Reading these comments, I see that health care professionals are so negative. She is providing us with a great resource. For all of the nit-picky commenters, if you can do a better job, make your own videos if you know so much better. All of the negativity just discourages expert staff with REAL bedside experience from making videos to help health care professionals that are new to their profession.
Well it does matter because people watching this will take this on as the norm and may use these methods in their own setting. For instance, jewellery worn in a clinical setting when performing procedure is prohibited due to infection risk that jewellery carries. A simple wedding band is all that is allowed. Also nail polish/paint/varnish is also not allowed for obvious reasons that I simply dont have to explain.
Dont flick or tap - it can cause hemolysis in the sample. Use a BP cuff inflated to arround 20- 30 (no more than 40) mmHg instead of the rubber constrictor (No, technically its not a tornequet - a tornequet is capable of stopping blood flow to the limb- these strips of rubber we use for phlebotomy dobt do that and are not technically tornequets). Let the BP sit inflated for a moment then quickly deflate the cuff and reinflate it to the systolic BP (usually between 75-90 mmHg) This will cause veins to pop up rather magically. The down side is with the BP cuff you need to move quickly to get your needle in. Once the needle is in and your draw is opperational you can release the cuff.
Outstanding! So sick of hearing i'm a hard stick:( Have literally left the hospital when they couldn't get an IV:( Only once has anyone done the warmer and it worked!
I see now that the veins will usually pop up even on your most difficult patients. You just have to give it time and do all your other techniques, like using the 2 tourniquet, warmer etc.
pretty sure it takes up to 48 hours of a tourniquet being on to cause actual tissue damage. the reason they tell you not to leave it on so long is if it’s putting pressure on the artery it can make some more sensitive people feel faint. or cause hemolysis of the specimen. but generally healthy people will be fine as long as it isn’t on for like a really really long time.
1. For the re-using problem, I guess she is just using the alcohol to make the veins more visible (reflection) but not for disinfection. I assume she would disinfect with another swab after wearing gloves. 2. Concentric motion is one practice and swabbing in straight line along one direction is completely fine as well
Please work with a vascular access specialist. Per INS standards, all areas of flexion should be avoided, such as the antecubital fossa you were recommending. These areas usually lead to catheter failure due to mechanical phlebitis and have a higher concentration of bacteria as well. If a patient is that difficult, we can can use an ultrasound to place a long, small gauge catheter in the forearm to increase dwell times (and usually do that without even needing a tourniquet either). Best to you! I think we all want patient-centered best outcomes!
AC veins are a good option for pre hospital providers especially when giving medications like Adenosine or others with a short half life. The information in this video is helpful.
Frankly, the ACF is completely fine for IV insertion, and in most emergency cases, 14/16 gauge cannulas will be put in the ACF because it is quicker and easier, and the veins are literally larger so are _LESS_ likely to fail in elderly patients with thinner venous walls that can blow due to the cannula edges pulling on the lateral vein walls during cannula insertion. This video is demonstrating how to find the veins, not where to cannulate them specifically. Also as said above, in temporary cannulas such as those put in for CT contrast injection, there is no real reason not to go in the ACF because the larger veins reduce the risk of infiltration and extravasation of contrast when pressure injecting at higher flow rates. Smaller hand and forearm veins, although ok for low flow rates and IV’s, have a greater known risk of blowing when pressure injectors are used. I’m fairly sure that this video was purely for demonstrative purposes. If not, I would be more concerned about the watch, bracelets and painted fingernails than the location of her cannula insertion.
The patient arm is not straight enough if that is happening use to happen to me as well. Have them hang the arm down off the bed let gravity help you and make the arm bone straight promise it will go in every time no resistance with threading. Good luck on your sticks
simple suggestion. make sure you name the veins. saying the vein on the left, vein in the middle and this one on the right doesn't cut it. call them by their proper names. the area is antecubital fossa, the median cubital, cephalic and the basilic veins (is the worst vein and not to be used). would have made you presentation more creditable.
Reading these comments, I see that health care professionals are so negative. She is providing us with a great resource. For all of the nit-picky commenters, if you can do a better job, make your own videos if you know so much better. All of the negativity just discourages expert staff with REAL bedside experience from making videos to help health care professionals that are new to their profession.
Exactly. They think they know everything. They wouldn't last a day on the floors.
Well it does matter because people watching this will take this on as the norm and may use these methods in their own setting. For instance, jewellery worn in a clinical setting when performing procedure is prohibited due to infection risk that jewellery carries. A simple wedding band is all that is allowed. Also nail polish/paint/varnish is also not allowed for obvious reasons that I simply dont have to explain.
OPPS, FAXXS
@@frazzeldazzel5445 Well that's simply not true everywhere lol
@@frazzeldazzel5445 Not even a wedding band is allowed where I live.
As an old chemo patient I appreciate this! My worst nightmare.
Dont flick or tap - it can cause hemolysis in the sample. Use a BP cuff inflated to arround 20- 30 (no more than 40) mmHg instead of the rubber constrictor (No, technically its not a tornequet - a tornequet is capable of stopping blood flow to the limb- these strips of rubber we use for phlebotomy dobt do that and are not technically tornequets). Let the BP sit inflated for a moment then quickly deflate the cuff and reinflate it to the systolic BP (usually between 75-90 mmHg) This will cause veins to pop up rather magically. The down side is with the BP cuff you need to move quickly to get your needle in. Once the needle is in and your draw is opperational you can release the cuff.
Outstanding! So sick of hearing i'm a hard stick:( Have literally left the hospital when they couldn't get an IV:( Only once has anyone done the warmer and it worked!
Isn’t bad to leave the tourniquet for so long? It may affect the composition of the blood
It’s a consideration IF you’re drawing blood but if your patient is sick and needs and IV really soon then I think it’s reasonable to do it.
Liked the heat pad
Thank you for sharing this video 🙏🏿🙏🏿
Slapping veins is not wise. Wtf
Bacillic is the last resort
Snapping the vein...omg stop. That's soooo bad.
O can't see any veins there!
I see now that the veins will usually pop up even on your most difficult patients. You just have to give it time and do all your other techniques, like using the 2 tourniquet, warmer etc.
Where can I buy a warmer?
yo bro....those 2 tourniquet's have been on hella long.....
I now double tourniquet all my patients. Haven't missed yet. Awesome trick. Thanks sooo much. 👍☺
pretty sure it takes up to 48 hours of a tourniquet being on to cause actual tissue damage. the reason they tell you not to leave it on so long is if it’s putting pressure on the artery it can make some more sensitive people feel faint. or cause hemolysis of the specimen. but generally healthy people will be fine as long as it isn’t on for like a really really long time.
It’s didn’t even last 3 full minutes, she’ll live
Interesting
Are you re-using the alcohol pad and applying it over and over again? Why aren't you using concentric motion to apply the alcohol pad? Just a thought.
1. For the re-using problem, I guess she is just using the alcohol to make the veins more visible (reflection) but not for disinfection. I assume she would disinfect with another swab after wearing gloves.
2. Concentric motion is one practice and swabbing in straight line along one direction is completely fine as well
Or using gloves? And slapping? And wearing jewelry???
You nails are supposed to to be less 1-4 of an inch.
You’re such a Karen omg
Please work with a vascular access specialist. Per INS standards, all areas of flexion should be avoided, such as the antecubital fossa you were recommending. These areas usually lead to catheter failure due to mechanical phlebitis and have a higher concentration of bacteria as well. If a patient is that difficult, we can can use an ultrasound to place a long, small gauge catheter in the forearm to increase dwell times (and usually do that without even needing a tourniquet either). Best to you! I think we all want patient-centered best outcomes!
We also don’t “flick” veins. Rubbing is best practice. I only put this information here so others know correct information.
AC veins are a good option for pre hospital providers especially when giving medications like Adenosine or others with a short half life. The information in this video is helpful.
@@RichardC313 Exactly, also if a pt requires contrast for a ct scan, forearm doesn't work as well.
Frankly, the ACF is completely fine for IV insertion, and in most emergency cases, 14/16 gauge cannulas will be put in the ACF because it is quicker and easier, and the veins are literally larger so are _LESS_ likely to fail in elderly patients with thinner venous walls that can blow due to the cannula edges pulling on the lateral vein walls during cannula insertion. This video is demonstrating how to find the veins, not where to cannulate them specifically.
Also as said above, in temporary cannulas such as those put in for CT contrast injection, there is no real reason not to go in the ACF because the larger veins reduce the risk of infiltration and extravasation of contrast when pressure injecting at higher flow rates. Smaller hand and forearm veins, although ok for low flow rates and IV’s, have a greater known risk of blowing when pressure injectors are used.
I’m fairly sure that this video was purely for demonstrative purposes. If not, I would be more concerned about the watch, bracelets and painted fingernails than the location of her cannula insertion.
@@RichardC313As well as CT Angiography.
Her arm is turning purple. 😳
Sometimes I have trouble getting the AC IV, the vein in the middle. When I put the catheter in, I get the vein but the catheter doesn't go all the way
The patient arm is not straight enough if that is happening use to happen to me as well. Have them hang the arm down off the bed let gravity help you and make the arm bone straight promise it will go in every time no resistance with threading. Good luck on your sticks
U can't clean the site then pop the arm lol,🤦
Realy very helpfull
simple suggestion. make sure you name the veins. saying the vein on the left, vein in the middle and this one on the right doesn't cut it. call them by their proper names. the area is antecubital fossa, the median cubital, cephalic and the basilic veins (is the worst vein and not to be used). would have made you presentation more creditable.
Spelling credible correctly would have also helped your post be more credible as well. : )
@@j.taveras8447 ouch! Meow.
making way too many mistakes
Wow this video is scary
Wrong method
I'm sure glad you didn't actually draw her blood? Maybe you were just demonstrating. Ok!