I first noticed 'that' in some young adults during PICC insertion: early twenties, CF. in a couple of cases the dilator sheath got pushed out of the vein. When I switched to peds, I noticed more: CF kids again, teens. Since I am not sure how to 'document' that 'complication', I just say it is 'venospasm' for the purpose of data tracking. there was about 4%. I am not sure if it is related to CF, age, pain, and or anxiety. By looking at the data, it is true that teens got less sedation (sometimes we assume they can cope better than other kids). I use that data to argue for more sedation for that population. I try to ask one sedation MD to publish the data: that the % of venospasm decreases once we have a real sedation team. well, it seems every one is busy. for piv, I have seen veins 'disappear' when the needle enter the skin but before hitting the vein (I like the side approach technique). see more among small kids/infants, not sure why. as you mentioned, it is very difficult to measure, to track. Once, entered skin (24g) side of vein; baby cried, vein 'disappeared'; waited for a few second for the vein to come back then entered the vein -- the cannula got pushed out when I tried to thread it in. My witness then was the attending. It happened so quick, the only thing I could say was: 'You see what happened?!"
--- Gwen Irwin <[EMAIL PROTECTED]> wrote: > This may seem to be a weird topic, but with our > years of ultrasound insertion of PICCs, we have > noticed that some patients really react to vein > entry BEFORE we are close to entering the vein, > while observing on ultrasound the location of the > needle in relation to the vein wall. When we > proceed past that point, we are in the vein with > excellent blood return and proceed to successful > PICC insertion. Local anesthesia works only on the > skin entry and doesn't prevent this reaction to vein > entry. They also react differently to vein entry of > the dilator/sheath introducer. > > This population of patients are also the ones that > complain of the most pain with IV insertions. Most > staff nurses give up before entering the vein with > an IV catheter, when the patient complains of this > pain. If we are called to do a PIV, we don't give > up at that point, but believe that we are right on > top of the vein and continue past the patient's > complaint to vein entry. We have a successful PIV. > > This is so hard to measure for a study, but our > observations have led us to believe that the > innervation of the exterior of the vein is different > for some people. We don't seem to see a large > percentage of our patients that have this type of > reaction, but it is noticeable, when it occurs. > Some of these people call themselves "weenies" for > IV starts. Based on the years of our observations, > we don't believe that they are weenies, but that > they have different innervation that actually gives > them a pain signal before vein entry. We have been > known to tell them that they have bad luck with > their veins, since they feel the stick into the vein > before it actually occurs. These also can be the > patients that have more vasoconstriction observed on > ultrasound, during PICC attempts. We have waited > for as long as 10 minutes to observe the vein stop > its vasospasm, and see the dilation that we > initially saw on our original assessment. > > I am wondering if anyone else is noticing this > phenomenon. I am really thinking it would be useful > information to share, but don't know how to study or > report this subjective observation. > > I would love to hear from you, if you think we are > crazy or if we are noticing something that has not > previously reported or discussed. We have seen it > so many times that we don't think we are crazy. > Your responses are always appreciated. > > Gwen Irwin > Austin, Texas > > > __________________________________________________ Do You Yahoo!? Tired of spam? Yahoo! Mail has the best spam protection around http://mail.yahoo.com
