I've only been doing the photographing of FA's for about 15 years?? and have
had a mixture of docs that can get veins every time and some that scare me when
they hold the needle.
Another little tip - all the dye is in, timer still going, nothing showing,
getting closer to that minute mark, and tourniquet is off, doc is long gone
from the room, have the patient lift that arm into the air. And then the show
can go on. Bolus was blocked. Had this happen twice now. Forget who told me
that tip. But, thanks.
Agree with Paul that all these various tips broaden our ability to participate
in the FA process, within the limits of the practice we work in. And the state
laws.
We are interested. This is why we are active followers of this posting.
Thanks for all the tips over the years.
Lori
Lori Guerette, CRA COA OCT-C
-----Original Message-----
From: "Paul Paquette" <dmarc-noreply@xxxxxxxxxxxxx>
Sent: Thursday, March 2, 2017 10:36am
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: From Denice thoughts on IV vs oral FA Caution please
Denice, Relax!
I'm only suggesting alternate tips to someone who asked about vein finders on
OPTIMAL, which BTW is NOT part of OPS's domain. These are the same tips I give
to the fill-in nurses & the stumbling new Residents who are murdering the pts
on multiple attempts. Even the nurse at a major clinic who rarely missed prior
to my suggestion has adopted this technique on a regular basis & now claims she
never misses.
As far as the OPS course, Kirsten is an RN & I am also CPT (certified
phlebotomy tech) & OPS's disclaimer statement is one of the 1st slides that is
presented along with our own statement that we are not here to discuss the
legalities & to research those on your own. We repeat it annually because it
gets pretty good attendance & reviews. Some students attend to improve their
own techniques, other to bring suggestions back to whoever injects at their
clinics. The other part of our talk are the vascular properties & the
hemodynamic flow (& also used to contain quick 1st aid & crash cart info but
that was too much for 1 course & is now a separate course) all of which we feel
are vital info to be passed along to anyone who is in our field.
Sorry if me making these suggestions make you feel uncomfortable but I intend
to continue to share my observations, knowledge & experiences to others that
ARE interested.
Paul.
-----Original Message-----
From: CPMC Ophthalmic Diagnostic Center <cpmceyelab@xxxxxxxxxxxxxxxx>
To: optimal <optimal@xxxxxxxxxxxxx>
Sent: Wed, Mar 1, 2017 1:05 pm
Subject: [optimal] From Denice thoughts on IV vs oral FA Caution please
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
