I’m not sure where this fits in, in this age of ultrasounding everything, but there is an interesting short report in EMJ. It describes a simple technique to achieve IV access in patients where the periphery is shut down. A typical scenario could be a patient in shock were all you can get in is a pathetic 22-24G cannula on the hand, when what you really want to do is a rapid infusion through a 14-16G in the cubital vein.
Authors Quinn and Sheikh suggest using a narrow bore cannula to fill the veins distal to the tourniquet, thereby making them wider and easier to cannulate with a wide bore.
1. Apply tourniquet.
2. Cannulate the dorsum of the hand with a 22G venflon.
3. Without releasing the tourniquet, infuse 100mL saline.
4. Cannulate engorged cubital vein with 14G.