IV ACCESS: 3 TOP MISTAKES
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- เผยแพร่เมื่อ 14 พ.ค. 2024
- In this animated video, Dr Hadzic share the three most common reasons why IV access fail. In Based on 3 decades of teaching and medical education, he has witnessed these three fundamental mistakes that are basis of most failures to secure an IV access. 1) The catheter is too short 2) The needle and catheter not inserted deep enough into the vein 3) The angle of needle insertion is too steep.
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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 TH-cam channel is accurate.
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I was a nurse for a long time and no one ever taught me how to do it in such a detailed fashion.. Thanks for the great teaching.
Hi Rose! Glad you are enjoying the content. Appreciate your feedback!
Me to
Are you not a nurse again ma?
Me either and been nurse for 5 years now
@@KinggTevann__ me undergraduate from Pakistan And your country plz
The entire explanation is the best teaching I’ve ever experienced. Wish all teachers on all critical procedures, would make it this clear! Thank you!
Hi Tracy! Thank you so much for your kind words; we really appreciate your feedback. Greetings!
my main issue used to be number 2 as i was too afraid of hurting the person/ lack of confidence. Also they taught us to have quite a large angle. Watching an experienced person confidently "ram" one in was helpful and practising with green or pink ivcs helped perfect myself.
Hi there! Thank you for sharing your experience. We all get better this way. Make sure you subscribe to this channel; a lot more is coming soon! Greetings!
You will gain confidence the more successful you become at IV cannulation. Went to school 1 extra year( phamokinetics, pharmacology, chemotherapy, and learning every vein and artery in body. No more IV schools that I am aware of. Not egoism (please) I just had the “ touch” . Stopped playing Fender Electric bass as I was losing sensation in index finger, had to choose, chose helping others. If long term therapy, may I suggest starting distally & working proximal, don’t ruin ACF, if infiltration, we have to go to other arm or above ACF with then called long intractable, May I suggest having someone teaching you standing at patients head, bending elbow, and entering basilic vein. Changing hospital on IV team head nurse did not know this one, I taught her. We work as a team. We have to, exception may be home care community heath on your own, but still having peers check your care, standards & ethics. Team effort
My favorite are the pink. The green are only for emergencies in my office OR in people with large veins. The blue fail way too often and the yellow are for emaciated old ladies (we don’t treat little children).
@@robertmartin3090 yes we were taught to go distal and work proximal but only once i was doing chemo training, i think it is mostly omitted otherwise. the team effort depends a lot on the culture of the ward unfortunately :/ My issues were quite a few years ago, now i am usually fine, your comment and these videos alone, show how much was lacking in the cannulation course
@@Visitkarte i have started to prefer pink but it depends a lot on what is given and how long the ivc is going to stay
Thank you!. Makes perfect sense. New to ultrasound IV start and I'm still making mistakes and this helps me to understand it so much more.
I went to school 1 extra year to be IV RN. I also have done thousands, 16 gauge to 30 scalp vein, direct , indirect approach. Tough one was in ER, ( Cardiac side 1000 bed hospital. Not egoism, but became 1 of 8 on hard vein team. If RN missed, you might have seen me or one of others. Tried to have 1 on every shift. Guy flat lined, as I had just entered cephalic vein. No BP, Dropped angle into dead space lowering greatly, felt insertion, cardiac team now could push meds. . Nice 👍 video. Thx, memories now
That is really great. Thank you for sharing. Make sure you subscribe to this channel; a lot more is coming soon! Greetings!
@@nysoravideo Thank You.
1 u ok ki I'm m n ZZZ
@@robertmartin3090 maybe a dumb question but what kind of meds ? Adrenaline ? Clot buster?
What kind of school to become IV RN?I need that,I am so insecure in my I’ve skills…Thank you
I have never seen someone explain so thoroughly and with such as easy-to-follow explanation. Thank you so much!!
Hi Tannaz, Glad it was helpful! Greetings!
Thank you so much for all the information you provide. You are amazing!
Happy to help!
Great video. I would suggest a fourth tip that is to look for vein bifurcations and puncture just before it in order to perforate it with the cannula already parallel to the vein , cause after the puncture the vein will collapse over the catheter and it will be inside yet. Most of the time I introduce the catether parallel to the vein and I catch it with a slight deviation to its direction.
Hi Alexandre! That is great. Thank you for sharing. We all get better this way. Make sure you subscribe to this channel; a lot more is coming soon! Greetings!
Such very clear& clarified explanation!!! Thank you so much for your time❤
Love this. I am in nursing school and learning the IV insertion skill now. This is great as I practice for my check-off. Thank you for the great teaching.
We are very happy to hear that!
Absolutely agree.. Im RN in Emergency room, degree of insertion is a key, only get 1 from experience. But in here, I get 2 in short time. Thanks, I know from where to improve now.
Very useful, one thing that comes with experience is to know how much deeper do you need to insert the catheter after the blood flash to make sure the catheter is in the vein, since the larger diameter the catheter is, the more distance there is between the tip of the needle and where catheter actually starts, but one helpful thing with the larger diameters is that on some veins you can have the tactile feedback of the catherer falling into the vein and enlarging the passage
Agree! Thank you for the feedback!
Agreed, great information
Thank you for watching. If you found this video useful, make sure you watch this video th-cam.com/video/9gugbodXdVg/w-d-xo.html on "Difficult IV access" for complimentary information. And do not forget to SUBSCRIBE and never miss new releases. Greetings from NYSORA!
Aria Kowsarian
You have mentioned my IV start problem: how much deeper does one need to insert the catheter after blood flash. Thank you for your helpful input.
I really thank u as a physician who rarely needs to do an IV insertion , I always had struggle doing this and now I think I could do it better. I hope so🙏🏻
Hi Reza! Glad you are enjoying the content. Appreciate your feedback!
You got!! You can do this. Repetition reduces fear.😊
simply the best... three examples of higher thinking about IV placement that are not the same old thing.
Thank you for sharing. And make sure you subscribe to this TH-cam channel - we have a lot more really interesting videos coming up soon.
I frequently see no. 2 with arterial lines. What's your advice to avoid that? Thanks for sharing.
I think one day the biggest mistakes that lead to insertion failure is the way the operator holds the catheter, the thumb on top and the index finger below making it impossible to decrease the angle after the flashback.
How can you explain please 😢?😊
Such an elegant explanation! First video of yours I've watched so I look forward to watching more!
So kind of you, and we are really glad you are enjoying our work. Please subscribe to the channel and enjoy the content. Greetings!
How cool are you sir? This was super useful! You’re my new favorite professor😊
Hi Anne! Thanks for that! Greetings from us all.
Such a helpful video! Explained very clearly and high-quality visuals! Keep up the good work, I have subscribed!
Awesome, thank you!
Incredibly good at your job as a teacher, you just earned an extra subscription.
We are very happy to hear that!
Bravo! Right to the point and well explained. Thank you
Glad you enjoyed it!
agreed!
Thank you for watching. If you found this video useful, make sure you watch this video th-cam.com/video/9gugbodXdVg/w-d-xo.html on "Difficult IV access" for complimentary information. And do not forget to SUBSCRIBE and never miss new releases. Greetings from NYSORA!
I had this done on me recently, super glad it was successful
Wow!!!!! Very helpful and THANK YOU for sharing your wisdom!!!
Glad it was helpful!
Experience taught me these mistakes, specially for me it was very common the mistake 2, when the needle is already in but the catheter not quite yet. Great video is a piggy I couldn’t watch it time ago but is great, definitely those are the most common mistakes
This is amazing... It's so helpful!
Outstanding overview. Always started distal to proximal on long term antibiotics. Chemotherapy, now minimally trained RNs go for ACF, ruining proximal if infiltrated. Many forget Basiic
Hi Robert! Indeed. Thank you for your comment! Make sure you subscribe to the channel so that you do not miss some super educational upcoming videos!
@@nysoravideo I did subscribe to your wonderful channel. Just an RN, not Nurse Anesthesia or Md. But I try to stay current with may things. Thank you
Brilliant visuals, sir.
Thank you
Thank you for watching us!
As a kidney patient, I thank you for posting these videos. Everyone: please listen to your patients! This Spring I had to have IV anti-viral treatment after contracting COVID. Told the "specialist" the best place is next to the bend of the elbow (cephalic?) and he said "oh no, there are great veins in your hands." I told him it wasn't going to work well but he was sure. As soon as he started it was "um, where'd your vein go?" and he proceeded to DIG AROUND until he got needle and then the the IV in, with me trying very hard not to curse at him. Quite painful and unnecessary. Heck, my AV fistula would roll when nurses were trying to get the the dialysis needles in!
That is so interesting. My kidney kid's hand veins jumped around too when he was in nicu. The nurse said in 16 years she had never encountered anything quite like it.
Standard practice is to avoid the elbow fossa actually (i.e. antecubital) as there's a higher risk of infection and extravasation. Patients tend to bend their elbows quite a bit and (especially with dialysis) flexion results in disruption in infusion and constant irritation to the vein. Also, (in my experience) an INT in the AC makes getting blood pressures awkward and a close high-pressure cuff can often blow the vein. Evidence based practice supports use of the AC only as a last resort. If placed in the AC, the INT should also supposedly be replaced every 24 hours (which seems cruel and unusual).
Unfortunately the wrist is off limits too d/t the apparent high-risk of nerve damage (and logically I suppose there's a good bit of flexion and extension there as well). This pretty much leaves either the forearm, which can be hard to use (especially without an ultrasound) in overweight, fluid overloaded, or highly thrombosed (read: dialysis) patients, ...or the hand.
It's obviously unpleasant to have the IV put into the hand and (in my anecdotal experience) usually results in much more initial bruising. At the same time though the IV is reliable and not going anywhere. It's pretty hard to fit a 20 gauge or larger IV into a hand vein though, so I don't blame you at all for being unhappy.
Ideally the AC should be left as a source for blood draws. Of course, saying that, reality is that the best IV (for most patients) is almost always going to be whatever is easiest. I probably see at least 25% of patients come up from the ER with AC IV's. The best IV is two IV's
To be clear, you're not saying your vascular surgeon put your fistula in your hand, right? I don't think that's possible.
Doctor, thank you!
Thanks, this is the best technical explanation and imaging I have ever seen.
Thank you so much for the kind words. We are happy it helps.
Your videos are always worth seeing
Hi Omar! Thank you for your comment.
Nothing can be best video than this regarding cannulation techniques
Glad you think so!
Thank you, Dr. Hadzic! Your explanations were perfect and sequenced well. I found it very easy to understand with your illustrations. Great teaching, Sir!
I’m going to share this with my school’s simulation coordinator to help the incoming class of student nurses.
That is so rewarding too hear. Thank You so much and we wish all the best to your students, feel free to send us a picture of them learning through our video at haris.b@nysora.com Best regards.
Wow very vivid and educative! Thank you!
Glad you enjoyed it!
Very informative loved it
I’m a vet tech and place IV catheters in cats and dogs. I should be able to use some of the techniques in this video!
Thank you for the knowledge
Glad to hear this! Thanks!
Thank you so much! I was so bummed bcs I always hit the vein and get blood but then the vein pops... I was making mistake number 2. This video is so educative thank you so much. Please if you have more IV tips and tricks do share them with us❤
Hi Mimi! Thank you for your kind words. We have already produced IV videos on our TH-cam channel and a lot more is coming very soon. Stay tuned for all the latest updates! Greetings!
Cannot be explained more vividly...Thank you sir
Thanks and welcome!
Absolutely agree. I've watched many videos about this, but this is the first with such brilliantly detailed visual demonstrations.
Returning RN, thank you for the refresh crash course!
Very helpful video!!
Thank you, new nurse here with a lot of phlebotomy experience but kept blowing veins left and right!
Take your time and try applying these tips. We have just posted a new video that might be helpful too: th-cam.com/video/RzjP-XZFJuY/w-d-xo.html Let us know what you think in the comments. Best regards.
Awesome video! Very well explained. As a new grad RN, I thank you for your help!
We are very glad to hear this was helpful and we wish you a lot of success.
Thank you for posting this knowledge! Lowering the angle.... THATS how the needle stick is different from phlebotomy process. The blood withdraw would typically be about 30° . High angle is good to withdraw blood from venipuncture, but bad for inserting catheter into vein.
You saved my Tuesday this week, I had a lady for sleeve gastrectomy, I managed to insert 20G cannula, no other veins visible nor palpable, Using ultrasound and remembering this video I inserted 16G in the left antecubital fossa, it went first pass, I am nearly sure the only other option would be a central venous line.
Hi Samy! Glad it is helpful. Keep watching- a lot more videos are coming soon!
It was an excellent overview, Former RN -IV team 40+
Thank you for watching. If you found this video useful, make sure you watch this video th-cam.com/video/9gugbodXdVg/w-d-xo.html on "Difficult IV access" for complimentary information. And do not forget to SUBSCRIBE and never miss new releases. Greetings from NYSORA!
Great insights!
Glad you enjoyed it!
great tips and video!!
Really helpful. Thank you 🙏🏼
Glad it was helpful!
45 degree angle is d way to insert the needle? how to avoid this 3 kinds of problem? thanks!
Incredible!
I am not even in this field or anything close to it, for some reason it was interesting to watch
Glad to hear this! Keep watching!
Dr Hadzic! Question! Or for any of you folks that can answer!
Recently I began working in an ED after working for a few years on an ambulance.
In the field, when we start a line, we immediately attach an extension set with a NS flush, check for blood return in the extension, and flush with NS.
In the hospital, as soon as the line is established we attach an extension set and vacutainer to the catheter hub and immediately draw labs.
Something I am experiencing constantly now in the ED, but never experienced while working on an ambulance- When I return to an established IV to draw labs again, it is extremely difficult to get blood return through an empty syringe connected to the extension set, but the line will flush perfectly fine with NS.
Why is this happening?
My first thought is a difference in equipment, but that doesn't make much sense because I have used multiple different catheters and extension sets in my time on ambulances.
The only difference now is that we draw labs immediately before flushing the line. Could it have something to do with a clotting effect taking place due to immediately drawing labs before flushing, possibly on the internal diameter of the catheter?
Please let me know. Thanks!
Thanks for the tips. Very useful for my work.
Hi there! We really appreciate your feedback! Thank you!
Thanks for the information and excellent video presentation as far as my experience in venous cannulation you should get the feel of venous puncture and the rest is easy 👍👍🙏🙏
Hi Chaitanya! Thanks for sharing. Stay connected, we have a lot more really interesting videos coming up soon.
In a 6 day stay i just went through 21 canulas ...my arms are so sore
The antibiotics are extremely corrosive but i have an underlying condition , hydrodinitis , so randomly my body sends every single bit of moisture in my body to a site my dermis is trying to protect my nervous system from experiencing..
I know my technical expectation isnt exactly spot on , but hospital has sent me home for 24 hours before we start another picc line , the one yesterday only lasted 4 hours before my entire arm turned red raw ..
I did blood collection, phlebotomy course just so i could be sympathetic with my nurses
Thanks for explaining
You're welcome
Very helpful video thank you
I have very wiggly and deep veins. I am CONSTANTLY victim to painful infiltration and awful, slow blood draws. I usually end up having to guide them on blood draws where I tell them how much to push and pull the needle back in (chronically ill so I get a lot of blood work done). Is there anyway to avoid so much infiltration? It hurts and the bruises are massive. They've even started IVs on my index finger.
This video is a life saver thanks
Thank you! your comment is much appreciated!
Namaste sir
Thanks the way you explain 😇🌱
Always welcome!
What a great video !! It was really helpful!! Thank You!! Greetings from South Korea.
Hi Lider! Glad you are enjoying the content. Appreciate your feedback!
Hallo sir, I'm a biomedical engineering student and I wish to know that, if you ever think about the implementation of a new technology which will ultimately helps you in your treatment procedures or making the procedures faster.
Do you think, there is a need to implement new technologies in the prevailing conventional medical processes? If any please do mention.
Thank you
Not mistakes Dr, learning curves & knowledge. As RN - IV ( 1 year course) you hit 3 great problems & solutions. Obese individuals are more difficult, palpating more challenging. I did carry all sizes, longer IV needles, and back then intracaths, had to be cannulaed at ACF.Failure of those on long term therapy usually then requires a pot a cath or subclavian. If one know their an anatanomy, it’s their. Now ultrasound, nice, before my time, hard veins. A step forward. Well presented, perfect “explanation of difficult IV cannulations. Thx for sharing. Infiltration of any chemotherapy agent can cause problems. Old now but Bleomycin, Oncovin etc. Love your experience, expertise & solutions
That is really great. Thank you for sharing. We all get better this way. Make sure you subscribe to this channel; a lot more is coming soon! Greetings!
@@nysoravideo outstanding channel, I am sure a great anesthesiologist 💯
Thanks
Thanks respected teacher you explain it very good
Hi Adil, Glad to hear this! Thanks!
Perfect video...! Thank you...!
Glad you liked it!
Thanks a lot for this video . I could correct myself with the help of it.
Hi Shifa! Glad it helped. Keep Watching!
I failed to get into medical school but still watching this video understood everything you said, thank you for enlightening me 👍
Don’t think of it as failure. Did 2 & 1/2 pharmacy school, draft #113, into military, sadly I was A student and 2nd Lieutenant in ROTC, 1 class away from signing. My wife’s father screwed that up, insisting I have military done, before marrying his daughter. We needed his signature at time. He hoped I would die in Vietnam, well still here at 71.
Try nursing
Very educational.
I was a heroin addict for many years. Self learned iv expert😂, dont know shit about this but i sure could find a vein in freezing winter in a cold dark toilett.
I like your teaching system. Its smart. Can you give info about this touch screen drwaing system software and hardware. Thanks
great vid!!!
Awesome! Thanks so much : D Getting chemo next week : (
We are glad this was helpful. We extend our best wishes for a quick recovery and hope that you will tolerate chemotherapy well. Warm regards from our entire team.
So is there a way to estimate how long a needle catheter is needed ?
How to be stable with the needle? I always shaking 😢😢??
Honestly, practice. The ER in my experience is the best place for it. Ik this was 11mo ago so sure you’ve made some progress by now. Communication skills as well. If you find yourself unable to explain why you missed, or how to handle it, become confident in knowing it’s just not something anyone can do without practice, and how to communicate that from the mindset of a competent provider. Take time honing your skills and other knowledge in your specialty if you don’t feel you are a competent provider. The veterans are trusted by the doc for a reason. Glean as much as you can from them. The patient you are practicing on likely could not stick you, try a second time and find someone else to do it if you miss. Stand by the second attemptees side to hand them whatever supplies they need as they need them but mostly just to watch their technique. If they have experience and nail it think over how they did so and what you did differently. Try to apply those skills next time. It helped me to not hype myself up too much on the hits on easy patients with awesome vessels, but to reassess how I did it on the easier stick and imagine what I would need to change with patient with a slightly deeper, smaller or more fragile vessel. As you do this eventually you get to the point of US guided finds but you at least work towards mastery from the easy sticks down. Little tip on the big muscly dudes bulging veins, stick without a tourniquet (anyone is welcome to advise otherwise if it’s wildly wrong, just worked wonders with getting quick access in my ER experience), the pressure and flow in those vessels is plenty enough without increasing it to the point where it creates resistance to your catheter advancement. These bulging vessels also roll often so take the extra second to secure above and below. Will save you the face palm afterwards. lol
These graphics are awesome!
Hi Ali! Glad you like them! Make sure you subscribe to this channel; a lot more is coming soon! Greetings!
That's great! I have learn alot from you!
We are very happy to hear that! Where do you practice?
Thank you, sir
Most welcome
Amazing Video Admir!
Hi Victor! Glad you enjoyed it! Thank you for your comment.
Took 9 nurses stabbing me, a young girl nailed that u showed perfectly, we cancer patients suffer the biggest made needles, attached 7 hours during chemo. 34 operations later, each anaetetist is perfect but non surgical nurses need this. U rock. Question, if u go past the vein n hit bone, shud i tell the doctors, Zoladex injections are huge insert insde the ovary, friggin hurts bro
Excellent graphics!
Glad you like them!
In some cases the blood backs up into the infusion set. What is it due to, please ?
I've had an IV messed up before. Saline was in the bag and I felt it burn all along my arm before I was put under for a surgery. Maybe I should have asked for a retry lmao.
How do u lower the angle if your position is close to knuckles of the hand
Nice video Admir, thank you
Glad you liked it!
Please where put the needle in the skin,direct to the vein or 1-2 cm bellow the vein?
Nice explanation 👍❤️
Thanks! Glad you found it useful.
والله انك اسطورة طلع اغلاطي كلها 😂😂 Thank you so much ❤
Thank you for watching! Which tip do you find the most useful?
dr im learning in college when we learn to canulation onle we do this with one frend and this awar traning i have problm with introduction of cnaula in to the vein can you helap plese how i learn very well canulation
why go in steeper and then go down? to reduce the distance between the point it pierced the skin and the point where it enteres the vein?
outside of this question, very well explained, even me .. a layman understands all 3 problems very intuitively
It's easier to pierce through the skin with a greater angle initially, especially for deeper veins. But not too much, otherwise you'll bust through, as the video cautioned
Thanks!
What i always teach my students is that they should not retract the needle at all before the catheter is entirely in place. After the needle is lowered and advanced a little (as shown in the video) the needle stays in place until every bit of the catheter is advanced into the vein. when there are very small flexible veins i even sometimes use the needle like a mandrin to stabilize the catheter for further advancement and push the two forwards together right after the catheter was advanced a little over the needle do the needle tip cannot puncture the back of the vein anymore.
interesting
This is why I prefer systems where the needle can be easily pulled back or re advanced vs spring loaded ones
Thank you for watching. If you found this video useful, make sure you watch this video th-cam.com/video/9gugbodXdVg/w-d-xo.html on "Difficult IV access" for complimentary information. And do not forget to SUBSCRIBE and never miss new releases. Greetings from NYSORA!
Thank you so much
You're most welcome!
How can I get admissions in nursing plxx help
How much is the diameter of lumen of vein?
I have mastered iv cannulation already with practice, but the mistake I used to make in beginning is I don't used to lower angle after the catheter is in vein and thn i saw one nurse in emergency department like lifting skin out with catheter after catheter was in vein 😁to lower the angle tht time i understood how it works,
Great! Thank you for sharing and keep watching; a lot more videos are coming soon!
I would suggest another technique, especially for more superfical veins, firstly don't aim to put the cannula into the vein aim to put it along the vein. Position the needle above the vein at as low an angle as practicable above the vein and advance it whilst providing conter traction on the skin. The needle is bevelled therefore if there is resistance to its progression the bevel will cause the needle to move deeper into the tissue until it hits fluid when it will generate no downward force and the needle will remain in the vein. Avoiding the catheter being positioned superficially in this case can easily be avoided by *not* pulling the needle back when flashback is obtained but instead holding it still relative to the tissue (with by definition the tip of the needle in the vein) and advancing the catheter off the tip of the needle - there is simply nothing to be gained by pulling the needle back.
Hi Tom! Thank you for sharing. Indeed, we all do things differently; in the end - it is what works for you. Thank you for watching and do subscribe to the channel - we have a lot more coming up soon; let's share the experience, learn from each other, and all get better at what we do. Cool that we have this medium now to collaborate without barriers. Greetings from NYSORA!
i remember someone advising that but it just didnt work for me most times, then again i dont go for superficial veins like hands.
Muy buen video solo pude entender por medio de las imágenes , porque no se inglés ,tendré que aprender
Thank you it's verry helpful
Glad it helped!