That "backflow" technique is a jewell. I didn't learn that until a good ten
years into doing this when the legendary Hoang Nguyen FOPS taught us that at
Duke back in the day, and I thought I was pretty good too, LOL.
Thanks,
Greg
On Mar 2, 2017, at 7:58 AM, Ethan Priel
<prieleye@xxxxxxxxxxxxxxxx<mailto:prieleye@xxxxxxxxxxxxxxxx>> wrote:
Kudos to Paul for giving spot-on salient points regarding finding elusive veins
.
Chapeau to Denice for watching out for OPTIMAL’s good name.
When encountering a difficult vein, ‘our docs’ often suggest the patient take a
break and drink a nice amount of water. Older patients are often low on
fluids and drinking helps the system refill with pressure rising.
These same docs have noticed that when trying to spear a really small vein in,
say, the back of the hand, it is often better not to use a tourniquet but to
rather have the patient let their arm / hand hang down, thus allowing the veins
to become engorged on their own.
If a tourniquet is used in cases where a / the vein has blown before, our docs
advocate the 2-person approach: the second one gets even the smallest return of
blood into the open line or needle, a staff member gently releases the
tourniquet, thereby releasing any ‘back pressure’ on the system and helping
prevent extravasations.
Best,
Ethan
From: optimal-bounce@xxxxxxxxxxxxx<mailto:optimal-bounce@xxxxxxxxxxxxx>
[mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of CPMC Ophthalmic Diagnostic ;
Center
Sent: Thursday, March 02, 2017 8:52 AM
To: optimal@xxxxxxxxxxxxx<mailto:optimal@xxxxxxxxxxxxx>
Subject: [optimal] Re: [**External**] Re: From Denice thoughts on IV vs oral FA
Caution please
This issue has been extensively examined by the huge Sutter Health legal team
here in California
In the state of California only an RN, not LVN, or MD may do short term
infusion therapy ( IV injection of medium or medication)
However, the ONE exception is that if you have a degree from a Radiology
technician program, that program specifically gives you the legal right ( in
the state of CA) to do injections IV of any medium.
OMIC can help practices in individual states to assess the risk. They have
investigated this issue exhaustively. This would be my recommendation
If you live in the state of CA- see above
Denice Barsness
San Francisco
From: optimal-bounce@xxxxxxxxxxxxx<mailto:optimal-bounce@xxxxxxxxxxxxx>
[mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of Richard Hackel
Sent: Wednesday, March 01, 2017 4:45 PM
To: optimal@xxxxxxxxxxxxx<mailto:optimal@xxxxxxxxxxxxx>
Subject: [**External**] [optimal] Re: From Denice thoughts on IV vs oral FA
Caution please
WARNING: This email originated outside of the Sutter Health email system!
DO NOT CLICK links if the sender is unknown and never provide your User ID or
Password.
IMHO: If it’s illegal in your state, don’t follow Paul’s suggestions.
Richard Hackel
Cambridge, MA
richardhackel@xxxxxxxxx<mailto:richardhackel@xxxxxxxxx>
www.richardhackel.com<http://www.richardhackel.com>
On Mar 1, 2017, at 4:04 PM, CPMC Ophthalmic Diagnostic Center
<cpmceyelab@xxxxxxxxxxxxxxxx<mailto:cpmceyelab@xxxxxxxxxxxxxxxx>> wrote:
I haven't had to use a vein finder & the Drs I've worked for don't like the
quality of an oral FA & find it useless in most cases so I haven't done that in
years either. I would politely disagree. While the quality may not be in par
with fine arts or an image I might use in a lecture, the clinical information
rendered ( which is the point) can be useful when applied to the right
circumstances. No image, no matter how poor, if it leads to a better
understanding of the stage of a condition should be considered useless, IMHO…..
Kirsten Locke & I give a course at OPS Annual Program on IV Tips. Can't give
all the tips now but heres a couple suggestions: I would caution the OPS or
any entity to give lessons in technique in conflict with a given state law.
The State Board of Nursing of any given state governs the act of “short term
infusion therapy” under which the IV administration of sodium fluorescein is
legally governed. I know that the OPS has a specific statement about this on
its website and I would encourage anyone on Optimal to read it, educate
themselves as to the laws governing their state, have these crucial
conversations with your hospital or practice administrators ( not the MD as
they are often not versed in law, more opinion) Look on the AAO website under
OMIC and you will see the statements of the AAO regarding this practice. If
you work in an institution with a Risk Management division, they are best
equipped to advise one on the rules governing your state, your practice.
If your having difficulties finding a vein:
-make sure your tourniquet is tight & not more than 3"-4" from the site you
choose to look at i.e. just above the wrist if looking at the hand, just above
the elbow for anticubital site. Often times the pts complain its too tight but
when you go to release it you find it's not tight at all. It may help to place
a towel or go around the pt's shirt sleeve were you want to apply the
tourniquet.
-Stay open minded. Everyone has their favorite location, left or right arm or
hand etc... But don't limit yourself to only those sites. I had to use a pt's
foot everytime he came in. If you live in a state that provides for the legal
short term infusion therapy of a non RN or MD, finding a phlebotomy class can
be very useful. Otherwise, the act of poking a hole in a vein ( Phlebotomy) vs
providing a bolus of solution into the blood stream using a butterfly or
straight needle ( not a catheter) can be quite different.
If you're finding small veins but they always blow or infiltrate:
-Try an "open butterfly" technique. I learned this from a nurse who
administered Chemo to Cancer pts, who consistantly have the smallest veins.
Don't attach the syringe with dye to the butterfly needle. Remove the needle
used to draw up the dye & set the syringe nearbye with tip propped up so as not
to contaminate the open end. Uncap BOTH ends of the butterfly again being
careful not to contaminate open end (I hold it up between 2 small fingers).
When you stick this "open butterfly" even into a small vein you'll notice the
"Flash" of blood in the tubing quicker & it will continue to flow to the end of
the tubing rather than stop a mm or 2 into the tubing or inside the needle
itself if the syringe was attached (no back pressure to stop it). Don't worry,
even with the tourniquet attached, the flow is slow enough to be able to grab
the open syringe & attach it to the butterfly. Draw back any remaining air in
the tubing & you're ready to push SLOWLY & release the turniquet midway thru
the push (this help to keep the vein a little more firm).
Paul, I’m sorry. It makes me very nervous to see you, or anyone within our
society giving “lessons” on how to perform what is in most states considered a
medical act, tightly governed by laws and regulations. Perhaps it is best
served to have you give these lessons off line, off Optimal where liability
might be at risk.
Respectfully,
D. Barsness
Past President, OPS
Director, Ophthalmic Diagnostic Services
San Francisco
