Wednesday, February 11, 2009

IV Starts L and D Style

I've failed at two of my two attempted IV starts in the past week. My preceptor said to me, "It doesn't get any better than this. In labor and delivery women have big, fat juicy veins." That made me think of what my son calls blood vessels: blood pipes. That's a much more accurate word for 'em, I think. When I think "vessel" I think earthenware, handles, a spout. Maybe a gravy boat. A vase, but one with useless little ear-like handles up at the neck, you know the style. Maybe blood tubes, but Tube Week has come and gone here on StudentNurse. Yes, I was sad you missed it, too.

But I think it *does* get better than this. First, I have to use lidocaine. Have you done that yet? You use an insulin syringe and make a little lidocainy bleb just under the skin and then wheeeeee! that vein in obscured or pushed to the side and suddenly you're going nowhere fast with that next fat needle. My precpeptor allowed me to go without the lidocaine, but I decided I would give my patient a choice (so, you'll be poked TWICE with TWO needles, but it might make the second stick hurt a wee bit less. What's it going to be gov'nor?) And, good afternoon, we're going 18 gauge here people. "What if they need blood products?" It's not like the needle is as fat as my pinky, but that monster obliterates those fragile hand veins. Gotta go for the forearm. You can't see 'em, you may not be able to feel 'em (especially with that bleb), but you know they're there.

So, I've gotten into the vein (check out the flashback in that hub!) and I've gotten the needle into the right spot, but then chickened out on the digging around for the vein because my patients were squirming so much (yeah, so much for that lidocaine). My precpetor was able to get it in with my start by pulling back a little and going a little deeper. And then blood comes kasplorching out on the chux ('cause remember it's that big fat needle in a big fat pregnant vein in that blood pipe-y forearm neighborhood...) and then, the final L and D challenge, you have to risk the whole IV start to draw blood because we don't want to stick these laboring women more than is necessary. So, I apply the Vac-U-Tainer (JC, how about some logo artwork?) and (with the first gal) popped four tubes in and wiggled four tubes out.

Oh yeah, L and D IV starts are a dream. Next time: no lidocaine for you!

So, I go to "work" and I'm all preening in the mirror beforehand. How do I look? And why do I care? Have you ever been in the nurses lounge on an L and D floor? Take a look around. Hair is neat, earrings and necklaces are worn, jaunty sweaters are thrown over festive scrubs. What's up? I have been in several photos now: Here's baby's first bath. Look at baby getting his first little beanie. Baby's first hepatitis B vaccine: aw, cute! And some of the posed ones: Here's our whole birth team.

But don't look at the shoes in L and D. My preceptor has some tennies with mesh and there's a blood stain on them. One of the midwives has a pair of dark blue Danskos that are really nasty looking. I notice lately she's been wearing shoe covers. I have my bright-white-from-last-year's-dark-days -of -all -white shoes just waiting to be oozed or kasplorched on. On average, a woman loses 500 ml of blood during delivery. That's two cups. And, name that bodily fluid, many of them make an appearance during labor and delivery.

NCLEX tip #2: When in doubt, assess.


Ms.L said...

I had an IV while in labour with my first(35.5 hours later,ugh) and the Nurse had a hell of a time putting it in. I think she tried four or five times before she was successful. She'd been nursing for some time too so hey,it happens to everyone at one time or another.

Molly said...

Four or five times! Zort! Poor you. We get three sticks and then we're outta there. A good nurse will call it quits at two and find the IV start expert in the unit.

Yeah, come to think of it, with my first no one could get the IV started and the one they did start infiltrated and my hand swelled up to the size of a football (seemingly).