Difficult veins - Made Much Easier with this technique!
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- เผยแพร่เมื่อ 16 ส.ค. 2023
- In this video, we're going to showcase a technique for securing IV access in challenging cases where multiple attempts have been unsuccessful. While using ultrasound for deeper veins is an option, there may not always be the time, tools, or skills available. Stay with us till the end of the video, and you'll grasp an invaluable technique to achieve IV access or draw blood, even when all else seems to fail.
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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 TH-cam channel is accurate.
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Take your IV skills to the next level and make a lasting impact on your professional life and patient care. Get your copy of the NYSORA’s Manual on Difficult IV Access today and be the change you wish to see in your medical practice! community.nysora.com/IVAccessManualYT
Real case and solving real problems, thank you Dr. Admir!
As an EMT, your videos have helped far more than anything else I have participated in.
I always bend the needles when I set IVs. Find that chances of through and though puncture is less with the needle bent. But caution about bending too much, sometimes the stylet gets stuck and cannot be withdrawn and sometimes a flashback may not be visible. Sometimes the venous congestion can create a dusky hue of the skin that makes vein location difficult.
Great technique.
The alcohol tip is under utilized. It has vasodilatory effects. As does heat.
Legendary stuff. Have used the reverse Esmarch technique multiple times in the ICU for long stay patients with edematous limbs who need peripheral venous access
Great! Thanks for the feedback!
Where can I get this device? I work in a rural emergency department and don’t always have access to ultrasound lines or central lines.
@@nathanbimrose7574it is an esmark. It is not a device. You can find it in the operating room department.
@@nathanbimrose7574 Sounds like you need to worry more about sorting out your supply of essential equipment for a modern emergency department, like devices for central access and worry less about esmarch bandages.
What to do when veins are now hard feels like a bone not vein
Whe he bent that needle, I nearly lost my mind
Thank you very much.
You are very welcome. What topics would you like us to cover in the future?
Great video thank you..!
Thank you for watching! Greetings and feel free to share!
So many great tips that I never learned in nursing school, thank you!!
We are so glad to hear that! 🙌 Have you subscribed to our newsletter for more educational content like this?
www.nysora.com/newsletter/
U can't learn everything in Nursing school, almost all Doctors I have worked with don't equally know about this. That is the importance of reading always... Don't tag nursing school as if...
Thank you for the videos
You are very welcome. NYSORA is a free tool for everybody willing to learn new things, but also engage in a productive conversation with the community.
Thank you! It is useful!
Glad it was helpful!
good one!
Thanks Mariano. We are happy you liked it.
Thank you so much God Bless you from 🇧🇷🌎
You are very welcome. NYSORA is here for you.
Another useful tip sir 👍🫰
Glad to hear that! Have you subscribed to our newsletter for more content? www.nysora.com/newsletter/
please do pediatric difficult iv cannulation.., thanks
Good evening, how are you? Excellent video and interesting technique! I'm also an anaesthesiologist, and so I sometimes have to work with patients with difficult IV access. Are there any contraindications to using this technique, and there a maximum time time that the Esmarch can be left on while trying to secure venous access?
So once you get flash, do you slightly retract the needle and then advance the catheter off of it? that's what it looks like in the video to me but just want to clarify. I have been slightly advancing the needle slightly and then threading the catheter off, but have hit a wall with advancing my IV cannulation skills.
I ended up getting a port, after I ran out of usable veins. I’ve had 40+ surgeries in almost as many years, so all my veins are shot. The port is the best thing I’ve ever done!
We are glad it worked for you, 40+ surgeries must have been tough, we really hope you won't have need for more surgeries and we wish you a successful and easy recovery.
What do you suggest if the vessel so deep into the muscle tissue. Would you suggest a guided ultra sound to attempt IV insertion?
I would use the other arm or start from distal to proximal, also the patient had the tourniquet for so long and that is very uncomfortable.
But the technique was good tho
Hello. The video you uploaded this time was very helpful. Thank you. May I ask you a question? In this video, the moment the needle pokes into the blood vessel, you seem to turn the catheter slightly. I wonder if there's any reason.😊
Greetings! That was an error in performance. Normally, we would not do this. We shoot these videos in real-clinical situations, and therefore, they are not always perfect. Regardles, the mission here was accomplished. Thank you for watching!
Nice - but I don't like to have recent puncture sites proximal to the new puncture site due to risk of extravasation... (Thanks for all your educational efforts!)
Your videos are excellent! 33 years of starting IV's and it never occurred to me that the needle could be bent. I will be testing this with our new angiocaths to see if they will still retract into the safety chamber. If so, I'm putting this into practice.
Thank you so much for your comment. We live and learn, right? All the best with it and please do let us know who it went. We are waiting to hear from you. Best regards.
Even during EJV cannulation we bend the needle so that it remains superficial
@NYSORA WHAT IS THE NAME OF THAT TOURNIQUET, THAT'S A PATIENT HAD ON, RIGHT AT ABOUT A MINUTE AND 25 SECONDS, BEFORE YOU/OR SOMEONE ELSE, STARTED WRAPPING THEM UP TO FORCE THE BLOOD DOWN, TO GET AT LEAST EVERYTHING TO POP UP
it was about @1:05, and I will love that wrapping up technique, I never thought about it, but that's covers like using like 10 tourniquets at one time, another thing I try to make sure they're warm, I usually put hot water and gloves, and then tie them up, or put heat compressors on them, those are in packets that you just pop,
Sir the technique is good. How can we try this in a cellulitis or where there's diffuse oedema of the limbs ? Once in a ckd case with generalised oedema I successfully gained iv at the dorsum but repeated pressure where slowly the vein becomes visible
That was the real case
Truly no BS
Indeed! Thankyou for watching and greetings from NYSORA
as much as i would like to try this method but our head does not allow me to do it😢
We should build a sleeve pressure machine
I have used a similar technique to engorge the veins in my practice. I would discourage practitioners from using the veins within three finger width from the base of the wrist, as you could inadvertently damage nerves. And I agree with previous comments regarding contamination of insertion site. Don’t hesitate to call the vascular access nurse, we’re always happy to help😊
The wrist veins are significantly superficial to the median nerve and not close to the ulnar nerve. It would require great clumsyness to even contact the nerve, let alone cause significant injury.
U must be Joking. Why Would a senior anesthesiologist call a stupid like you.
@gustavakesson2758 You have a history of spewing nonsense and making a tool of yourself. Keep it up bottom-feeder.
@@ChulBaekHyun im glad i dont have a history of acting like a psychotic narcissist as you have :)
good technique ! even in my country the anesthesiologist don't need to establish intravenous pathway by themselves. but your video still helped me a lot！
We are glad to hear that. We published a lot of educational content in our weekly newsletter. You can subscribe to it here: www.nysora.com/newsletter/
GOAT
That is a big statement! Thank You!
I used the ESMARK technique, not rushing, and letting the tourniquet work
Thanks for sharing. Where do you practice?
They always have trouble getting blood from me!! My veins are really deep so they have to dig,or they try my other arm!! They eventually have to take my blood from my hand
I could not imagine getting punctured on the inside wrist veins. The pain must be off the charts. That is a soft sensitive area with such thin skin 😮
I've was given an IV injection there and was crying so much after . It was horrible after a few hours I asked them to remove it because it felt like I was dying
You need to see a psychiatrist
As an RN I love this site! It does hurt a bit more but no one uses it and I would rather poke 1 time than multiple.
🙏👍
As a patient sometimes it's dehydration. I prefer to use the vascular department to find the vein than nurses constantly sticking me.
❤
What is the reason for spinning the IV after flash in the vein? I've tried bending the IV before but haven't had much success that way.
Hi Brian. It is a mistake. It was not meant to spin, but the it span accidentally. No big deal, it is just that it does not look pretty on the video. However, our videos are filmed with patients consents in the actual clinical practice for everyone's benefits. And Lord knows, videos are brutally true - they are always less perfect than lectures! ;) Greetings and thanks for watching!
@@DRBLUESNYC
Ty for asking and answering that. I’ve never bent the needle before but I can see how it would be beneficial especially for hand placement.
Can an ace wrap be used in place of an Esmarch bandage?
Yes!
But sir u inclined the needle if am not wrong... please explain sir
Come to India
U guys will learn better cannulization !!
I thought this exact thing😂
Lose, not loose at 4:38
Oops, mistakes happen. Thanks for brining it up.
I think you shouldn’t touch the vein after the alcohol wipe. Despite using sterile gloves. Because they are not sterile anymore after touching everything.
Agree with you. The hands were scrubbed with alcohol gel beforehand. But with IV access - you are always between the rock and the hard place - tough to make it all perfect in difficult situations. Gloves should be mandatory - but then - this would lead to more failures, and the GREEN folks would complain about the waste and the impact on the environment. Greetings!
Remember that unless you’re using a sterile field (which most IV starts aren’t), gloves are primarily for the protection of the practitioner, secondarily for the patient. Obviously, you want to keep it as clean as possible, but getting the IV started is more important.
I rarely use gloves (unless necessary) because to me, I think it's more difficult to palpate a nimble tender vein with gloves. I keep my hands well disinfected and they are more sterile than these open-box gloves that lie around open for days
Chuck a PICC
Not usually impressed, but I am now... expert advice, ty.
We are glad to hear that. What kind of topics would you like us to cover in the future?
Lol, I can see that the janitor is going to hate you due to the incredible venous pressure.......biohazard on the floor everyday lol.
If you see clearly he has not removed the needle from the cannula until the pressure has been released and so blood doesn’t leak down
Do you know how painful inside the wrist is??? Horrible
Never use the inside of the wrist and NEVER flick/tap the vein’s 👎
That’s not true
Why?
these iv cannulas are horrible. USA health care system is truly bad
Vein to catheter ratio was totally disregarded in this video. The choice of vein site at the volar aspect was totally inappropriate. I disagree with this technique. Best method is the USG-PIV done by a USG-trained vascular access specialist.
Bullshit
@@gustavakesson2758 pardon me?🤣🤣😂😂🤣🤣
@@ChulBaekHyun you dont know what your Talking about. At all. It is obvious.
Key words: “difficult start.”
Obviously not optimal placement, however, that gets sacrificed when access is more important. USG-PIV by a specialist is not available in several locations and/or in certain scenarios.
@@giblets4510 this dude doesnt even understand that the Guy in the film is an anesthesiologist, as much of an expert it gets.
Ultrasound is the gold standard. Just use that instead of all of this black magic.
Silly comment. This is generalised IV advice, most units don't have on hand ultrasounds and most RNs aren't cleared to use them anyway, not to mention developing nations where even anaesthesiologists may not have readily available equiptment for an US guided approach. Knowing how to troubleshoot problems in medicine is more important than relying on technology.
@@lachyt5247 any hospital which lacks the availability of an ultrasound machine in the event of a difficult IV placement should not be open to the public. And I'm not sure what you mean by "cleared" to use the machine? Is there some state certification that I don't know about in order to use an ultrasound machine (sarcasm)? Anyone can learn to use one. And honestly, I've been working in the OR for years. I would bet money that in any facility, I can find an ultrasound machine in preop a lot easier than I can find something as obscure as an Esmarch bandage.
@@lachyt5247agree with you. It’s like -saying - why bother with everyday cars, electric Porsche is the Standard! Greetings! ;)
Ultrasound is amazing but learning how to deal with iv access without it is key. This guy doesnt do "black magic", he actually gives really nice tips which i use every day in the ICU, OR or even in the ED.
@@darislavnikolov Oh wow! Thank you for the feedback Darislav. It makes making these videos and sharing clinical tips, hard learned bedsite with a greater community. Greetings!
Goodness..... why are you wearing sterile gloves? Why are you cleaning the area well before you know exactly where you're going? Your needle safety is frightening.
as mentioned, alcohol can make veins more pronounced through vasodilation while also sterilising the area.
The hospital I work at does not allow under the wrist and I've never heard of this being allowed. This is crazy as fuck. Seriously?