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Thread: IV set ups and equipment

  1. #11
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    Thanks Fidel.MD for the correction. The first thing that happens when they come into our ER for N/V/D. I draw labs and start an IV. Some of the Docís has even let me start suturing on the ETOH Ptís

  2. #12
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    Quote Originally Posted by classeair View Post
    Thanks Fidel.MD for the correction. The first thing that happens when they come into our ER for N/V/D. I draw labs and start an IV. Some of the Docís has even let me start suturing on the ETOH Ptís
    Yeah. A couple of reasons for IV's getting started - some legitimate, some.....well, less so.

    Mainly, it's to have a ready portal for IV drugs, should they be needed - better to get access while you can, then have their veins collapse and have to work at it.

    Sometimes, people are just dehydrated, and a liter of fluid tops them up... The V/D part of NVD.

    But, think about this: A bag of IV fluid costs (retail) around $2.00, and the associated stuff to start it doesn't amount to $8. So, a very maximum of $10 cost (probably half that).

    Guess how much gets billed? WRONG, add another zero or two on the end.

    And much of the time, the fluids are not indicated at all. The last thing a patient in wet CHF (congestive heart failure) needs is more fluids. First thing they get, though.

    Or, paramedics will start an IV in the field, and some idiot ER nurse will remove it, and start another....because the one in the field wasn't started under aseptic conditions (I've actually tossed nurses out of my ED for that bull****). So, the patient now has two punctures.....which is how infection gets into the body, and ED's aren't sterile either.

    Or my personal fave, trauma responses where some nurse decides that their contribution will be the foley catheter of life..... never mind what the patient needs or the physician orders.
    Good medicine in bad places

  3. #13
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    Hey, now..... I have a few 'Doc stories'...
    leave the gun... take the cannoli...

    In times of strength prepare for times of weakness...

  4. #14
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    Our Doc's have standing orders or a protocol on what we can do for say Chest Pain. Like EKG, O2, line and labs and so on.

  5. #15
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    Yeah. And as soon as some physician can explain the logic in giving massive IV boluses to a patient that they've ordered lasix for, I'll kiss his ass.
    Good medicine in bad places

  6. #16
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    Quote Originally Posted by driftz240 View Post
    ivs are great after a hard night drinking...lol joking
    Its even worse, when joe starts tryn to mix vodka or margaritas in one!

  7. #17
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    Default Bringing this thread back from the dead to report...

    ...A Major Failure...

    Think I might have mentioned before that I basically developed and took my own "Self-paced IV Administration Distance Learning Course" a couple years ago. I got an "A". Just kidding, but I had bought the "Ditch Medicine Vol 1" DVD, and it looked fairly simple so I went online for more study, and then bought enough supplies for 8 IVs. After some early failures I started getting the hang of it, and was running out of supplies when Ebola hit the news last year so I decided it was a good time to restock, and might as well get double+ the amount.

    Just for some background, I tried to find the simplest and easiest method to start with, so I went with a small gauge winged infusion sets (easier one-handed operation than a catheter) and administering NS through the easy/shallow/protruding veins in the back of my hand since my arm veins are pretty small and don't plump up much bigger. The pros here might consider this almost useless for anything other than fluid maintenance or a route for IV meds given the small gauge of the needle and the small vein chosen, and if so they're probably right. About the fastest rate I can get is 750ml in an hour, but haven't tried putting it in under pressure like with a BP cuff on the bag either, but this was meant as more of a starting point for learning/practice than a final goal. Then again there's nothing wrong with starting more than one IV at the same time in different limbs either I guess. Anyway, I started off practicing at least once every month, but then started slacking earlier this year. It'd been about 3 months since the last self-practice session, so I finally decided on Saturday I needed to practice.

    Fail. Didn't advance the needle enough after I got into the vein, think it worked itself out while I was securing it with the tape/tegaderm but I didn't realize it at the time. When I started to flush the blood out of the tubing with the saline syringe the problem became apparent. But since the needle was still under the skin I decided to try taking another shot at repositioning it and getting back in the vein (never remove a needle completely and jab again with the same one), but it was harder to see the vein now with a little subq blood around it, and the vein wasn't as pronounced because I'd already taken the TQ off. Fumbled around trying to get the TQ back on (working one-handed, and a needle hanging out of my other) for a 2nd attempt, but finally gave up and admitted defeat. This was the second time I failed because I didn't advance the needle far enough in the vein so I'm pretty pissed at myself. It's also my first failure in the last 7-8 attempts which pisses me off even more. Going to go through the complete steps in mock (needle-less) sessions a few times this week, and at least one more time before I do this again for real in a couple weeks.

    Some pics from earlier this year, showing the way it's supposed to go. Gather the supplies and equipment:



    Open everything up, flush the IV tubing, apply the TQ, pre-cut tape into 6-8" strips, and prep the IV site:



    Venipuncture, allow the blood to fill the infusion set tubing, then re-cap the tubing, and secure the needle with tape and tegaderm:



    Attach the saline flush syringe and flush the lock:



    Remove the flush syringe, attach and secure the IV tubing, and set the drip rate:

    Everything marked, everything 'membered. You wait, you'll see.

  8. #18
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    I must say that in 25 years I've not used a butterfly as an iv catheter...
    leave the gun... take the cannoli...

    In times of strength prepare for times of weakness...

  9. #19
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    Quote Originally Posted by HatetosayItoldyouso... View Post
    I must say that in 25 years I've not used a butterfly as an iv catheter...
    Only on neonates...
    Good medicine in bad places

  10. #20
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    gratefully I don't work with that demographic ...
    leave the gun... take the cannoli...

    In times of strength prepare for times of weakness...

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