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73-year-old Hispanic female with congestive heart failure. She has a history of COPD and chronic corticosteroid use. She has received respiratory treatments with Atrovent and albuterol in the ER but no IV has been started.
a.Why might this client’s IV be difficult to successfully start?
Mike_T says:
I know exactly how you feel, I was in a very similar situation. I remember that I was so nervous at that time and I took it out on everyone around me. I didnt know what could I do until, thanks god, I found Smoke Deter. Now I can look back and laugh on myself and in the same time I remember how helpless I was. I hope that I'll never be in the same situation again
Because of the whole clinical picture, this person does not have an adequate heart function to pump an efficient amount of blood in order to fill all veins. Although the patient has COPD and CHF, she sounds as if she is probably dehydrated so that would also reduce vein filling.
From my experience, the patients were taught to monitor their fluid intake but they essentially drink less to avoid CHF and therefore become dehydration. Being short of breath is not fun.
I had to lower the arm until something popped up and put the tourniquet on the arm. Not too tight because of bruising and tearing of skin. No heat on these patients and slapping the arm is even worst. I have seen this tissue paper tear just handling the patient. Start IV with care though it may not be easy and may require a blind stick.
I havve had problems with steriod use patients because the skin is so thin–tissue paper–that because of the wrinkles, it is hard to see a vein. This patient will probably have multiple bruising, too. Good Luck
This Pt may need & benefit from the breathing treatment & not require the IV. Also, with her long hx of steroid use, he veins will be "fragile’ meaning that when they are punctured with an IV catheter, they are likely to rupture. There are Lots of medications & conditions that have this effect on a persons veins.
Things that lead to difficult IV access:
Elderly – less connective tissue strength in epidermis, leading to veins that "roll."
Chronic steroid use – fragile veins that blow easily.
Dehydration – inadequate intravascular volume and thus, small veins.
Overuse – Too many previous sticks in veins such as IV drug users or patients undergoing chemotherapy, requiring frequent IVs.
Obesity – thick adipose tissue make veins hard to find.