Think Before You Insert an IV - Patient Care - @ JEMS.com


Think Before You Insert an IV

Providers should remember to not inflict unnecessary pain on their patients

 

 
 
 

Thom Dick | From the June 2012 Issue | Friday, June 1, 2012


Just when you think you’re never going to be surprised again in your life, you get the surprise of your life.

I recently spent a week in a hospital because I had to have an ankle removed. I learned a ton, Life-saver. Then, I spent a week in a skilled nursing facility (SNF) and learned another ton. Gotta say, I received some great care (and a renewed sense of humility) in that SNF. You’ll probably be reading about my stay there, someday. But that’s another story. This one’s about something that happened in the hospital.

I’ve often marveled that the word “hospitality” is mostly made out of “hospital,” and yet the staff in so many hospitals seem to understand so little about hospitality. (Small wonder there’s a joint commission.) As evidence, I’d like to tell you about my IV. That’s it, just the IV. I won’t bore you with the rest of a very long list of observations I made before and after the Versed part, which came right after the IV. (I think.)

My wife and I reported to a surgery center, where a nurse named Karen gathered my clothes and a whole lot of information about me. Now, I have great veins. I know that because they’ve all been found by student EMTs and medics. In particular, I have great “intern’s” veins. (You know the ones. They’re the veins formed by that big branch of the cephalic vein that intersects with the crease of the lateral wrist.)

Well, Karen started exploring the veins on the backs of my hands before she settled on my left intern’s vein, which was so prominent I could see its shadow. I don’t know how she could have missed it with that big 20, but she managed. Finally, after poking, digging and stabbing, she nailed it.

I have hairy arms. I noticed Karen was going for the IV without shaving the hair on my wrist and thought maybe I should say something. But I was too slow, so she poked me and slapped an OpSite on top of all that hair, then plenty of tape on top of that. Writing this, I would like to tell you (and her what happened in the course of the next five days.

On the day after surgery, the site had to be re-taped because the IV became unstable. To secure it, another nurse simply added more tape (circumferentially, I might add). The day after that, another nurse ripped all the tape off (but left the original OpSite, clinging only to my hair) and just replaced the tape. When I asked her to moisten the tape with alcohol before ripping it off, she said she was too busy to do that. Two days later, I mentioned to a fourth nurse that the IV was falling out (again). By that time, a lot of congealed blood was visible in the tubing.

The nurse cleared the line by flushing it and shoving the congealed blood into my vein. I’m sure it’s now a space-occupying lesion in one of my lungs. Then he asked if I minded having a newly graduated nurse start a replacement IV. I agreed, and within five minutes, a pair of really young nurses entered the room with an IV tray.

When they started ripping the tape off, I asked them if they would please moisten the tape with an alcohol prep. One of them kept on ripping, saying he didn’t have time for that, so this time I insisted. Sure enough, the alcohol soaked through the backing on the tape, and within seconds it had softened the adhesive. The tape came right off. But then they treated me like a smart ass for making the suggestion.

“Sorry,” I said. “I’ve started a lot of IVs in my life, and I just know it works.”

That didn’t impress them, especially after I asked them to shave the site this time. In fact, one of them looked at me as though I was being a jerk.

“You know,” he said. “We’re not students. We’re nurses.”
“I’m just telling you,” I said. “It really hurts when people rip that tape off of somebody’s hairy skin. Not to mention the added risk of infection.”

I know you start lots of IVs on hairy people. And sometimes when you do, you’re in a real hurry. But do them a favor. Hell, do me a favor. Give ’em the benefit of a one-second shave.

They may never know the difference. In that case, let me say this in advance. Thank you!

This article originally appeared in June 2012 JEMS as “Do No Harm: It’s important to not inflict unnecessary pain."




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Related Topics: Patient Care, Trick of the Trade, Thom Dick, IV, Jems Tricks of the Trade

 
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Thom Dick

has been involved in EMS for 43 years, 23 of them as a full-time EMT and paramedic in San Diego County. He's currently the quality care coordinator for Platte Valley Ambulance, a hospital-based 9-1-1 system in Brighton, Colo. Contact him at boxcar_414@comcast.net.

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