iv catheter incompetence

Re: iv catheter incompetence

Bibs — Mon, 18 Nov 2013 00:22:44 GMT

I went through a phase recently of not being able to advance the catheter off the stylet. After looking at my technique the problem seemed to be fixed by making sure I push the catheter in a couple more mms after I get the flash and by making sure I push the cannula off the stylet and keep the stylet still. I was pulling the stylet out first I think and the cannula was not fully in/ kinking because stylet wasn't there keeping it straight.

I spoke to someone who spends a lot of time putting cannulas in people and apparently when they can't advance it they try flushing with saline at the same time as advancing. The thinking behind it is that cannulas sometimes get caught at valves in the vein and the flushing apparently usually works. I can't say this has worked for me (because my problem ones turned out not to be in) If you're sure your cannula is in the vein and not through or along side it maybe try having a couple of mls of saline handy in a syringe and try flushing if you can't advance it? Will also help to confirm if the problem ones are actually in the vein. Maybe worth a try.

Re: iv catheter incompetence

Anthony Todd — Fri, 15 Nov 2013 17:18:05 GMT

[quote user="Martin Atkinson"]'brace yourself Shiela'[/quote]

Geez, Martin, the aussie who said that was one of the "gentle probing" ones!

SOP, as far as I have been told is "Honey, I'm home".

But I agree with your catheter copulatory advice although, if you cut down, you are making it too easy [which is the idea, of course]

Re: iv catheter incompetence

Martin Atkinson — Fri, 15 Nov 2013 13:47:47 GMT

I'm generally ace at getting catheters in veins but I still have 'bad vein days' and can't hit a hosepipe. I never like the advice to pull out the stylet as soon as it flashes back, it doesn't work for for me, I advance all the way in before I remove it. I always cut down through the skin first and insert boldly without gently probing first (a bit like Australian fore-play - 'brace yourself Shiela') but the one piece of advice I always give those struggling is to look where you want the catheter to go not at the hole you're sticking it through, that way it magically lines up.

Re: iv catheter incompetence

Anthony Todd — Fri, 15 Nov 2013 08:31:16 GMT

[quote user="Gillian Mostyn"]Some other staff, however, seem to develop a deep hatred of some types! As has been said, it is perhaps an innate 'sensitivity' as some people are good at placing a canula, others never seem to be. You just have to harness the power of the force.....[/quote]

and add syringes, and any other item of kit that is ever used, to that.....

+1 or as Louis Armstrong might have said:

"If you have to have venepuncture explained to you, you'll never, never, know!"

Re: iv catheter incompetence

Gillian Mostyn — Fri, 15 Nov 2013 08:19:03 GMT

yeah - we have had all types (Ian is very price concious - he's from Yorkshire ) and I don't see anything different at all in any of them. Some other staff, however, seem to develop a deep hatred of some types! As has been said, it is perhaps an innate 'sensitivity' as some people are good at placing a canula, others never seem to be. You just have to harness the power of the force.....

Re: iv catheter incompetence

Anthony Todd — Fri, 15 Nov 2013 08:18:34 GMT

Far be it for me to give advice but I'm going to anyway.

Some vets and nurses are hopeless at getting veins and always will be. You can always pick them 'cos they fluff about with the patient already restrained always blame the nurse when they miss, and have multiple stabs, usually right through the vein, thus getting an obstructive haematoma which gets larger by the second.

[One learned to be accurate when using necrotising thiopentone on the 4 to 6 cat-spays a day!]

What I still notice is that, when the nurse raises the vein, he/she clamps the finger and thumb round the foreleg without dragging the skin taut and locking the index finger behind the olecranon.

This means that you have a floppy skin over a floppy vein in a mobile foreleg held by a finger and thumb which can slide up and down and round and round making puncturing anything more difficult.

Get the nurse to start the clamping mid-way between carpus and elbow and drag the skin as the finger and thumb is moved back before locking behind the olecranon making everything, including the vein taut and fixed in position.

Mind you I started with boiled stainless steel reuseable Record fitting needles which started off blunt and got blunter!

But I'm sure you all do that anyway and it's only the people I watched who didn't......

Re: iv catheter incompetence

CatherineThomas — Fri, 15 Nov 2013 06:52:49 GMT

I don't think cheapness necessarily has anything to do with it, it's just that you get used to how a certain types works. I've worked with lots of vets who will only use jelco catheters/cannulae. But I find them more difficult to push off the stylet and much prefer angiocaths which are apparantly cheaper.

Re: iv catheter incompetence

Michael Woodhouse — Thu, 14 Nov 2013 22:46:36 GMT

Are they the Trogue cannulae? We bought some and the vets not happy! There was a thread on here recently about them. Do seem to get a flash then nothing far more than we did with Jelco ones.

I suspected the money saved could be thinner cannuale tube so less stiff and less 'feedable'. If that makes sense.

Re: iv catheter incompetence

An On MRCVS — Thu, 14 Nov 2013 22:38:55 GMT

Thanks guys :)

I know it's all in my head a I could do it fine for years, I just have a mental block now. The nurses are lovely, they don't put any pressure on me, but I DO put it on myself. Yes the catheters are the world's cheapest, but everyone else has no trouble with them. I'd been used to the posh ones, but now I can't even use the posh ones. If I'm on my own with a sedated animal and a tourniquet I'm fine too.

Evelyn - I mean I put the catheter in, so it's about 1/3 or so in. I then go to push the catheter off the stylet and into the vein and it won't go and sort of bends like Dagmar says. It just gets stuck. Sometimes I can salvage the situation by pulling the catheter back a little and floating it in by running fluids through it. I think I must be pushing through the vein alright. There's no haematoma though.Do you put the whole thing into the vein and then pull the stylet out? I might try that maybe. Hitting the vein isn't a problem and placing butterfly catheters ( cannulas!) is fine too. Rabbit ears are no problem either, even the little ones.

I'll have to figure out my superpower!

Re: iv catheter incompetence

Joyce Whitehead — Thu, 14 Nov 2013 22:16:54 GMT

I've become a big fan of tourniquets rather than a thumb. In many cases the vein seems much easier to see and feel, and there is no variation in the way it is held up. Obviously still have a nurse holding animal and elbow.

Re: iv catheter incompetence

Stephen Courtney — Thu, 14 Nov 2013 22:08:40 GMT

I've had a terrible fortnight of bad vein days. Fortunately not for euthanasias but it is excruciating on an ops morning when it's not going right.

My rule of thumb is try one vein, if that doesn't work after 2-3 attempts i ask the nurse to put it the remaining good vein for me. Once I'm psyched out I'm no good to anybody

I like the tip about the stylet being in the vein while the sleeve is outside - i think this might be what I'm doing wrong. Maybe....

Re: iv catheter incompetence

Utlendigur — Thu, 14 Nov 2013 22:02:20 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="bob lehner"]bad old days - we used to give drips via ordinary hypodermic needles.[/quote]

Bad old days? There was nothing specially wrong with it,

[/quote]

Except that you had to get the work experience student to hold the leg still for a few hours to stop the needle making holes in the vein...

I'm another who makes a little nick in the skin - not all the way through, just through the epidermis so that the cannula/catheter slides through easier. I find I have phases of not being able to get veins too - usually breed related for some reason. I'll get a cannula in a wriggly dehydrated chihuahua first time but be totally incapable of getting it into a GSD with a vein like a hosepipe. Like others have said, the more you think about it and get convinced you will fail, the more it becomes a self-fulfilling prophecy - think positive!

Re: iv catheter incompetence

David Mills — Thu, 14 Nov 2013 21:37:37 GMT

The cheaper the catheter, the crapper it is.

Scrimping using cheap-shit catheters is possibly one of the most counter-productive, infuriating things in veterinary medicine, especially when you end up using 3 times as many as a result.

To the OP, it'll get better. Just keep trying. I find young cats are good for practice - easy to see vein, little fat. Knock em down with dom and they don't move either and if you get them within 15m of injecting then veins should still be prominent enough.

Nothing to add to above, other than try and go through the skin with a quick push, prevents the end of the catheter curling back as it sometimes does with the cheaper ones with the slowly slowly approach.

Re: iv catheter incompetence

bob lehner — Thu, 14 Nov 2013 21:18:51 GMT

Maybe it's a can(n)ula until you take the troc(h)ar out - then it becomes a catheter .....?

Re: iv catheter incompetence

Gillian Mostyn — Thu, 14 Nov 2013 19:53:48 GMT

[quote user="Mark Hedberg"]And I notice our resident pedant didn't spell it right either! :D[/quote]

Canula is a variant of cannula and both spellings are correct, I believe.

Re: iv catheter incompetence

Noweia — Thu, 14 Nov 2013 19:51:57 GMT

Everyone has their Bad Catheter Days - you're just having a Bad Catheter Month. Like all these things, the more you stress about it, the harder it gets!

The same happened to me when we switched catheters, then I got used to them, now I find it harder with the original type!

Re: iv catheter incompetence

Mark Hedberg — Thu, 14 Nov 2013 19:41:05 GMT

[quote user="Gillian Mostyn"]

[quote user="Mark Holmes"]Actually many cannulas say iv catheter on the side. A fact I was grateful for when a know it all bloody client complained that I used the term catheter when I "Obviously meant cannula, and should know better" I fetched one and asked him to read it - he shut up.[/quote]

I try to make myself use the correct term, if nothing else because I train VNs and want them to get into good habits. I still usually ask for the IV catheter though....

[/quote]

And I notice our resident pedant didn't spell it right either! :D

Re: iv catheter incompetence

Gillian Mostyn — Thu, 14 Nov 2013 19:32:14 GMT

I try to make myself use the correct term, if nothing else because I train VNs and want them to get into good habits. I still usually ask for the IV catheter though....

Re: iv catheter incompetence

Mark Holmes — Thu, 14 Nov 2013 18:35:33 GMT

[quote user="Gillian Mostyn"]

[quote user="bob lehner"]I guess us old guys were never taught a proper method, as catheters were either not available or not in common use in the bad old days[/quote]

They are certainly taught the correct term.... canula!

Another tip - use the correct size! A smaller gauge canula does NOT equal easier to place - some people use the smallest size they can get away with but they tend to bend and kink far more easily!

[/quote] Actually many cannulas say iv catheter on the side. A fact I was grateful for when a know it all bloody client complained that I used the term catheter when I "Obviously meant cannula, and should know better" I fetched one and asked him to read it - he shut up.

Re: iv catheter incompetence

Gillian Mostyn — Thu, 14 Nov 2013 18:26:39 GMT

[quote user="bob lehner"]I guess us old guys were never taught a proper method, as catheters were either not available or not in common use in the bad old days[/quote]

They are certainly taught the correct term.... canula!

Another tip - use the correct size! A smaller gauge canula does NOT equal easier to place - some people use the smallest size they can get away with but they tend to bend and kink far more easily!

Re: iv catheter incompetence

Anthony Dennison — Thu, 14 Nov 2013 18:24:35 GMT

[quote user="Busybee"]Also, to prevent blood pouring out in between removing the stylet and attaching the bung or fluid line, I find if the patient is co-operative, you can just about keep the tip of the stylet in the end of the catheter to prevent blood flowing out, while wrapping the first strip of tape around the leg and securing the catheter in place. Once secure, you have two hands free to whip the sylet out and attach the bung or fluid line.[/quote]

Or have a helpful nurse occlude the vein by putting pressure just over where the catheter went in. I will use the bung from the catheter to stop blood going everywhere whilst putting the first tape strip round.

Re: iv catheter incompetence

Francisco Gomez — Thu, 14 Nov 2013 18:22:48 GMT

[quote user="Evelyn Barbour-Hill"]

A visit to the optician sorted that out.. I quite like wearing glasses now, I can frown at the clients over the top of them.

[/quote] Hmmm, interesting point, our Anon is 10y+ experienced, presumably close to or late 30s... Could THAT be the problem?

Re: iv catheter incompetence

Busybee — Thu, 14 Nov 2013 18:13:13 GMT

I bet everyone on here does it slightly differently.

Two tricks I've learnt that may help:

With the 'octopus manoeuvre', another way I've found is to use the left hand to continue holding the leg from underneath and grasp the stylet with your thumb and first finger wrapping over to the top. The right hand is then free to flick or push the catheter off the stylet.

Also, to prevent blood pouring out in between removing the stylet and attaching the bung or fluid line, I find if the patient is co-operative, you can just about keep the tip of the stylet in the end of the catheter to prevent blood flowing out, while wrapping the first strip of tape around the leg and securing the catheter in place. Once secure, you have two hands free to whip the sylet out and attach the bung or fluid line.

Re: iv catheter incompetence

Evelyn Barbour-Hill — Thu, 14 Nov 2013 17:50:21 GMT

[quote user="bob lehner"]Younger grads are presumably taught a proper technique nowadays.[/quote]

Proper? Or just different?

[quote user="bob lehner"]bad old days - we used to give drips via ordinary hypodermic needles.[/quote]

Bad old days? There was nothing specially wrong with it, but catheters are better.

I'd say this, though: I went through a period of never being able to get a vein. I couldn't work out what was happening. A visit to the optician sorted that out.. I quite like wearing glasses now, I can frown at the clients over the top of them.

Re: iv catheter incompetence

Dagmar Steele — Thu, 14 Nov 2013 17:24:01 GMT

Thanks for the video Bob!