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what is going on guys welcome back to another episode of the er forum so in today's video we're going to show you guys how to place a peripheral iv and i have uh we kind of have a little setup going on here i have a generous volunteer who's going to help us accomplish this endeavor and then we have a spectator over there as well so welcome to the episode [Music] okay so what we're going to use today guys a 10 cc flush normal saline these are essentially a 90 star kit has a tegaderm tourniquet four gauze pads some tape and some core hexagon in here and then our typical white side a lot of the stuff is in the er um and then we will be using a 22 gauge because i'm a nice boyfriend and we're not so that's pretty much everything we're going to use and we're going to kind of do our best to uh sanitize the area with alcohol and then we'll get started all right guys so essentially what you want to do with your patient first is get in a comfortable position make sure the patient's comfortable make sure you're comfortable i usually i'll sit down sometimes i'll be kneeling down other times during codes when you need to put a line in you'll just kind of get in whatever position feels more comfortable for you so first thing i do is kind of get everything set up i will unpack it my uh saline flush there i'll take out the 22 gauge that we're going to use kind of get everything ready and that way once i actually start poking the patient everything is where i needed to be so during this time just kind of talk to your patient a little bit the less nervous you seem the less nervous they are right so i kind of asked them how the football game was who their favorite sport team is what they plan on doing and what were their plans before they ended up coming to the er and stuff like that so this is the chlorhexidine that i was telling you guys about this is what we'll actually use to cleanse the skin before we perforate it this is our tegaderm which we'll use actually hold the iv in place and then we have some tape in here we have a tourniquet which are terrible i usually use the er tourniquets that we have but eternity comes in the package and then some gauze just in case she starts bleeding a little bit more than i anticipated so what you want to do first is grab your saline flush with your wide tubing we're going to do what's called priming the tube so essentially what we're doing is we're going to prime this y tubing with saline and what that does is gets all the air out of the tube because i don't want to put any air into her and cause a pulmonary embolism right so leave saline flush through the tubing and that way it's all great in the er we actually draw blood off this tubing it ends up getting primed with blood anyway just for the video purposes we're going to go ahead and prime the tube so the white side is now primed now i'll go ahead and grab my tourniquet and we will start looking for any available veins oftentimes what you want to do is make sure you ask the patient if the right or left-handed she's right-handed i know that so that's why we're going to try the left arm over here just so that way she has her right hand available to be able to text make phone calls things like that again this is all under the impression that we're not having an emergency right now so is that okay okay so we'll tie the tourniquet young patients typically have really good veins in the er a lot of times it's not based off what you can see it's what you can feel so you'll kind of go and start filling for certain veins in the anticubicle phosphate they'll teach you in nursing school to start down here in the hands i blow a line here and i try to use one down here there's a chance that it's gonna cause a problem here but if i start here and blow here i can work my way up in the er you just end up getting really good at getting things on the first try and so you're very confident being able to come up here so she has a huge vein right here that i can completely fill and i'm not sure you guys can see that but there's a very large vein that's right here so that's where we're gonna go these chlorhexidine packs what we're gonna do essentially you guys can see that is you just pinch the two sides here that are on the actual corners you shake it up a little bit and it'll start to be inundated with fluid here okay that's what we're going to use to clean and we clean side to side it's cold a little bit yeah all right so now the site is cleaned i kind of open up my tegaderm here get that ready lay it right next to her there and we're all good to go guys so i make sure my gauze pads ready i have my 22 gauge needle ready my saline flush is ready and it's primed and we kind of know where we're already going to go so take your needle you're going to locate where it is you want to go and i usually go at like a 45 degree angle big pokemon three one two three perforate the skin make sure we got a flash which we do we go ahead and advance the catheter i will hold pressure just proximal to the actual iv catheter withdrawing my needle and then i will connect my y tubing now see how there's some blood coming there younger people tend to get freaked out about that just clean it up a little bit it's no big deal and we go ahead release our oh if we're going to draw blood draw blood at this time if not release the tourniquet [Music] and we go ahead and flush no pain no you're probably going to taste something nasty do you smell or taste any saline usually you can taste it and that usually means i'm in the right spot but that's essentially how you place a line guys and then you kind of just do all your you taste it and then you just prep your line here and kind of make it all pretty and uh this is where i'll put my name or my initials the time to date and make sure when you guys place this tegaderm here you make sure that the opening window can see the iv catheter just case there's any phlebitis or any problems here i can notice that okay but there was no pressure when i was pushing which is great she tasted and smelled the saline go through which is again another indicator that i'm in the right spot and there's our line so how do you feel fine keep it fine so that is how you place a uh peripheral line guys it looks very pretty again this was a 22 gauge i don't know if you guys can see that let's see if it focuses maybe not but that's how you place a peripheral iv again young people very easy to do a lot of times their veins are just sort of popping out on you i use the 22 gauge and the er would use at least a 20 maybe an 18 but honestly you can get anything done with the 20. the reason we don't like to use 22s in the er is because everyone that comes in the er is a trauma until proven otherwise if i'm going to give this person a fluid bolus if i'm going to give this person emergent blood i need to have a large bore iv if i'm going to give a ct with contrast either for ct energy or ct belly i need a large bore iv this is going to blow her vein because there's too much pressure in there when they're actually pushing the contrast or when i'm giving the fluid or giving the blood so a large bore iv is better but obviously for this video we're gonna do something smaller so i really hope you guys enjoyed it this video if you did don't forget to punch that like button and hit that subscribe button and follow me holland and uh jason on instagram if you want to see what we're doing on a day-to-day basis so i really hope you guys enjoyed the video we'll see you in the next one