I have had this happen often enough and always figured it was just that I
hadn't gotten the Lidocaine deep enough into the tissues to numb the region.
But now that begs the question--how deep are people infiltrating the
Lidocaine?
David
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
