IMHO: If it’s illegal in your state, don’t follow Paul’s suggestions.
Richard Hackel
Cambridge, MA
richardhackel@xxxxxxxxx
www.richardhackel.com
On Mar 1, 2017, at 4:04 PM, CPMC Ophthalmic Diagnostic Center
<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
