I'm not sure if this falls into the same category of behavior, but I have
had a few of these patients who are on the 'sensitive' side announce to me
when I've gotten into the vein. I'll be watching the ultrasound, and before
I see any blood return the patient (who has been tense and anxious) will
suddenly say to me, "There, you're in now." This is not after repeated
pokes or wiggles of the needle on my way to the vessel.......these are
people who do (as you say) seem a little more sensitive. I always
congratulate them on 'calling their insertion', and they just laugh and
thank me for my work. I've only been using US for a few months, but this
has happened to me 3-4 times.
Alma Kooistra RN, CRNI
----Original Message Follows----
From: "Gwen Irwin" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]
Subject: Do you notice the patient's reaction to vein entry?
Date: Fri, 11 Aug 2006 21:25:19 -0500
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
