IV Insertion: Avoiding Common Mistakes

We've all experienced this scenario: flash in the chamber but the catheter doesn't advance. Is it the dreaded "backwall" or something else?
Dr. Saddawi-Konefka, anesthesia residency program director at Massachusetts General Hospital, discusses how understanding the design of an IV catheter can improve your cannulation technique and success rate.
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Equipment:
Introcan Safety® IV Catheter 20 Ga. x 1 in., FEP, Straight
Introcan Safety® IV Catheter 16 Ga. x 2 in., FEP, Winged
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Demonstration by Daniel Saddawi-Konefka, MD MBA. Peer reviewed by David Hao, MD (@davidhaomd).
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Disclaimer:
Invasive medical procedures can result in harm to patients and practitioners and should be performed only by qualified medical professionals. This video is intended solely for informational purposes and to supplement, not replace, proper training and supervision by qualified instructors.
Viewers are advised to check the most current information provided by the manufacturer for every device being used, and to verify the indications, contraindications and proper procedural technique. The dose, method of administration, and contraindications for any administered drug should be confirmed before use.
The authors of the video do not assume any liability for any injury or damage to any person or property arising from the use of this video.

[@donnamaas4909]

Very helpful, maybe this is why I get so many flashbacks and then comes to a stop. Heartbreaking 😔

[@fixelanimations7389]

Finally. This is what the cannula manufacturing company should also be explaining about there products.
You, my friend, has made what many feel is the dark arts into a logical transparent technique based on the parameters of the bevel. Thank you and thanks to your mother for insisting on medicine over law

[@ivanntellez]

Great explanation.... I had been trying to explain this million times and this video is very clear.

[@mattreav]

Very helpful demonstration!

[@davidmoss9926]

Very nice production. I've been drawing out these problems on the back of tegaderms and glove boxes for years, this video demonstrates it perfectly.

[@ErichBSchulz]

This needs to get to a wider audience but it applies equally to small cannulas in small veins as it does to big cannulas.

[@rossmoorman9335]

Totally agree. I have personally screwed up so many 20 gauge IV insertions because the very moment I saw any flashback I tried to insert the catheter. I used to wonder how it was possible to get flashback but not be able to advance the catheter, but once I took a good look at the needles and realized how far back the catheter actually is from the tip of the bevel, it all made since to me. Ultrasound makes it a lot easier, but I am trying not to become dependent on it, because I know it is more time-consuming and a lot of healthcare facilities don't have them.

[@ajubara3020]

Such a relieving vid

[@beyogawellwithgina4861]

This was very helpful thank you

[@tselothabte6367]

Very helpful 😄

[@PuenteAJ]

Everyone working in the medical profession needs to study and understand this.
I have been on the receiving end of terrible failed insertions so many times from people that do not know what they are doing.

[@MutheiM_Marz]

yeah.....4 failure iv insertion to me today.
thanks new nurse.

[@nancyliu7714]

Hi, do you mean pushing "a little bit up" as in the angle of the bevel goes upwards slightly or do you mean up as mean the tail end is a little higher than then the skin (20 or 30)

[@DeAnneHolliday]

Is this compliant tubing used for training and practice or just for demo? I ask because I think it might be a good way to practice instead of a sim lab arm. Where can I buy this compliant tubing you used?

[@PracticalAnesthesiaTechniques]

We repurposed the tubing from a standard nasal cannula!

[@littlepeky]

I hate the feeling when they blow I feel very disappointed of myself IVs kick my bootie more often than not

[@alxseb]

Would you advise advancing the needle further after an initial flashback using a 24G in a neonate?

[@PracticalAnesthesiaTechniques]

Hard to say as a general rule. The concepts apply more significantly to larger bevels but still apply to a 24G.

[@kaseycomstock]

Hi, I’m a student learning techniques. I have a question. Would it be a good idea to begin to twist the needle slightly as you are making that last extra 1 cm push of inserting the needle so as to prevent potential back walling?.

[@PracticalAnesthesiaTechniques]

Twist as in rotate?

[@joannaluca8495]

I would not do that. The needle has to be straight.

[@MamaChristine]

I find the angle of your handholding the catheter isn’t the right angle to start the IV. And after the cathshowstheflash, drop needle flat and use fingers holding wings to push forward.

[@brendal1156]

Hmmm backwalling 🤦‍♀️