iv catheterisation

RE: iv catheterisation

Beats — Tue, 03 Jan 2017 00:51:08 GMT

premed with acp on healthy routine neuters and let place an iv cannula for propofol induction.

Have a box of Jelco iv cannulae 22G and 20G and tell her they're really cheap.

RE: iv catheterisation

Evelyn Barbour-Hill — Sat, 31 Dec 2016 18:31:16 GMT

Americans do love their "tape", don't they. What a faff.

That's a very co-operative cat.

RE: iv catheterisation

mariette asselbergs — Sat, 31 Dec 2016 17:56:26 GMT

The nurse raising the vein is very important. I have struggled with several nurses over time who thought it was helpful to pump instead of just holding the vein shut. they thought they were helping to fill the vein and could not get their head around the fact the the pumping needed to be done upstream i.e. at the foot. Also my +1 for first practicing with a smaller cannula. I personally hate the blue ones...... Pink and yellow are fine with me, the blue one's never want to slide through Staffie's or Jack Russel's skin.

Mariette

RE: iv catheterisation

Anthony Todd — Sat, 31 Dec 2016 15:34:42 GMT

[quote user="bob lehner"]This is a good training video:[/quote]

Apart from referring to "catheters" throughout [smug smirk] the person holding up the vein is not locking the index finger behind the acroneal process so that the cat can withdraw the foreleg or just move it around.

This makes venepuncture really difficult, also this doesn't tense the skin over the vein making it even more difficult.

IMHO this is key to fore-leg venepuncture.

RE: iv catheterisation

bob lehner — Sat, 31 Dec 2016 15:15:18 GMT

[quote user="Evelyn Barbour-Hill"]Diagrams may help here – many people learn practical skills by visualising what they are trying to do as they do it.[/quote]

This is a good training video:

https://www.youtube.com/watch?v=r7drVOoAw4I

RE: iv catheterisation

Anthony Todd — Sat, 31 Dec 2016 13:04:34 GMT

[quote user="Anthony Todd"]over-the needle catheters[/quote]

ie cannulae; humble, grovelling, apologies.....

PS. What's the best brand these days; 'cos the worst ones may be part of the "insertion" problem??

Back in the day there was enormous variation in "peel back" tendency.

RE: iv catheterisation

Nicola Cole — Fri, 30 Dec 2016 22:09:39 GMT

I would get her to practice on sensible animals for routine procedures, with someone you know is good at raising veins in a good position (as it can make a big difference) with a second person initially watching from her end-so they can see what is going wrong (but someone she won't find scary!).

To begin with I would also avoid trying to place the largest cannula and go slightly undersized until she gets used to it.

And I never cut down (personally I would teach her to do it without doing this).

RE: iv catheterisation

Evelyn Barbour-Hill — Fri, 30 Dec 2016 19:50:40 GMT

[quote user="Anthony Todd"]Perhaps the brand or quality of the over-the needle catheters has improved, but I'd love to see someone get one of the "old", say ten-years, catheters through a labrador's skin without the catheter peeling back or just distorting so as not to be possible to enter the vein....[/quote]

Perhaps you should have come to see practice with me ten years ago.

Anyway, this is now, and intravenous cannulae (smirk) have improved, and we may presume that Patrick's trainee is being supplied with those of quality.

The cut should not be the first resort (and in my opinion a nurse should not be doing it without explicit permission).

RE: iv catheterisation

Eilidh Corr — Fri, 30 Dec 2016 19:21:25 GMT

Make sure you're not using nasty cheap catheters for starters. They're much less forgiving of less confident phlebotomy than good quality ones.

Otherwise find some sighthounds to practise on. She will get there, with time, if you don't make a big thing of it. Can she be left with another (diplomatic) nurse to get on with the next one?

RE: iv catheterisation

Anthony Todd — Fri, 30 Dec 2016 19:04:00 GMT

[quote user="Evelyn Barbour-Hill"]I can't agree with the suggestion of cutting the skin. That's a technique for when the veins are all "collapsed" – shock, severe haemorrhage and so on. It need not and should not be resorted to otherwise.[/quote]

Perhaps the brand or quality of the over-the needle catheters has improved, but I'd love to see someone get one of the "old", say ten-years, catheters through a labrador's skin without the catheter peeling back or just distorting so as not to be possible to enter the vein....

This is with a lovely labrador cephalic vein too!

RE: iv catheterisation

patrick murphy — Fri, 30 Dec 2016 18:51:30 GMT

a.it is a lack of confidence and I feel resolve, but she has trouble visualising, and I think that I will profer her your tips. thanks. I always stay away, as of course the chance of a VS finding a vein is inversely proportional to the number of VS's watching,a golden rule.

RE: iv catheterisation

Anthony Todd — Fri, 30 Dec 2016 18:25:42 GMT

I think pro golfers call it "the yips", but some practice owners will correct me.

RE: iv catheterisation

Anthony Todd — Fri, 30 Dec 2016 18:18:48 GMT

[quote user="Robin Grimmer"]I find that a little nick in the skin really helps [/quote]

+1 x10, yup, did it every time in the day when the catheters suffered from "peel-back" as they went through the skin....

Yes, back-in-the-day it was called a "cut-down" which really helped, so that's a really good trick

The cat or dog doesn't seem to notice the cut either.

Dunno why or how, but some people can hold veins and the cats stay dead still and I'll be blowed if I know why...

Same as our GP. the phlebotomist is just brilliant, first time, every time; others are poking around, in, out, over, under, beside, through etc.....

RE: iv catheterisation

Robin Grimmer — Fri, 30 Dec 2016 15:44:46 GMT

I find that a little nick in the skin really helps catheter placement, especially in cats. Just a tiny nick longitudinally.

RE: iv catheterisation

Evelyn Barbour-Hill — Fri, 30 Dec 2016 15:42:03 GMT

I can't agree with the suggestion of cutting the skin. That's a technique for when the veins are all "collapsed" – shock, severe haemorrhage and so on. It need not and should not be resorted to otherwise.

Is it the identification of the vein that's a problem? Practise with the easier patients, clip the hair well, get a good vein-raiser (some nurses are, some just are not!) to raise the vein, then get her to look for the vein and trace it with a felt-tip. Don't make her go beyond that until she's mastered that bit.

Is it judging the depth of the vein? I mean, does she always try to insert too shallowly? In some dogs you really have to stab down through the thickness, then pull back ever so sightly and adjust the angle to slide up the vein. Or does she always go too deeply – some cats' veins seem to be only the tiniest distance from the surface. Diagrams may help here – many people learn practical skills by visualising what they are trying to do as they do it.

RE: iv catheterisation

Gillian Mostyn — Fri, 30 Dec 2016 15:33:44 GMT

[quote user="Martin Atkinson"]b) look where they want the catheter to go not where they are inserting it[/quote]

This.

One of my nurses had an issue with placing IV cannulas... I could never understand why as the introduction always looked perfect, but then would head off in the wrong direction!

RE: iv catheterisation

Miriam Lodewyks — Fri, 30 Dec 2016 15:03:06 GMT

You can definitely reassure her that we all have "bad vein days" (and even weeks!). I know, I had one a little while ago. It soon becomes psychological... I just have to trust that the knack will return and keep practising.

+1 for removing the bosses (and owners!) from the room...

RE: iv catheterisation

Martin Atkinson — Fri, 30 Dec 2016 14:11:29 GMT

[quote user="patrick murphy"]

I have a trainee nurse, almost qualified who just cannot 'get' catheter placement.

[/quote]At which point does it go wrong? Can she do IV with a simple hypodermic needle?

At risk of teaching granny to suck eggs I tell them to: a) cut down through the skin before introduction, b) look where they want the catheter to go not where they are inserting it, c) withdraw the needle as soon as they feel the reduction in friction which tells them that they've entered the vein and/or when blood flushes back, d) if the catheter is not flushing back withdraw it slightly until it does then advance it carefully again while the assistant is still raising the vein.

I don't know why but it seems they're taught not to cut down these days and point d is missed because they give up and withdraw the whole thing before trying to re-insert.

I'm not sure where James gets his cadavers from but I've yet to find one that has good enough veins to practice on!

RE: iv catheterisation

James Dunne — Fri, 30 Dec 2016 13:45:10 GMT

Hi Patrick

I guess with any new procedure, we should pick the battles we can win first. I'd start her off with quiet animals, perhaps younger ones as well whose veins haven't been trashed over the years. Start her nearer the carpus to see the vein more clearly, nick the skin over the vein to reduce the likelihood of the catheter blunting on its entry. Make sure there are not too many chiefs looking over her shoulder. If a cadaver is available, let her practice on it if possible. Make sure she is constantly encouraged and that her colleagues are supportive. Let her know that even senior veterinary surgeons get 'bad vein days'! Write down a stepwise instruction for her and make sure the person involved in restraining the patient is cool and collected. Beyond that, practice, practice, practice. Hope that is of some use!

RE: iv catheterisation

Braden Collins — Fri, 30 Dec 2016 13:41:09 GMT

I find the explanation that placing a catheter is simply sliding one tube inside another helps some nurses.

I also find letting them practice in anesthetised animals helps, as does removing the boss from the room.