# New IV Tool



## ZmanTX (May 24, 2013)

Recently I had someone close to me go through a procedure. It has been a while since anyone I've known had gone through any kind of surgery. However, when I was able to talk to him/her they brought to my attention a new tool used to help with IV's (at least it was new to me). It is a portable/handheld LED light device used to locate veins on a person, honestly I was surprised and the first thing I thought of was "How valuable could this be in combat?" With combat injuries and situations IV lines are imperative to start(replenish fluids and to complete blood transfusions) and this could or could not be a potential asset.
So my question is what are your thoughts on this device? Would it be an essential tool in your med kit or do you think it would be more of hassle?

Here is a link to the site I found when I used google:

http://www.veinlite.com/


----------



## policemedic (May 24, 2013)

A few things come to mind regarding this device. 

The first is that IVs are not terribly important, and fluid resuscitation has caused as many problems as it has solved.  People don't die from the lack of a piece of plastic in their vein.  In the first phase of TC3 IVs shouldn't even be a thought; the second phase may present the opportunity but other interventions should be prioritized over starting a line. 

Next, I don't need to fuss around with a device like this and I don't need to carry the weight.   Difficult cannulation is easily solved by IO insertion. If the tactical situation permits, a Surefire light held against the skin offers a good view of the vasculature.   MTFs and certain medics have the capability to insert peripheral IVs with ultrasound guidance if there is no emergent need to do an IO.


----------



## ZmanTX (May 24, 2013)

"fluid resuscitation has caused as many problems as it has solved"

In your experiences what kind of problems have you encountered?


----------



## policemedic (May 24, 2013)

Hemodilution and encouraging bleeding top the list.


----------



## amlove21 (May 24, 2013)

Zach M said:


> "fluid resuscitation has caused as many problems as it has solved"
> 
> In your experiences what kind of problems have you encountered?


 
Yea man- this has come full circle at this point. We have went from "2 large bore IV's wide open right away" to where we are now- I don't even carry a full 2 litres of fluid in my med ruck anymore. 

2 500cc bags of hextend, a 500cc bag of saline, and 2 or 3 100cc bags for med admin. That's honestly about it. 

Look up goal directed therapy, permissive hypotension, proper fluid challenge and fluid administration algorithms and read all that - and when that 6 months is over, come back and we can get into specifics.


----------



## amlove21 (May 24, 2013)

PS- if you're a medic worth half your shit and need a light for an IV- just stop. You suck.

I mean, shit- 2 sticks that are hard get you an IO in my world anyway, so get up for it.


----------



## Muppet (May 24, 2013)

IMHO. A waste of money. That veni-lite  contraption. No need to talk more about fluid resusc.

F.M.


----------



## ZmanTX (May 25, 2013)

amlove21 said:


> Yea man- this has come full circle at this point. We have went from "2 large bore IV's wide open right away" to where we are now- I don't even carry a full 2 litres of fluid in my med ruck anymore.
> 
> 2 500cc bags of hextend, a 500cc bag of saline, and 2 or 3 100cc bags for med admin. That's honestly about it.
> 
> Look up goal directed therapy, permissive hypotension, proper fluid challenge and fluid administration algorithms and read all that - and when that 6 months is over, come back and we can get into specifics.


 

Look forward to it Am.
Thanks for the info everyone!


----------



## Red Flag 1 (May 25, 2013)

RF 1


----------



## SpongeBob*24 (Jun 21, 2013)

Back in my day when I was doing IV's I went straight into the HEART......PULP FICTION style!!!!!


If I'm out of IV, 1000cc of coffee right into the vein.....and I make really GOOD coffee?!?!


----------



## TLDR20 (Jun 22, 2013)

Go IO, a monkey could do it.


----------



## TLDR20 (Jun 22, 2013)

Red Flag 1 said:


> Looks like a gimmick, looking for support, and a following. Like many tech "aids", it tries to replace art and technique with " clever " new tool. I have found  many viens by palpation alone. The touch also tells me just how good the vien will be  for what I need to do. Veins that are sclorossed, poorly supported and rolling are not going to be identified by this new "aid". One of my residents once canulated a brachial artery, instead of a large vien, with a long central line. When asked how he managed to do that, he said  it felt like a great vien, after the torniquet was  applied. I expect this gadget will be equally misleadiing, in some cases. Beware the gadgets that take your feel, and fingers away from your patient; they stand in the way of the art needed in our practice.
> 
> My $.02. Back to my wee cave here in The Valley.
> 
> RF 1



That was a terrific post.


----------



## Muppet (Jun 22, 2013)

cback0220 said:


> Go IO, a monkey could do it.


 
I remember when we, the county got I.O.'s (EZ IO guns) about 7 years ago. I drilled EVERY sick person, cardiac arrest and trauma we had. Then I got in trouble for "spending money" because they are expensive. Now we do tibial and humeral I.O.'s for REALLY sick / trauma's only so the squad does not go broke. Have to try I.V.'s first.

F.M.


----------



## policemedic (Jun 22, 2013)

And that's just one of the problems with the current insurance/billing  reimbursement model.


----------



## DoctaJ (Jul 17, 2013)

Zach M said:


> Recently I had someone close to me go through a procedure. It has been a while since anyone I've known had gone through any kind of surgery. However, when I was able to talk to him/her they brought to my attention a new tool used to help with IV's (at least it was new to me). It is a portable/handheld LED light device used to locate veins on a person, honestly I was surprised and the first thing I thought of was "How valuable could this be in combat?" With combat injuries and situations IV lines are imperative to start(replenish fluids and to complete blood transfusions) and this could or could not be a potential asset.
> So my question is what are your thoughts on this device? Would it be an essential tool in your med kit or do you think it would be more of hassle?
> 
> Here is a link to the site I found when I used google:
> ...



I've used the VeniLite. As many have stated, it's a gimmick. Unless your pt has carrot veins, it's difficult to differentiate between the different shades. Give me some time and I'll post a picture. 


amlove21 said:


> PS- if you're a medic worth half your shit and need a light for an IV- just stop. You suck.



This made my night. But really, if you suck at IV's, you need to consult your local ED and try to get some IV team time. If you REALLY need to give someone fluids or meds, you can't beat the EZ IO. Also, if you have the right J Loop, the size of said loop is the right dose for local anesthetic and the treatment of ICP. Convenient.


----------



## amlove21 (Jul 17, 2013)

I dig it. Love the EZ IO. Fast, relatively painless, great piece of kit. 

@DoctaJ , consider getting vetted through the site. I'd love to see a colored tag to go along with your great inputs.


----------



## DoctaJ (Jul 17, 2013)

amlove21 said:


> @DoctaJ , consider getting vetted through the site. I'd love to see a colored tag to go along with your great inputs.



I looked into it. Just need to get my 214 out. I saw you could email from AKO, but didn't find further information.


----------



## DoctaJ (Jul 17, 2013)

So here it is. I took several pictures. The first one is without fluorescent lights on (which really need to be off for the device to be even slightly beneficial.) Next you'll see one with lights on, followed by two next to a pen light for size comparison. IMO, the Veinlite might be useful in a hospital setting, but not so much in a moving truck. I would rather feel for the vein than us this device. Further thoughts?


----------



## Muppet (Jul 17, 2013)

You actually bought this thing bro? Waste of money IMHO. I would have bought a new pair of Danner boots or something I could really use.

F.M.


----------



## DoctaJ (Jul 17, 2013)

Firemedic said:


> You actually bought this thing bro?
> 
> F.M.


 
Lol, no. I didn't. Our department did. Along with a Doppler, E-Scope and a long list of other shit that doesn't work well in a truck.


----------



## Muppet (Jul 17, 2013)

DoctaJ said:


> Lol, no. I didn't. Our department did. Along with a Doppler, E-Scope and a long list of other shit that doesn't work well in a truck.


 
What's the E-scope?

F.M.


----------



## DoctaJ (Jul 17, 2013)

Firemedic said:


> What's the E-scope?
> 
> F.M.


 It's a stethoscope that amplifies lung sounds or heart tones. Rather than your standard ear pieces, it comes with an earmuff style headset.

http://cardionics.com/e-scopeelectronicstethoscope.htm


----------



## Muppet (Jul 17, 2013)

Oh, yea. that thing also. I know a medic that carries one. Again, don't believe in it for E.M.S. I would rather get a King Vision for difficult airways.

F.M.


----------



## DoctaJ (Jul 17, 2013)

Firemedic said:


> I would rather get a King Vision for difficult airways.
> 
> F.M.


 
Ain't that the truth. Those things rule. Well, they appear to. Can't say I've ever used one. Have you ever had success with the King LT that you can slide an ETT through?


----------



## Muppet (Jul 17, 2013)

DoctaJ said:


> Ain't that the truth. Those things rule. Well, they appear to. Can't say I've ever used one. Have you ever had success with the King LT that you can slide an ETT through?


 
Never tried that. I have used the King multiple times and usually just ventilate through that, with the Etco2 waveform attached.

F.M.


----------



## DoctaJ (Jul 17, 2013)

Firemedic said:


> Never tried that. I have used the King multiple times and usually just ventilate through that, with the Etco2 waveform attached.
> 
> F.M.


 
I've been fortunate; I haven't had a colossal shit storm of an airway yet. Now that I've said it...give it a week. CPAP has become my friend recently.


----------



## Muppet (Jul 17, 2013)

You will get bathed in blood soon enough. Been there, done that. Don't forget to ventilate first. Lots of new medics think they need to "get the tube", forgetting to ventilating the pt. (B.L.S. B.V.M.). Do you use M.E.I. / R.S.I.? CPAP has decreased the tubes I have gotten but if it prevents the older C.H.F. / asthma pt's from getting vented and staying on the vent, I am happy.

F.M.


----------



## DoctaJ (Jul 17, 2013)

RSI. I prefer etomidate/sux. I suppose if I knew the pt didn't have a gag reflex, MEI would be a viable option. I just know that if I was being tubed, I wouldn't want even the slightest chance of being partially awake. Not to say you can't under-dose someone with Etomidate, but I like the idea of a completely relaxed jaw. What about you?


----------



## Muppet (Jul 17, 2013)

P.A. has M.E.I. (etomidate alone) but only 2 squads in the county I work in uses it. The S.O.P. written for it sucks and so most squads and  medical directors don't believe the S.O.P. was written correctly so "we" don't use it. I would like to see R.S.I. but apparently the S.O.P.'s are written for the lowest common retards that don't do a lot of jobs, in the center part of the state. P.A. has I guess > 13,000 medics with command so that makes it hard to control. Hell, E.M.S. in the urban / burbs of Phlly have a hard time carrying the monitor TO the pt. let alone giving meds to paralyze a pt. So, I don't believe that giving MORE toys to medics that are medi


----------



## Muppet (Jul 17, 2013)

W.T.F.! Anyhow, giving more toys to medics that suck I don't agree with.

F.M.


----------



## DoctaJ (Jul 17, 2013)

Firemedic said:


> P.A. has M.E.I. (etomidate alone) but only 2 squads in the county I work in uses it. The S.O.P. written for it sucks and so most squads and  medical directors don't believe the S.O.P. was written correctly so "we" don't use it. I would like to see R.S.I. but apparently the S.O.P.'s are written for the lowest common retards that don't do a lot of jobs, in the center part of the state. P.A. has I guess > 13,000 medics with command so that makes it hard to control. Hell, E.M.S. in the urban / burbs of Phlly have a hard time carrying the monitor TO the pt. let alone giving meds to paralyze a pt. So, I don't believe that giving MORE toys to medics that are medi


 I totally understand the lowest common retards. There are a couple medics in my area that are scared to given valium to a combative or seizing patient, much less completely knock them out. My volunteer squad recommends 2-5mg Versed for intubation, and we don't carry Sux. At work is a different story. It's almost scary how much they let us do and how many drugs they give us. But anyways, protocols pretty strict in PA?


----------



## DoctaJ (Jul 17, 2013)

Lol..from Veinlite to useless shit to airway to drugs to protocols. Slightly off topic..


----------



## amlove21 (Jul 18, 2013)

DoctaJ said:


> Ain't that the truth. Those things rule. Well, they appear to. Can't say I've ever used one. Have you ever had success with the King LT that you can slide an ETT through?


Yup. Works very well.


DoctaJ said:


> ...At work is a different story. It's almost scary how much they let us do and how many drugs they give us. ...


As a 68W? I was not aware that a W could pass narcotics. When you're "at work", what do you mean? Are you a different flavor of combat medic (e.g, other than a 68W)?


----------



## policemedic (Jul 18, 2013)

amlove21 said:


> Yup. Works very well.
> 
> As a 68W? I was not aware that a W could pass narcotics. When you're "at work", what do you mean? Are you a different flavor of combat medic (e.g, other than a 68W)?



Speaking for Whiskeys, narcs were OK.


----------



## DoctaJ (Jul 18, 2013)

amlove21 said:


> Yup. Works very well.
> 
> As a 68W? I was not aware that a W could pass narcotics. When you're "at work", what do you mean? Are you a different flavor of combat medic (e.g, other than a 68W)?


 Ah, sorry for the lack of specificity. Work would consist of an ALS truck in a medium-sized Ohio city. Unfortunately, I signed my contract as a 68W too early to realize that I should have gone AD. Now I can't even get any recruiters to talk to me about AD. I considered switching branches and attempting PJ..but I have plenty of time to accomplish those goals. But as for the 68W question..nope...strictly 68W1O.


----------



## DoctaJ (Jul 18, 2013)

policemedic said:


> Speaking for Whiskeys, narcs were OK.


 
Correct, the only Schedule II's in the standard 68W scope are MS and Fentanyl, if I remember correctly.


----------



## TLDR20 (Jul 18, 2013)

DoctaJ said:


> Correct, the only Schedule II's in the standard 68W scope are MS and Fentanyl, if I remember correctly.



In pre measured doses yes.


----------



## Muppet (Jul 18, 2013)

DoctaJ said:


> I totally understand the lowest common retards. There are a couple medics in my area that are scared to given valium to a combative or seizing patient, much less completely knock them out. My volunteer squad recommends 2-5mg Versed for intubation, and we don't carry Sux. At work is a different story. It's almost scary how much they let us do and how many drugs they give us. But anyways, protocols pretty strict in PA?


 
Actually, the S.O.P.'s in P.A. are fairly progressive. You can view them by going to the P.A. Dept. of Health website and looking for P.A. statewide protocols.

F.M.


----------

