WHAT THE HELL I AM DOING? I AM ENGORGING A VEIN IS WHAT I AM DOING!

iPhoneIcon_BigI’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.

Paper lives here:
Emerg Med J. 2013 Jun 15. Establishing intravenous access in an emergency situation. Quinn LM1, Sheikh A.

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4 Responses to WHAT THE HELL I AM DOING? I AM ENGORGING A VEIN IS WHAT I AM DOING!

  1. Sebastian says:

    Already saw that one on Twitter and really liked this simple trick. Haven’t been able to try it yet, but I’m pretty sure is an easy and fast method.

  2. Domhnall says:

    I’ve used it a few times (changing out a 24g in an adult trauma patients hand), but care should be taken that if you blow the vein you might well lose the use of your ‘good’ IV. Also be aware that if you are actively infusing IV fluid into the distal IV don’t be surprised if you get a clear to serosang IV fluid flash into your catheter

  3. skorppari-76 says:

    This is an old trick. I already learnt this as an med student in Kuopio in 1990’s ;). Have been using it a couple of times when surgery resident. Works ok.

  4. greedylobster says:

    Tried this in a crashing patient with haemopericardium. Sneaked in a 22G. Pushed three 20mL syringes of saline and somebody was able to put in a 14G. Great trick to have up the sleeve, no matter how old it is.

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