Outpatient Surgery Magazine - Subscribers

Backbreaker - Outpatient Surgery Magazine - April 2019

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://magazine.outpatientsurgery.net/i/1101772

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Page 129 of 146

IV Tips & Tricks IV 1 3 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A P R I L 2 0 1 9 to look, they automatically retract their arm, and this can cause you to lose the insertion site," she says. Ask the patient to slide over to the railing on the far side from you, which will allow more room for the arm on which you're working. Laying the arm flat on the bed will stabilize it and works better than having the arm hanging off the edge of the bed. "The goal is to position yourself distally to the vein and keep the catheter aligned with the vein," says Ms. Gallagher. Because no 2 arms are shaped alike, you can use a rolled blanket or pillow to straighten the arm. The hand should hang off the end of the blanket or pillow, which gets the knuckles out of the way if you're using a hand vein. Having to hold the catheter over the knuckles can change the entry angle of the needle, which can cause you to go too deep and miss the vein. For bigger patients who fill the stretcher, you can also use the bedside table to straighten out the arm and create more workspace for yourself to insert the IV. Adjust the table to lift or lower the arm to a more workable and comfortable angle, says Ms. Gallagher. Tourniquet etiquette When applying the tourniquet, be aware of the hair on the patient's arm. Instead of putting the tourniquet directly on a hairy arm, put something between the arm and the tourniquet so you don't pull on the hair. You can use a sleeve, wrap a piece of gauze around the arm before applying the tourniquet, or even use a blood pressure sleeve and set it on IV start, says Nikolaus Gravenstein, MD, profes- sor of anesthesia at the University of Florida College of Medicine in Gainesville. 2

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