this gives the “Lie” of the vessel, and the trajectory insertion should follow this path.
What ever way works for the learner is ok with me… but I always use the technique where I start in transverse “follow the tip” until I know I have the point right above the middle of the vessel … use the bounce to confirm. next practice with the learner turning from the transverse to the sagittal, while keeping the vessel in the middle. practice on the phantom the object of the game is to have “railroad tracks”. that means the vessel walls parallel. Once they have the railroad with the probe in the left hand, this hand does not move. the only thing that move is the needle hand. if the needle doesn’t light up and you have railroad tracks, wiggle the tip left and right until it lights up, then advance.
Reinforce bracing the probe hand on the patients body.
There are a couple of schools of thought but when transitioning between the Axial plan (marker on my left) I prefer to turn the probe so that the marker is closest to me… that way the needle is coming in on the screen in the sagittal from left to right… it just seems more natural to me.
I don’t use local anesthetic, it will
In large patients that don’t have much catheter in the vessel use derma bond/sure-close/cyanoacrylate to adhere the hub to the skin… to remove, use acetone wipe. Also use Coban to secure.
I think key is practicing on the pork shoulder phantom… getting the flip and just practicing for an hour on which way is up and down and how to make the needle move the way you want is priceless.
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