Little Tape Chevrons

My IV skills are slowly but surely developing. Everyone who’s new at starting an IV gets so excited about getting flash, that there’s kind of that “Oh crap…well now what do I do?” moment after you withdraw the needle. I’m starting to nail more and more IV sticks, so the “OH MY GOD, I GOT IT!! YAY! Oh, wait, I’m not done?” feeling isn’t quite as strong. I’m actually thinking ahead a little bit more before just diving right in. That includes focusing on the less glamorous parts of starting the IV. Such as, oh, properly occluding the vein as you attach the extension set, so the patient doesn’t bleed out freaking everywhere.

"Uh...well, I think his blood pressure was high enough to handle this..."

“Uh…well, I think his blood pressure was high enough to handle this…”

(Image credit)*

 

I don’t really have that down 100% either, but I’m getting better at it.

The other big piece is securing the line in place. I tend to be pretty decent at that. One day, a paramedic showed me something I hadn’t been taught in class–the chevron. It looked pretty neat and handy. I liked that you could secure it more firmly in place if the loop of the chevron was pointed distally. And, if you pointed the loop proximally, you could pull the edge of the catheter off of the inside of the vein wall just enough so that it flows better. Pretty sweet, huh?

Oh, except that I saw it done in the nice, quiet, controlled environment of the hospital with a cooperative patient. And that the tape had already been ripped for me.

The next time I started an IV, I gleefully thought to myself, “I’m going to make my preceptor so proud! I’m going to surprise him with this cool little chevron trick! He’s going to just beam with pride!”

Oh, you ignorant, ignorant AEMT.

First off, I had an EMT-B tear my tape for me. I’ll be the first to admit that when I was a Basic, and a medic asked me to tear him tape, I never really knew exactly what he was looking for. How long? How wide? Well, turns out this Basic did exactly what I used to do…just take off huge hunks of the 1″ tape, stick it against the cabinet, and assume I’d figure it out. The paramedic preceptor I was with was busy sticking on EKG leads, so I went ahead and tried to quickly whip together my chevron. I was hoping he’d look back at me after he was done, and grin at my cleverness (even though he’s been in the business forever).

Have you ever tried to make a neat little chevron using 1″ tape while bouncing down the road? Because it comes highly NOT recommended.

This is what a tape chevron is *supposed* to look like. Just admire that textbook perfection.

This is what a tape chevron is *supposed* to look like. Just admire that textbook perfection.

(Image credit)

And this is what mine looks like.

And this is what mine looks like.

(Original image credit…I just added some Paintbrush magic.)

This is the newbie, frustrated, stubborn, bouncing-around-in-the-back-of-an-ambulance version.

When I finally smoothed down the last crinkled piece of tape, I looked up at my paramedic preceptor. He was watching me from the captain’s char, with that sad, “aw…that’s so cute,” patronizing, “good effort, kiddo” smile on his face, complete with the “your earnest innocence is so endearing” raised eyebrows. I returned the look, and sheepishly smiled.

After we transferred care of the ball-of-tape-with-the-patient-trapped-inside, the paramedic chuckled and patted my shoulder.

“So, next time?” He started, stifling a good-hearted, bemused giggle. “You tear the 1″ tape in half. And uh…chevrons are…well…”

“A textbook thing?” I offered.

“Kind of. Yeah. Not so easy or practical in real life, huh?”

I shook my head, smiling just a little.

“It’s okay…at least that line isn’t going anywhere. For, like, the rest of that patient’s life.”

*By the way, it’s not real blood in that picture. Promise.

Comments

  1. Great post. Thanks for sharing the ups and downs of training.

  2. It’s a pain in the neck trying to secure an IV like that. I’m kind of surprised that the service doesn’t have biocclusive dressings. Much easier.

    Oh, and those neat little chevrons won’t work on a sweaty patient. Or one covered in blood. Or shit. Or if, goodness forbid, you have to start an IV on someone with burns on the arm. In those cases, you’ll end up using a lot of tape just to keep everything in place.

    • probietopractitioner says:

      We actually do have biocclusive dressings, and I did use one on this call. The little loop of the chevron was pointed in the other direction (compared to the picture I have in this post). My chevron wasn’t around the catheter; it was around the tubing. You could argue that my goal was to pull the catheter off of the inside of the vein wall by just a hair…in reality, a simple strip of tape (or a few) would have done just fine in securing the tubing. But no, I was feeling ambitious and wanted to try the chevron thing. It’d been a while since I was showing my ignorance, so I guess I figured now was a good time to turn that around.

  3. You get style points for trying to do all of that in a moving ambulance.
    Much of what we are taught is based on what worked for nurses and doctors in the clean, not moving, confines of hospitals. A lot of that won’t work in the field, as much as the aforementioned doctors and nurses would like to believe that it will.

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