Don't make these 2 mistakes!
ฝัง
- เผยแพร่เมื่อ 19 ม.ค. 2023
- In this video we feature an example of deceivingly easy veins that turn out to be difficult IV access. The application of the tourniquet in this patient quickly brought about a number of veins that are visible and palpable, so it looks like a no-brainer. However, the veins are tortuous and have thick walls, with loss of tissue elasticity around them, which made roll easily. In the video Dr Hadzic demonstrate how to combine the LOW angle of insertion with FASTER speed of needle advancement to troubleshoot the difficulty. He then shares 5 TIPS to facilitate IV access in these patients.
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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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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
I make this mistake of inserting slowly. Will definitely try this tricks! Thanks
Hi Krishna, Glad you are enjoying the content. Appreciate your feedback!
always an amazing learning experience. the way you explain the anatomy of the mistakes helps so much. i am grateful
Pulling back is useful in most cases!
This technique helped me many times to cannulat successfully 🎉
Glad to hear that!
Great tips, great content. Thanks NYSORA!
Hi Ernad, Glad it was helpful!
Thank you NYSORA for another excellent video 👍
Hi KD, Glad you enjoyed it!
thanks dr hadzic, I watched most of your guides on iv insertions 4 months ago and really benefitted from them, now I feel more comfortable, but they are cases in the elderly where you could see the outline of the vein and how deep it is and still get nothing
Great technique and presentation!
i have no idea when i will use this, i love it
I like the idea of bending the needle to have better access. I usually go through the vein. I look forward to trying this method! Thank you for your teaching!
Hi Christi! Thanks! We really appreciate your comment!
It’s hard to bend some of the new safety needles but I have had a lot of success with this technique in the past
I have put in thousands. I like angling the cannulation
Merci beaucoup ça a été très clair.
Thanks for the tips!
Perfect! Only those who have years of practice cannulating veins know these details 👏
Glad it was helpful!
Another amazing video Dr Hadzic, I can tell you ever since your first video showing the needle bending technique I have used it numerous times to great effect cannulating small superficial veins of elderly patients (hand, ventral aspect of wrist, dorsal feet) with a few immediately lifesaving cannulas placed (hyperkalaemic+acidotic renal failure patients, septic patients, patients needing minimum 20 gauge IV for CTAP/CTPA)
So kind of you, and we are really glad you are enjoying our work. Greetings from NYSORA!
What a legend you are my friend. Great video
Hi Hamza, thank you for your comment! Greetings!
I like your idea of 'insert the needle fast'. I do this with small veins while placing Sono IVs. Often times people fail to cannulate smaller veins with a 20ga catheter on ultrasound because the vein collapses. I like to guide my needle tip directly on top of the vein and then very quickly insert it into the lumen. Even if the vessel collapses I can often advance my catheter.
Couldn't agree with this more. When I'm training nurses/doctors on ultrasound guided access, I always stress the importance of setting your needle over the vein wall and directed towards the center. Countless times have I witnessed the trainee puncture the vein wall and then stumble to find their needle tip, leading them to sit in the wall for too long and end up blowing the vein.
In other words; SPEAR it!
I like your Idea of bending needle as well as all the ideas you explained....quick insertion of IV is also best technique...thank you so much sir...
Thanks for sharing!
Why do I never get patients like this to cannulate? Nurses always call me to cannulate severely oedematous patients.....
Haha…when nurse can’t cannulate and call u …this can be challenging sometimes specially the oedematous and collapsed pt. and resident doc is under performance pressure 😂
😂 the nurse can usually cannulate this type
😂
Rolling veins are more difficult to canulate
Not all the nurses call doctors for intravenous cannulation if it’s difficult
Tortous veins can be challenging and deceiving even if they look like those of bodybuilders! For us we make use of gravity by bringing the arm lower than the heart plus tourniquet and some mild hand-tapping and of course quick insertion.
Hesitation will always make you miss or roll the vein.
Great teaching presentation ❤
Glad you think so!
Try to stabilize , lower angle quickly, do not hit back wall. Many times I used indirect approach. Great video Dr
Very insightful, with more experience these tips make sense in retrospect
Glad to hear that!
Great video great tips thank you..!
Hi ni an, Glad it was helpful!
I'm watching this as a way to help me learn to cope with Trypanophobia. but it was also very educational.
Glad you found it useful!
Brilliant.Brilliant.Brilliant. Thank you.
Glad you enjoyed it!
Very amazing video
excelente video, gracias por compartir, bendiciones
Love the cannulation videos. Please post more
Hi Bilal! Keep watching; a lot more is coming soon. And we are really glad you are enjoying our work. Greetings!
I love to put on IV catheters. I'll definitely be trying the bending method for superficial veins!
Please let us know how it went. Much success!
Thanks for sharing...I always have trouble with the "good" veins and will use these tips next time.
Hi Ellen! Glad it was helpful! Greetings from NYSORA!
@@nysoravideo I used your technique at work yesterday and it worked! Thank you!
Thanks alot
Thank You Doctor for sharing your experience.
I want to share my story here. When my father sick at hospital some staff make mistake with this causing swollen my Father hands, mybe she to deep penetrate when i see she stab right at vein but cause swollen after that.
Thanks for everything 😊
Thank you for watching. We are here to support your learning process.
good job
thank you sir for expaing
THANK YOU FOR THE TIPS!! 💙
I have some pretty big veins and even a blind person can start an IV in my arm. Recently, two nurses failed 3 times to get an IV started. I saw their mistake as they were doing it, but I didn't say anything as a patient. But, it was obvious to me that the nurses needed to release the tourniquet BEFORE they flush the line.
Omg, they tried to flush the line with the tourniquet still on??
I'm the opposite, i dont shut up and tell them everything (nicely)
😅😅😅
Thanks for your helpful videos. We want you to show us a video about the external jugular vein success tips
Great idea! Will do! Greetings!
Yes sir. Please do one on EJV
Amazing explanation thank you ❤
Glad it was helpful!
Teşekkürler.
never thought about leaving the failed attempt in there... thanks!
It’s funny how I see your videos with tips for IV placement technique, but I brought it up to my nursing instructor, they immediately shot it down, saying that doctors who do this do not know what they are talking about. Even 9/10 a nurse may be better at placing IV’s, everything they teach in school is not always right. As long as the technique is safe and effective, why should it matter?
Anyways, thank you for the video.
Thanks for your good ideas
Glad you like them!
Bend the needle? Try bigger catheter and no tourniquet. The bigger needle is thicker and can enter the veins much easier. Stabilize the vein by pulling down below insertion point. This works 100% of the time on large, tortuous veins.
Please post video.
It works like a charm, thanks 💖💖👏👏👏👏 2/2
Great 👍
Hi NYSORA, thank you so much for the videos.They are excellent .
what techniques can we apply in case of invisible veins?
can you recommend us the best veins for blind Peripheral IV insertion attempt ?
Hi Peace! Thank you for your comment. thank you for showing your interest in "this topic', For more information, Subscribe to Nysora's Compendium of Regional Anesthesia nysoralms.com/courses/nysora-compendium-of-regional-anesthesia. Greetings!
Thank you soooo muchhhhh!!! you have been a great help!!!! I have a question, I work at the hospital, the other day we have a very hard stick person with a veryyyyyyy small veins. We needed to collect the blood culture. we used the butterfly, we got the flash but the blood was dripping one dot at the time. we only collected may be 2 ml. how do you handle a situation like this? Will also do a video coving blood culture with hard stick people with small vein? Thank you so muchhhhh!!!🥰🥰🥰🥰🥰🥰
That’s a beautiful tourniquet. Do you know the make/model?
i believe its not the speed, but how you stabilize the skin.even if you leave the previous iv cath, the same scenario will happen, hematoma will happen once you remove the cath.
great video
Glad you enjoyed it!
Dude, you're awesome ‼️
Hi there, thank you! Your comments are much appreciated!
I see this problem in small birds 9/10 times. For example: chickens, pigeons, seagulls ... Their veins are, if your lucky, wider then 3mm in diameter so you need a insanely small IV. This brings up the problem that you can not rush it in since the flow rate is very small and it takes time for blood to show up in the control chamber. They are also very fragile and once you have a hematoma you can't use the same vein or one in the neighbourhood since you have no view. And obviously you can't ask them to sit very very still :D
Luckily you get the feel for it over time.
Kasper, this is EXCELLENT. Thank you for the feedback
@@DRBLUESNYC Be my guest.
Lol the description perfectly fits neonates too, now every time I’ll remember chickens
amazing i wish i could learn practical from you 😍😍😍😍😍👍👍👍👍💯💯💯💯💯
Hey there. Of course you can! Have you checked out our events at which you can learn directly from Dr Admir? www.nysora.com/events/
I got this on my arm when needle inserted was like electric shock running to my wrist and when they used it before coming to tube. It was really painful while liquid is coming through
Sir thanks a lot🙏🙏
Most welcome!
Thank you sir please load more information about medical. Thank you sir
Hey there, you can find more educational content in our newsletters, have you subscribed yet? www.nysora.com/newsletter/
i learned a great deal a great deal
Большое спасибо за видео🙏🙏🙏👍👍👍👍👍👍👍👍👍👍
Было бы хорошо, еслиб был переводчик как у доктора Берг, специально для русскоязычных пользователей.
Thank you so much for the video!!! it was so helpful. Can you do a video on when do use a syringe instead of butterfly or evacuated tube? would you also, do a video on how to find difficult stick? Thank you so much!!!
Hi there, thanks a lot for your comment and that you for the ideas, we will try to produce those videos soon, too. Best regards.
nice share
Are they holding the skin taught enough or trying to kind of stabilize the vein at the same time?
Yeah, I'm definitely gonna pre-bend from now on. I've pre-bent for local infiltration before, but never IV access.
Wish I had seen this video before I had made similar mistakes. I couldn't cannulate even after multiple pricks in a elderly patient. He was really angry at me.
I've clearly identified mistakes I personally made with such a patient I had
Hi Born Fadil, Glad it helped. Thanks!
When I was taught cannulation in the 90s I was taught to find a bifurcation and insert between the veins.
I have never heard of bending the needle.
I would prefer some studies done on needles to ensure I'm not risking part of the needle, like at the bevel, or catheter breaking off.
hey ı have just found your channel by chance. I graduated in 2022 and actively working in a hospital for seven months.
and ı am still struggling on taking blood sample and IV catheterization. It is mostly because of covid pandemic and online schools I think. what can you suggest to me?
Although this type of vein is visible , it is a very difficult one because of rolling
best ways to be solve
Great master g namaste om namaste namaste namaste
I learned
Why didn't you choose the nice long vein on the medial forearm? It seemed to be very straight, Albeit in a slightly more awkward position.
Same thoughts. I would have chosen the veins on the upper arm or the forearm. I saw that it’s more stable & straight.
One more thing, since I work as a Oncology Nurse, we cannulate or the best choice is the forearm veins, clean stick meaning we don’t through & through. ( That is if the patient has no CVC line).
The forearm veins is best for patients on chemo or any medications that are vesicants or irritants.
I am amazed by the idea not to remove the catheter so as to prevent hematoma. Thanks!
Serious question: in what kind of practice are you (the doctor) performing IV cannulation in amounts enough to gain significant experience? I've basically only seen nurses/paramedics performing this skill with repetition.
just to add, this is a good video with good advice. i like that you leave the catheter in to prevent hematoma
I've seen it a lot in outpatient surgical centers where anesthesia is one of the few providers qualified. Anesthesia as a specialty is also big into vascular access for monitoring so it's not uncommon as an anesthesia resident or attending to be proficient in an IV start.
All Anesthesiologist get skilled to do it, day in day out.
@@akshayuttarwar3240 I agree
As an anaesthesiologist I'm usually the last resort (excluding my seniors) to get a line placed when nurses haven't been able to place one multiple times. Anaesthesiologists are usually the most skilled and experienced at inserting an IV catheter.
god im so scared for my cat scan w contrast lol...im worried ill be the pin cushion ...or do they often get it right first try?
Kindly make a video in pediatric iv cannulation
Hi Emjaj! Thank you for the great suggestion. We will definitely put this on our list. Greetings!
These cannulation systems look extremely unhandy. I’m glad we use much better catheters (Venflon) that are easy to hold and angle. Also you never seem to use one-way valves which we always put on the catheter. It makes switching IVs much easier and cleaner.
I would choose straight veins which he has on the left
Vet tech going to nursing school here, I feel like this Catheter is also really long, which can make insertion a little more difficult as you have less control of the needle the longer the cannula is.
Why didn't they use the first cannula when it was pulled back and showed flash of blood, rather than sticking again with new cannula?
Because there's a risk of extravasation if she punctured through.
@@maried3750extravasation or infiltration? Or both depending on?
How do I send this to the nurse who bruised my arms today
That was done to me in the hospital and Doctor's Office. Very painful.
Ouch. The operating nurse inserted one on me and realized it’s not right and has to redo again. Takes 3rd time to do it correctly. 😢
Crazy ass collection of veins
I have pretty limited experience so this might be a dumb question, but why not just use the veins on the antecubital fossa (Cephalic, median cubital, basilic)? what is the benefit to placing an iv on top of the hand when those other three are so much easier to access?
The IV catheters in antecubital locations bend and obstruct easily. In addition, they are very inconvenient to patients - they limit the use of the extremity as the alow can not be bent. Does that make sense! Greetings and thansk for watching!
I have many issues with these tips, most of all they chose those veins instead of those huge long ones just proximal of those.
What is the average failure rate for IV cannula insertion? Thanks
Every person is different. In my experience, iv drug users are difficult because their veins are tuff as leather and obese diabetic patients usually have deep spider veins. They are thin and deep. You can go for a whole day without a miss, and others where you can't seem to get one in. Those are very frustrating days which by tge third patient you just want to give up. It's hard to quantitate since every patient is different, or you might not be having a good day.
This person have great veins, which can be deceitful. I find holding the vein down while inserting the needle helps with rolling veins. Iv drug users, sometimes have good looking veins, but they are all scar and tuff as leather. Overweight diabetic patients with deep spider vains, are also very difficult to do. Never dig around or use the same vain. If I can't by the third time, it's somebody else turn. I never liked bending the needle. Just go parallel without hesitation. Hesitation will always make you miss the vein.
RN here. I'm not sure I'd go in that shallow. Getting flash with venipuncture for phlobotomy is not really different than for an IV. Speed and stabilization are important, but an extremely shallow angle just increases you chance of sliding over the vein.
The case here is really prominent veins. Generally very often they r protruding over the skin surface. So it makes sense to have this very low angle in very prominent veins.
There was a nice straight vein further up, really goes to show you just because someone can edit a video doesn't mean they know what they're doing.
Yes I saw those two nice straight veins further up also. BUT what would be the point in doing a video teaching us how to cannulate easy veins? Whe are here because most patients DONT have straight easy veins.
Call a certified IV Nurse. Drop your angle. Another possibility is indirect approach. Wait for flashback. Please don’t continue. You may go through back wall- now hematoma. Thx to all. Knowledge makes us all help the patient
Hi Robert! Thank you for sharing! Greetings!
I mean I’m no Dr, but as a RN that floats in ICU, CVICU, ER, Med surg, and Tele, I have NEVER heard of pre-bending the needle. I definitely wouldn’t teach that technique to others in the hospital unless they are advanced practice or highly trained. Pre-bending sounds like an accident waiting to happen if you think about it. I just imagine the needle breaking off after the safety mechanism is activated and remaining in the catheter, or worse sliding out of the catheter into the vein upon removal.
Gives me the heebie jeebies 🤣
Me too. Also what if the curved up needle pops out or the top of the arm!😮
The biggest problem is....in USA, most lab technicians are not trained well. They always fuck up my arm with yellow skin. I even got long lasting bruise at blood donation...never again.
Why not go for that long straight vein that’s more medial in the first place?
What is your advice for hard veins d/t IV drug users?
Ultrasound. There are much better veins deeper that people can't use (or see) because they arent superficial like most veins (that are at the top). I have had THOUSANDS of patients have horrible veins on the top. The second I grab the ultrasound, you'd be surprised how many good veins there are. I havent missed an IV in MONTHS because of the US. If you have it at work, I suggest using it. Its pretty easy to learn.
while i was being prepped for a little surgery on my feet, the lady had to insert and reinsert my IV THREE TIMES because she couldnt find my vein.. i was crying since i was 11 at the time
Sometimes... Especially bei older patients or "dried" ones (Hypovolemia) ALREADY UNDER ANAESTHESIA (mostly for the 2.nd IV-Line), I "make the skin wet": disinfect again, spray it or just a drop of sterile NaCl bevor punction... The needle just "slides" better... ;) (The patients are already sleeping, they feel no burn/pain at insertion).
Interesting how you bent needle to try second attempt, leaving other catheter in, I always used one hand for whole insertion and cannulation
Bill of extra canula should not be hand over to patient.
Thanks for the video but i pity the patient as the torniquet was left on for so long tat the veins became so prominent.
Im a nurse... And theres no vein i dont cannilate... But i have a ritual...its a crazy one though...immediately i get to the patient and after due consent, everyone disappears and i converse with the vein... I tell it "be nice to me please" out loud ... It seems for sone reason, my eyes can see the patient becone transparent and the veins pulsate and ive always found even the deepest of them for 7 yrs running with 98% times at the first try!!! I hope i dont sound coocoo?
Hi Micheal! Thank you for sharing your experience. Greetings!