Paramedic by Peter Canning

Author:Peter Canning [Canning, Peter]
Language: eng
Format: epub
ISBN: 978-0-307-55893-0
Publisher: Random House Publishing Group
Published: 2012-02-08T05:00:00+00:00

Veins

Having acknowledged the importance of system building, I have to reaffirm my preference for the street and the pure challenge of the trade.

I love doing IVs. The best veins are in the bend of the elbow—the antecubital (AC) veins. There is also another great vein that runs along the thumb side of the wrist. It can sometimes take a needle as big as a sixteen, and is easy to tape down and doesn’t ihibit the patient’s movement like the AC can. The hand has the most visible veins but can rarely take more than an eighteen.

If you can’t see a vein, then you have to feel for one. Veins are soft and spongy. Finding a vein by feel is like being a prospector stumbling onto a lode.

Depending on the vein size and whether you want to administer medications or replace fluids, you choose your catheter size. The lower the number the bigger the catheter. Twenties and eighteens are for administering medication. Sixteens and fourteens are for fluid replacement, although sometimes I have used eighteens and even twenties to replace fluids if I cannot find a vein big enough to take a sixteen.

I like doing IVs because it is a skill that you either have or don’t have. It gives you a sense of accomplishment, a moment that tells you are doing your job well. It is very much like sinking a basket. It doesn’t mean you win the game, but for that one moment, you are getting the job done.

Putting in IVs takes practice, as you need to learn to develop your technique. I was terrible at first. I’d often go right through the vein, or I’d get a little flashback and then advance when only the point of the needle was in, so the catheter would shred the vein. Small hematomas would rise up under the skin. They would sometimes grow to the size of golf balls, and I’d have to hold pressure on them to keep them down. Other times I’d be under the vein or to the side, and the vein would move or roll when nudged. When I took the paramedic class I did as many IV rotations as I could, knowing that if you can’t get a line, you can’t do your job. I didn’t want to have to worry about it.

Some people have great veins, particularly athletes; other people don’t, particularly fat people. Some older people have frail veins that puncture easily; even the catheter can rip the vein if not inserted very, very gently. When I started doing IVs I’d first look at the person’s arms, and either say no problem I can get this guy or oh, no, this is going to be a hard one.

I missed my first eight IVs as a paramedic. That was two tries each on four people who had nothing for veins. I was greatly bummed, then I got an old man with huge great veins, but my confidence was so low, I almost missed on him.

In playing basketball—and in doing an IV—confidence is just as important as technique.

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