How to insert difficult IV or draw blood sample in patients with difficult veins: Best technique
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- čas přidán 29. 08. 2024
- Intravenous access
There are several different methods to facilitate an IV line placement in patients with difficult peripheral IV access. Of course, you can use ultrasound to find and cannulate a vein in a difficult patient, but this requires a considerable amount of skill, equipment, and TIME. And frankly, you would not make the surgeons happy by wheeling in an ultrasound machine when the case is already delayed. In this video, Dr. Hadzic teaches his street-smart, a surprisingly little-known technique, that is much simple and faster than ultrasound.
4:04 Difficult veins: Case #1
5:52 Difficult veins: Case #2
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Disclaimer:
Medicine is an ever-changing science. As new research and clinical experience broaden, changes in treatment and drug therapy are required. The authors and publishers have checked with sources believed to be reliable in efforts to provide accurate information within the available or accepted standards of care. However, given the possibility of human error or changes in medical practice, neither the authors nor the publisher, nor any other party involved in the preparation of this platform warrants that the information contained herein is in every aspect accurate or complete, and they disclaim all responsibility for any errors or omissions for the results obtained from the use of the information contained in this work. Readers are advised to confirm the information contained herein with other sources. For example, readers are advised to check the product information of each drug mentioned, and that any information contained on NYSORA's CZcams channel is accurate.
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As an intern, to avoid difficult cannulation, apply three cotton balls with tape to both arms and get someone better to do it.
Now that’s funny!
That's cheating hawu😂
@@buyimncube2588 I think thats what some of my nurses do and then call me to start their IVs.
Negative. You have to make mistakes to improve. If anything the less experienced should be the ones called over to start an iv or get a blood sample. If you baby them and have others do their job they will never be mere than they are at that moment.
Haha i might use this technique someday 😃
I made my entire EMS department watch this video. Each and every Paramedic is thankful. Its standard in the field now for difficult sticks. Success has been 3 fold. Thank You!
So happy to hear that! Thank you for sharing!
Have you outfitted your organization with these style constricting bandages?
do you guys carry the esmarch on your ambo? im trying to think of anything my service has that would be similar and im drawing a blank
@@rachelgrace4346 you can use an ace wrap in a pinch
@@rachelgrace4346 you can stop by the physical therapy department at the hospital and ask for a few feet of theraband. I'm sure they would oblige you
I'm a recoverd 17 year I.V. heroin user. I've been hospitalized many times and I've taught a couple nurses how to hit difficult veins. I'm very good at it!
I listen to my patients because they know their bodies. Works all the time
Good luck, I’ve had addicts and my first question to them always is “Where’s your best vein, bud?” Unfortunately, inevitably it’s “I don’t know, they’re all bad now”. Damn it!
czcams.com/video/3krE0-hW7yI/video.html💥💥
I get addicts in the ER and if they're not currently high they've all been super super nice about finding veins with me! I'm not that good yet so I usually ask for help anyway, but then at least I can tell them where to try first
When patients start talking about which veins are good ones I know they are either a nurse or have a history of iv drug abuse.
I used to work in pre-op holding. Started a lot of IVs. Used BP cuff, warm blankets & hung arm down for gravity assist when faced with a difficult start. Some veins are just difficult to access despite your best efforts.
Yes. Some are a hardstick but the vast majority of issues is the result of the dumbass hospital keeping it stupid cold. When they pull their heads out of their ass then starting IVs won't ever be an issue but there will always be a few patients that their veins are too small for the gauge or their veins roll but generally speaking if the dumbasses turn the temp up that solves the problem because it will allow the veins to deconstrict.
@@pabloblanco2656 Amen to that.
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I was having a surgery on my arm and they tried to start an IV on me and all the nurses tried and then all the doctors in the emergency room tried the only one who could get a vein to work for me was the anesthesiologist he got it way up in my arm and when he put me to sleep they started a better one
Your incredible comments and support are much appreciated! If you or your nurses or colleagues are having trouble with IV access, the new NYSORA IV Access App is here to assist. Try it free for 7 days and give us your feedback. Let's master IV access together! www.nysora.com/iv-access-app/
I’m a paramedic, just went from the city of a tops 10 min transport to the county of at least an hour transport. I can definitely see myself taking out ace bandage and trying this once or twice. Great!
Good luck to you! I've got several good friends that have made the switch (or cover some shifts in rural areas) and while it certainly can change how you practice, most of them enjoy having the ability to actually use their skillset before arriving at the hospital!
have you tried it yet?
@@j.elliottcole9506 I have! Not as often as I would like, but I have used this method a few times. It does help!
Thank you for watching. If you found this video useful, make sure you watch this video czcams.com/video/9gugbodXdVg/video.html on "Difficult IV access" for complimentary information. And do not forget to SUBSCRIBE and never miss new releases. Greetings from NYSORA!
Your incredible comments and support are much appreciated! If you or your nurses or colleagues are having trouble with IV access, the new NYSORA IV Access App is here to assist. Try it free for 7 days and give us your feedback. Let's master IV access together! www.nysora.com/iv-access-app/
I just shared this on my phone with a prep op nurse in between my cases. When I returned to retrieve my phone, I see that she is sharing the video with 3 other nurses. I am sure all the preop nurses in our hospital will know this technique . Thanks for sharing the great video and knowledge.
Glad it was helpful!
We truly appreciate your awesome comments and support! If you or your nurses or colleagues are struggling with IV access, the new NYSORA IV Access App can help. Enjoy a 7-day free trial and let us know how it goes. Together, we'll excel in IV access! www.nysora.com/iv-access-app/
I'm a former emergency nurse and now nurse anesthetist and I have a very high success rate with IV but sometimes I have to cheat with ultra sounds. I will try this very intersting technique as soon as possible! Thanks!
Glad it was helpful!
@@nysoravideo Done! I have used this technique today! Very effective!
@@Tibosan2 Thank you for sharing. If you found this video useful, make sure you watch this video czcams.com/video/9gugbodXdVg/video.html on "Difficult IV access" for complimentary information. And do not forget to SUBSCRIBE and never miss new releases. Greetings from NYSORA!
Where ur working ? Give me details about nurse anaesthetist
@@muhammedshakir7873 bonjour, je pense qu'il travail en France. Je suis aussi infirmier anesthésiste, c'est une spécialité (2 années universitaires supplémentaires )de la profession infirmier. Cette profession existe dans quelques pays européens mais pas dans tous.
Bye ;)
I decided to watch this after a hospital visit to the VA hospital. The nurse was trying to draw blood and put an IV in me. She was unsuccessful in my left arm several times. It started to hurt after the 4rth unsuccessful poke and I told her to stop and just do the right arm. It took another unsuccessful poke and another nurse to get the job done. I wish the first nurse would watch this because she didn't even care about keeping the patient warm. I was shivering and maybe that could of helped her draw blood easier along with this method.
Thanks for sharing Jorge.
This is the best IV technique I have ever seen. We have done the double tourniquet and BP cuff but not walked the blood down distally.
Indeed. Thank you for your comment! Make sure you subscribe to the channel so that you do not miss some super educational upcoming videos!
Thank you for watching. If you found this video useful, make sure you watch this video czcams.com/video/9gugbodXdVg/video.html on "Difficult IV access" for complimentary information. And do not forget to SUBSCRIBE and never miss new releases. Greetings from NYSORA!
Your incredible comments and support are much appreciated! If you or your nurses or colleagues are having trouble with IV access, the new NYSORA IV Access App is here to assist. Try it free for 7 days and give us your feedback. Let's master IV access together! www.nysora.com/iv-access-app/
As a Paramedic I want to add in that veins don't wiggle, roll, run away, etc. Can they spasm or be moved/pushed by a needle before it punctures the vein? Yes...
Is there anything we as providers can do about these issues? ABSOLUTELY!
Holding traction on a vein, preferably at 3 points (2 minimum, above & below the insertion point) and keeping that traction until the cannula has been fully inserted typically makes the difference between a successful attempt or having to stick a patient again.
Also, PRACTICE! In the beginning it doesn't even need to be practice sticking, but take your tourniquet home and practice finding/feeling the veins of anyone that will allow you to try! If you learn what veins feel like (that soft, sponge like, slightly bouncy feel - everyone explains it differently) plus learn to feel for valves, bifurcations, etc. You'll be much better prepared for whatever situations you may come across. Some of the best veins can be felt but are not particularly visible!
This video is great! While it's "low-tech" that's exactly the type of continued learning & teaching we should all be doing because it's accessible most anywhere at anytime!
People in healthcare are dumbasses these days. All it takes is don't keep the stupid hospital so cold and you won't have any issues. It's an easy fix problem.
@@pabloblanco2656 Simply not true.
@@ronthompson9036 L o L more indoctrinated right is wrong and wrong is right. The rejection of truth has been solidified
Hey Ladymadecrazy! Greetings! And thanks for watching. Do subscribe to this channel as there's more coming up. And let's share the collective experience so that we all get better in what we do!
Thank you for watching. If you found this video useful, make sure you watch this video czcams.com/video/9gugbodXdVg/video.html on "Difficult IV access" for complimentary information.
Bravo doktore, nema, sto Balkanac smisli ne može niko. Svaka čast 👍
I'll keep you posted after trying this technique in my cancer patients. 😍 Thank you
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As someone who very much dislikes no is tormented by the thoughts of IV and any needles because I was on dialysis for almost 11 years. I was diagnosed with systemic lupus nephritis which completely ruined both of my kidneys and overall health. I had both arms destroyed by procedures in which they tried to get fistulas and or grafts. I remember when they did this green light to track my veins which made it a lot easier to find it and get an IV or draw blood. I have been poked by different people for years and I always tell them to please use a butterfly needle. I have had some less compassionate people one who told me that I should stop being scared and he poked me digging .I yelled at him to stop because he was hurting me. He called me a big baby and started laughing at me. I wish they would implement this every where especially for people who have trouble like myself. It would definitely help ease the anxiety of the over poking.
I’m sorry for the rude and unprofessional behaviour you’ve experienced. This is not acceptable
Your wonderful comments and support mean a lot to us! If you or your nurses or colleagues are struggling with IV access, check out the new NYSORA IV Access App. Try it free for 7 days and give us your feedback. We'll master IV access together! www.nysora.com/iv-access-app/
This is a technique that can be used even in the most resource limited settings. Nowadays there is too much reliance on technology but not everyone has access to ultrasound. Thank you for showing this useful technique.
And yes, anything that happens amiss is always blamed on the anesthesiologist. 😅
Totally agree.
Thanks so much for your amazing support and comments! If you or your nurses or colleagues are facing tough IV access, the new NYSORA IV Access App has got your back. Try it free for 7 days and share your thoughts with us. Let's ace IV access together! www.nysora.com/iv-access-app/
I appreciate your video. I am someone who has terrible veins and always get nauseous from the digging. Now I can show your video which takes less time to watch then dig in my arms and hands for a vein.
Glad it was helpful!
I have really terrible veins and am on IVIG so I will definitely save this video in case we have trouble with my veins again in 2 weeks. I have had to cancel my treatments before becUse we couldn't hit a vein.
I am in paramedic school now and currently practicing IV's on a fake arm (the veins actually fill with fake blood, it's pretty cool). So far it has been pretty easy to locate a vein because it is basically Shaq's arm 😂
I want the real deal! An 80 y/o F with diabetes and edema. I'm glad this video delivered, and showed actual IV situations. TY
Glad it was helpful!
I am a very difficult patient to start an IV. Thank you for educating me on ways to help nursing staff start my IV! Thank you!!!
Thanks so much for your amazing support and comments! If you or your nurses or colleagues are facing tough IV access, the new NYSORA IV Access App has got your back. Try it free for 7 days and share your thoughts with us. Let's ace IV access together! www.nysora.com/iv-access-app/
As a surgeon- thank you for your service!
Big thanks for your fantastic comments and support! If you or your nurses or colleagues are having trouble with IV access, the new NYSORA IV Access App is here to help. Enjoy a 7-day free trial and tell us what you think. Together, we'll nail IV access like pros! www.nysora.com/iv-access-app/
After watching this video I cannulated all difficult paediatric cases. Thank you for this video. So helpful.
Glad it helped!
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We need more anesthesia providers with the willingness to speak truth to power. Thank you for “standardizing,” the level of care given to the pt. presenting with hip fracture/advanced age. Mom fractured her right hip February 2020. Dad his left April 2020. Mom fractured her left hip August 2020, and died at home in November. Both received “spinal,” for the first surgery and did very well. Mom received general/endotracheal for her second-she did not recover from the cognitive decline.
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To Harold Marks: Spinals work well for uncomplicated hip procedures lasting 2 hours or less (the duration that a spinal works). If it is a complicated surgery lasting longer than two hours a spinal is not a good choice in any circumstance.
@@RR-ge9ds who did not know that! You are preaching to the pope.
I used to be a patient care assistant and ever time no one could draw blood on the patient, I have my own technique for Pre-Op patients for difficult veins. I used to used almost the same technique or sometimes a double torniquetes. Whatever works and whatever gives you the best option for you to succeed.
This was outstanding, Now that I'm Nursing school I will definitely use this video again and show to my classmates when is time to do IV drawn.
Thank you.
So happy to hear it helps! Thanks for sharing!
Big thanks for your fantastic comments and support! If you or your nurses or colleagues are having trouble with IV access, the new NYSORA IV Access App is here to help. Enjoy a 7-day free trial and tell us what you think. Together, we'll nail IV access like pros! www.nysora.com/iv-access-app/
Very successful technique!!! I'm taking the time to make sure I share that, because what took me 45 minutes before just took me 10. And only that long cause I had to watch this.
Glad it was helpful!
Thank you for watching. If you found this video useful, make sure you watch the latest release with complimentary information czcams.com/video/jzbJXvnuH-c/video.html And do not forget to SUBSCRIBE and never miss new releases. Greetings from NYSORA!
Thank you for all your fantastic comments and support! If you or your nurses or colleagues are struggling with IV access, be sure to check out the new NYSORA IV Access App. Try it free for 7 days and share your feedback! Let's master IV access together! www.nysora.com/iv-access-app/
I've never seen an esmarch bandage after 15 years. I rarely try the blood pressure cuff trick, but after watching this I think I'll start using that.
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Going to college next year for lab technician, I can't get enough of videos related to veins, needles and such..thanks
Great to hear that! Best of luck!
Interesting! As a patient with capricious veins, I'll remember this video and try to teach this to the poor nurses who irremediably fail to put an IV in next time!
Your wonderful comments and support mean a lot to us! If you or your nurses or colleagues are struggling with IV access, check out the new NYSORA IV Access App. Try it free for 7 days and give us your feedback. We'll master IV access together! www.nysora.com/iv-access-app/
I am very difficult to find. My veins are very small and tend to slip aside at attempts to venipuncture. I am considering purchasing my own Esmarch strap and bring it with me. I can "coach" the people on how to apply it on me. It beats a venous cutdown!
This is a great video. In addition, I would also suggest that the staff gently "prevent" the vein from sliding away from the needle during placement. This can be done by putting another finger just proximal to the insertion point over the vein to "hold it down."
A "sliding target" is always harder to get.
Sanjosemike (no longer in CA)
Retired surgeon
Thank you for sharing!
Great tip! Thanks for sharing
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We appreciate your amazing comments and support! If you or your nurses or colleagues are having trouble with IV access, the new NYSORA IV Access App is here to help. Enjoy a 7-day free trial and let us know your thoughts. Together, we'll become IV access experts! www.nysora.com/iv-access-app/
Excelente técnica! La he probado con pacientes propios y he ayudado a más de un colega a encontrar accesos venosos en pacientes difíciles. Fácil, rápido y efectivo!!! Saludos desde Argentina.
I am such a HORRIBLE STICK!! It takes a few nurses however many times they want to try, then we try ultrasound or go for a P.I.C.C. I am actually used to it by now and I help out as best I can!!!
Thanks for sharing Dana!
Your videos helped my alot. And gives me confidence to try iv replacement ☺️ . As It is the most important thing in any health care facility
Thank you Dreamer! Glad you like the video. Thank you for watching. Do subscribe to this channel and share with your colleagues; a lot more videos are coming up - let's share our clinical experience! Cheers!
Nice video! Once I started using the ultrasound, I haven't missed an IV once (in MONTHS). I love that machine!
Thank you for sharing!
You are a true hero
@@DieWolf57 I try my best ;)
We appreciate your amazing comments and support! If you or your nurses or colleagues are having trouble with IV access, the new NYSORA IV Access App is here to help. Enjoy a 7-day free trial and let us know your thoughts. Together, we'll become IV access experts! www.nysora.com/iv-access-app/
Very informative. I'll try using a ace bandage in worst case scenario. Dealing with CKD, low EF's and fluid overload can be challenging to draw labs or insert new IVs
Thanks, let us know your experience with this technique
Thank you for watching. If you found this video useful, make sure you watch this video czcams.com/video/9gugbodXdVg/video.html on "Difficult IV access" for complimentary information. And do not forget to SUBSCRIBE and never miss new releases. Greetings from NYSORA!
Your wonderful comments and support mean a lot to us! If you or your nurses or colleagues are struggling with IV access, check out the new NYSORA IV Access App. Try it free for 7 days and give us your feedback. We'll master IV access together! www.nysora.com/iv-access-app/
Videos like these are great for paramedics cause we just simply don't have ultrasound or vein finder available to us (in most systems anyways). Thank you for sharing this. I'd never seen the technique of actually bending the needle before
Glad you like them! Greetings to you and all your colleagues from NYSORA!
Hervorragende Technik !!! Es ist so nützlich !!! Ich werde mit den Krankenschwestern teilen und ich werde mich auch bei meinen Patienten bewerben !! Vielen Dank, dass Sie all Ihr Wissen teilen !!!
As a pediatric nurse who works exclusively on a vascular access (IV team) I would never recommend placing IV’s in someone’s wrist like that. There are many nerves in that area and the risk for permanent nerve damage is very high. Please be mindful.
Hi Cactus Flower! Point well taken. Thank you for sharing. Indeed where venous access is available elsewhere it's preferable. However, superficial location of these nerves in expert hands and with small IV catheters can be used with relatively little risk. Greetings to you and your colleagues!!
That is very true. My nerves got permanenntly damaged during an insuccessful cannulation. The nurse was going way too deep in the in the antecubital vein and then she shot the saline solution in my arm multiple times despite not being in the vein. I was screaming in agony. In the end she got mad and started cursing and left me there on the bed without anything on my arm. Needless to say, there was obviously bloos everywhere. Then another nurse came and she said let's just draw blood and do exams and if she needs to stay in, then we will try again with the iv. Anyway, after that i went home because the results were okay. But my arm was so swollen for weeks. I didn't develop a bruise because she was who knows where but not in the vein. But after that i had severe tussue inflamation, i had to use a cream and my nerves never healed.To this day, if i touch a particular spot on my forearm it tingles and starts to slightly hurt.
I'm just a patient but find this very interesting especially after so many failed attempts, over many years, at cannulation. My worst was just yesterday when the cannulator at my CT scan said the vein had “popped”. He didn’t say, ‘I’ve popped the vein.’ Apparently I have visible but fragile veins - something which no one has ever stated before. More training should be given to medical staff who perform this task.
Excellent video.
Very happy to hear that these videos could help!
We have plenty of training. You clearly have a lack of understanding. Everyone wants to pretend they are unique, but I assure you that your vascular system is not.
Every patient is different. Even with massive training, if it's a difficult patient, it's gonna be a hard time too.
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Thank you for all your fantastic comments and support! If you or your nurses or colleagues are struggling with IV access, be sure to check out the new NYSORA IV Access App. Try it free for 7 days and share your feedback! Let's master IV access together! www.nysora.com/iv-access-app/
I'm just a medical assistant student and pretty soon I'm going to have to learn to give IVs what this is is fully brilliant.
We are happy you find these videos helpful! Thanks for sharing!
And when you qualify you will be as uncaring and heartless as the rest of them.
@@flowerpetals1396 let's hope so it's their skills and knowledge you need not someone to hold your hand
We truly appreciate your awesome comments and support! If you or your nurses or colleagues are struggling with IV access, the new NYSORA IV Access App can help. Enjoy a 7-day free trial and let us know how it goes. Together, we'll excel in IV access! www.nysora.com/iv-access-app/
Thanks for sharing. My veins r very thin and difficult to find, and this made my hospital stay extremely hard twice..with this technique I now have some relief in mind..
Hi Sarita Joshi! Greetings! And thanks for watching. Do subscribe to this channel as there's more coming up. Greetings from NYSORA!!
Great, I will use it in the next patient with poor veins👍
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Thank you for all your fantastic comments and support! If you or your nurses or colleagues are struggling with IV access, be sure to check out the new NYSORA IV Access App. Try it free for 7 days and share your feedback! Let's master IV access together! www.nysora.com/iv-access-app/
I love it and thanks for sharing. I am sure many people would benefit from this vedio.
You are so welcome!
Big thanks for your fantastic comments and support! If you or your nurses or colleagues are having trouble with IV access, the new NYSORA IV Access App is here to help. Enjoy a 7-day free trial and tell us what you think. Together, we'll nail IV access like pros! www.nysora.com/iv-access-app/
Wow I’m impressed!! I had surgery last week and the Anaesthetist couldn’t get a cannula in. I did warn him in advance that he would have problems. This is a problem I have whenever I have surgery, in the past I’ve had two Anaesthetists try and get a cannula in and I ended up with a cannula just over my outer wrist bone which was very painful when the Anaesthetic went in.
I used to be sedated for dental treatment and the anaesthetist there could never get a cannula in either, so he had to put me to sleep with gas.
I was told by the Anaesthetist last week that if he couldn’t get a line in that he would have to get the ultrasound machine in to locate a vein. On his first attempt he told me he had popped a vein in my hand and it looks all bruised now, but fading, he managed to get a line in on his second attempt on my left forearm on the inside. A few days before surgery I had to have routine blood tests and the nurses struggled to draw blood, it took 2 nurses several attempts and several needles later they managed to get one vial of blood. I’ve had 26 surgeries now and it always seems to be a problem.
I’ve had Phlebotomists take blood and can do it first time!!! Maybe they should be anaesthetists??!!!!! Lol
Drawing blood is much easier than placing an IV.
Rarely is it difficult to actually puncture a vein to obtain blood, the complicating factor with an IV is poking it just deep enough without going through the backside of the vein to allow the IV catheter to carefully slide into it… without slipping out during insertion
- as an ex-phlebotomist, now an anesthesiologist
@@timdunagan8230 really, you must be super good at it then. I’m having a bad time atm as I need dental treatment and I’m local anesthetic resistant . So have to wait 18 months to see a dentist that can sedate me! Meanwhile I’m in pain!!! No fun at all!!
Your wonderful comments and support mean a lot to us! If you or your nurses or colleagues are struggling with IV access, check out the new NYSORA IV Access App. Try it free for 7 days and give us your feedback. We'll master IV access together! www.nysora.com/iv-access-app/
Thanks for this, an interesting use of the Esmarch bandage, and I might well give this a try next time there are surgeons pacing up and down peering through the window of the anaesthetic room as I'm onto my sixth cannulation attempt...! Just to flag up, in your second case study the patient's face is briefly visible (alebit under a FRSM) whereas all the other participants' faces are blurred out - not sure if that was deliberate as the patient didn't mind, but thought you'd like to know. Keep up the good work, this is a great video.
Thank you! All patients signed consent for recording video and sharing for teaching purposes. Regardless, showing participants' faces is not necessary, and we are very grateful that just about all our subjects are happy to contribute to the education. Our postproduction staff does their best to blurr and de-identify, but a sharp eye always detects an omission or two. Thank you again and best regards.
Thank you for all your fantastic comments and support! If you or your nurses or colleagues are struggling with IV access, be sure to check out the new NYSORA IV Access App. Try it free for 7 days and share your feedback! Let's master IV access together! www.nysora.com/iv-access-app/
Beautiful. I'll give this a shot. I've been having quite difficult access patients lately 🤜🏽🤛🏾
I hope you find it helpful!
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Thank you for all your fantastic comments and support! If you or your nurses or colleagues are struggling with IV access, be sure to check out the new NYSORA IV Access App. Try it free for 7 days and share your feedback! Let's master IV access together! www.nysora.com/iv-access-app/
Great video. Two hot tips...bend the needle, and "wrap the arm." I have been a Dental Surgeon for 48 years, and have done over 8,000 I.V. surgeries, and I can tell you, any little technique tip is welcome. Dr. W.
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So cool. That is defo a must to be taught in schools
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Great ideas, i went to 1 year school 1000+ bed hospital to be an IV RN. Included pharmacokinetics. Tapping I always used. I always would start distal & work proximal. Now everyone goes for ACF, ruining other sites. So when I worked in OR-many times anesthesia would say “ do you mind” -of course not. Team efforts. Like you lowering angle is very important as well as direct( above vein) or indirect ( where a bifurcation might occur. Many forget about basilic vein , standing behind patient. Please do not misconstrue with egoism. It is a valuable skill set. Everything from 16 ga-30ga. Esmarch is great idea. Great video
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Even if it has nothing to do with you, it is an anesthesia delay. Truer words were never spoken.
I'm a home health field nurse so I'm on my own with no technology. I will definitely be trying this technique. I don't have an Esmarch but I'm sure Coban will work in it's place.
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Heck! I wish one was used on me! I eventually had a PICC line put in and got a Massive infection in 2 days later. My temp was 103° for at least a week before I was admitted. Besides the fever, the chills were excruciatingly painful. I hope never to be that sick again.
I like this ace bandage idea for vasculature that just won't inflate, particularly the elderly or those in shock.
We shouldn't have to bend the needle (risking fissures or separation from base) if the angle of entry starts parallel to the skin, then 10 degrees down. Most errors I've seen is a 45 degree entry that goes right through an oval shaped vessel. When I had surgery, there were four attempts to start my IV while I watched that 45 degree angle push into my hand. The anxiety level of the staff was escalating, and I was worried he would ruin all access points with bad technique, so I said calmly, "I draw blood all the time, so let me talk you through it. The blood vessel is just under the skin, barely 1/8 of an inch, for lean people like myself, and variably deeper for obese, but not so deep it's in muscle. First, when you pull the skin taut, don't put your thumb over the vessel feeding your access site because even with the tourniquet, you're inadvertently shutting off the flow to the vein with your thumb. Instead, pull the skin from either side of the feeding vein. Next, when you push the needle down on it, the blood vessel will go from round to slightly oval because it's pliable. If your angle is too steep you'll pass right through the vessel to the other side. Come in shallow until you get a flash, then level out." To his immense relief (and mine), he got it during the tutorial and I was wheeled away to la-la land.
You did mean to say start parallel then go 10 degrees? We were taught 10-15 to start then level out once in. I love your explanation!
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I do CT scans, some times they are very difficult because the great amount of contrast that we use in a very short time, and the veins must be enought big to this propose. And with oncology pacients is the worst because the chemiotherapy debilits the veins. I will try with my coworkers this metod. Thanks
For real I do mri scan. These patient will literally complained about how “they just did their lab work and it was easy and quick “. And I’m like drawing blood and injecting contrast in the veins are not the same smh. If the that veins ain’t strong enough for the contrast it will blow .
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Hvala Dr Hadžić, odličan video! Puno pozdrava!!!
Pozdrav!
Thanx a lot!
By the way our surgeons are really understanding and always have no problem with waiting:)
lol, is this a joke? and i have no problem waiting for a med student to close a ventral hernia repair....
thats awesome, sounds like our ct surgeons! they stay in house in the unit and do rounds on their patients all night to make sure everything is going good! they also always bring the staff fairy dust and golden coins as treats!
czcams.com/video/3krE0-hW7yI/video.html💥💥
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The blood pressure cuff allows greater control over pressure applied. I use the BP cuff exclusively. It is also very helpful when the walls of the vein are thin and applying too much pressure causes them to burst.
Good point!
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The best technique to succeed is... to have no other choice but succeeding. I've never been the best at "canulation" through my GP residency. But when I was alone at the 3am taking care of a pregnant woman in septic shock because of pyelonephritis I succeeded an arterial blood puncture first try (for blood gas analysis) in the ulnar artery... only to realise 10 mins later that I accidentaly chose the ulnar artery instead of the radial one. And her blood pressure was something like 60/30 mmhg.
It was such a powerfull moment. It needed to be done, I had no other choice... Boom. Done.
I used to suck at arterial blood punctures, still do under normal circumstances though.
Well said! There really is something powerful about moments like these, when you're put to the test and have no choice but to make it happen. Kudos for making sure your patient had the best possible care, and best wishes from all of us at NYSORA.
Here in the Philippines we use shoelace for tourniquet and so far in our er department we had 90 percent success rate
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Great tip to help with IV access. I will definitely be trying this. One criticism however, your colleague appears to be placing a Bair Hugger hose under the blanket without the use of a warming blanket, commonly referred to as "hosing" the patient. This has led to burns and should be avoided.
Agreed. Ideally, it would be a forced-air device into a specialized full-body warming blanket. Unfortunately, this would be impractical and time prohibitive in many of our fast-paced OR cases where patients are fully awake and able to advise on too much or too little heat. Thank you for the comment and do the Reverse Esmarch. We have been releasing also some low-tech clinical pearls. I am personally always surprised to learn that trainees and practitioners have seen or heard of these. Best
This patient is awake for IV placement and would be able to verbally tell the staff if he became too hot. On an anesthetized patient I agree with you. But he is suggesting this for IV placement alone so they can induce the patient. In this circumstance I don’t see it as a problem.
@@Love-ql7rd k...but non verbal, un responsive and the intellectually disabled also get surgery when it's required.
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Salut, je ne connaissais pas cette technique mais finalement cela me paraît logique ;)
Je vais essayer et je te dirai mon expérience.
Merci beaucoup et à bientôt.
IV certified, great series. Some require indirect approach or directly at bifurcation. They blame anesthesia, when they never are properly tra, always use ACF
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I love how they show an ideal youthful arm to place an iv in lol
Thank you for sharing. God bless you sir.
You are very welcome!
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Thanks for the new method of venipuncture 👍👍
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first time i did it, it went awesome, second time i did this, it went really bad, the guy i was to train on had really difficult veins. Tomorrow im going to ace it, following your tips. Thanks!
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I am sure you meant … above the Diastolic pressure - if it’s below the “diastolic” [as you say 2:37] then the blood will flow out as well as in and hence nothing to cause congestion and distension of the veins which is what you want.
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Filipino Nurses be like: Hold my coffee and lemme do it 😂
Lmao the truest thing I've ever heard.
Mexican ones will be like hold my snacks
Aw they are the best, never fail 🤣
This is good for the OR but in the ER most patients will refuse an iv placement at the inside of the wrist. Also not very useful to get large bore IV's in the ac which are preferred for emergencies
I was thinking the same. I’m a new grad working in the ER. We usually stick to the AC, forearm or hand. Wrist is a last resort. I’m trying to find videos that can help me because I’m awful at IV sticks unless the patient has excellent veins.
Any IV is better than no IV. I think your comment is ill informed.
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Thank you very much for this kind of video. It is always outstanding to learn from you!
Glad you enjoyed it!
We’re excited to share that NYSORA’s Difficult IV Access App is now available on the Apple Store and Google Play. Written by anesthesiologists, it’s packed with countless tips and clinical videos on how to successfully access tough veins.
We warmly invite you to test drive the app for one week for free and let us know what you think. We believe this app will be immensely helpful to you and your colleagues. Download the app for free, share it with your colleagues, and let’s all improve our IV skills together www.nysora.com/iv-access-app/
I can’t be so thankful for this video, after I watched, I did a canula to a patient with very difficult veins, no even support workers or Dr manage to canulate her. I am health care assistant and this video helps to do it 😁
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Thank you, Its a great video and great timely presentation
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I have those veins, so small and tiny....Drug addicts can handle easily those problem and i saw with my own eye in the hospital after all the nurses gave up
Idea of using BP cuff is also great..will surely try it
Hi Ishita! Thank you! Your comments are much appreciated!
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Great technique ❤❤❤
Hi Nipuni! Glad you are enjoying the content. Appreciate your feedback!
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I’ve never seen someone bend the needle omg. Didn’t know you could do that!!
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Excellent technique!!! its so usefull!!! i will share with the nurses and i going to apply to my patients too!!thank you very much for share all your knowledge!!!
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This is wonderful. Thank you very much.
Glad you enjoyed it!
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Thank you sir. Im so grateful i will not panic in search of a vein again
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We’re excited to share that NYSORA’s Difficult IV Access App is now available on the Apple Store and Google Play. Written by anesthesiologists, it’s packed with countless tips and clinical videos on how to successfully access tough veins.
We warmly invite you to test drive the app for one week for free and let us know what you think. We believe this app will be immensely helpful to you and your colleagues. Download the app for free, share it with your colleagues, and let’s all improve our IV skills together www.nysora.com/iv-access-app/
Thank you!! Genius in its simplicity, more effective than bp cuff/simple tourniquet!!
Thanks Susan. Please report back! ;)
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Thank you! Thanks you!
Superb sir.will do this next time
All the best! Thanks for watching!
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Without IV access patient can't safely be kept alive during theatre. No surgeon could ever tell me to hurry up when I'm responsible for the patient's life. Maybe it's different in the UK but here the surgeons ask us if they can start operating and can't if we aren't happy. If we take long in the anaesthetic room so be it.
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Thank you so much sir for the knowledge... but as ER nurse we don't have time for that luxury... but it is an excellent technique. Thank you
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Going to try it with my next difficult cannula
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Thank you Dr Hadzic, love your videos! We usually use SC Lidocaine to numb the skin before poking. I personally hate when my attending while trying to help me puts a tourniquet above the elbow when we always aim at dorsal hand veins. That’s NOT how you do it! Anesthesiologists unfortunately are not taught proper techniques as nurses are. You have to apply the most of the pressure as close to the puncture site as possible. So I reposition the tourniquet and sure enough veins (not always but still) are more plump. Or I follow the example of another attending who asks a nurse to apply a good tight squeeze just above the patient’s wrist and it brings the veins up nicely. This is the only way actually how we do it in Peds in our institution. Plus we have hand held GE ultrasounds, helps to hide from an irritated surgeon… who has to wait anyway, yep, life is hard for them at times. ;P
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I have extremely difficult veins. A nurse once told me "If you weren't alive, I'd think you don't have veins". A vein finder doesn't even show my veins. I've had 7 I.o.'s, 4 in my shin and 3 in my shoulder. I've had IV's put in the palm of my hand, foot, between toes, armpit, behind my knee, legs, foot, behind my ear, my neck, arms, etc. I finally got a mediport put in because I have need for regular blood draws and the potential of needing rescue medicine for my Epilepsy.
I hate waking up having an IV in my foot. I am very hard stick even for anesthesiologist. At least yesterday when I had my surgery for my hand they actually listened and they didn’t try to stick me 10 times before they gave me an ultrasound to find a vein.
What an amazing video! Thanks a lot for making this, very helpful!
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This is called lovely technic
Don’t bend a catheter because the tip of the catheter can shear off and become an embolism. I like the idea of the esmark.
Thanks for the advice!
You’re welcome!
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Wonderful technique, however that particular elastic bandage is rare here in East Africa. 😫😫
Thus is quite common in orthopedic settings, you can definitely find it, even in LMIC countries
Use an ACE bandage.
Is an ace sufficient?
You can even use a long sleeve t shirt- worst case scenario- because it still works... just keep the idea change the tool
Maybe a foam bandage would work too
I'm a retired RN and one of the things I miss most is that little vibration when the needle initially pierces the vein. It's sort of like poking a sausage with a fork.
Great video, thank you!
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Excellent video. Very helpful.
Glad to hear it!
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I have great vein that are like hoses. They can easily be seen and felt. I warn staff that my veins wiggle. Some love my veins while others struggle. My last ER visit, the nurse made 3 attempts. I wasn’t sick, cold or dehydrated (I went in for a cat bite). She was having trouble, she said, cuz she couldn’t tell the difference between veins and tendons. 🤷🏼♀️
Its no fun starting out as a nurse or phlebotomist. I’m sure she felt as bad as you did.
Cannot tell the different between tendon or veins?
They should go to classes and learn again 👀👂
That's not good. She needs more supervision or practice and time before she sets IVs alone, there are differences between the two that are major and easy to identify, even in very difficult patients. Terrible excuse.
As a Paramedic I've got to add in that veins don't wiggle, roll, etc. Can they spasm or be moved/pushed by a needle before it punctures the vein? Yes...
Is there anything we as providers can do about these issues? ABSOLUTELY!
Holding traction on a vein, preferably at 3 points (2 minimum, above & below the insertion point) and keeping that traction until the cannula has been fully inserted typically makes the difference between a successful attempt or having to stick a patient again.
Also, PRACTICE! In the beginning it doesn't even need to be practice sticking, but take your tourniquet home and practice finding/feeling the veins of anyone that will allow you to try! If you learn what veins feel like (that soft, sponge like, slightly bouncy feel - everyone explains it differently) plus learn to feel for valves, bifurcations, etc. You'll be much better prepared for whatever situation you may come across. Some of the best veins can be felt but are not particularly visible!
This video is great! While it's "low-tech" that's exactly the type of continued learning & teaching we should all be doing because it's accessible most anywhere!
@@amwelch0424 this ridiculously long useless comment again!..😏
Best to tried after one puncture. If multiple trial done distally, blood oozing will be excessive. Avoid sensitive wrist area.
Interesting! I will try for the next difficult vein access.
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Super interesting to see new techniques however I couldn’t help but think how small the cannulae are in these videos 😅 In my job 16G is standard so we don’t go anywhere near the distal peripheral veins 😬 Also I have “difficult” veins myself and can say that a cannula there has been the most painful out of so so many that I’ve had & that includes in my feet
I know when I spent time working with the IV team prepping patients for the OR, they wanted them to arrive with 2 large bore IV's for surgery!
Often these were very sick, elderly, & dehydrated patients to start with, so getting even one 18g & a 20g sometimes seemed miraculous! 🙃
As for those small gauge cannulas, particularly in that area... I have horrific veins as well and my wrists were feeling quite a lot of empathy for those in the video!
An obsession with 16G will make the perfect the enemy of the good enough. A 22G is far better than nothing.
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It will be interesting to try this method!)
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We love you from Iraq 🇮🇶❤♥
Thank you for all your fantastic comments and support! If you or your nurses or colleagues are struggling with IV access, be sure to check out the new NYSORA IV Access App. Try it free for 7 days and share your feedback! Let's master IV access together! www.nysora.com/iv-access-app/