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.

Fake Confidence is Still Confidence

“How are your IV’s coming?” My EMT-I partner asked me, as we responded to a call.

“Ugh. Terrible. I can’t hit the broad side of a barn now. Haven’t gotten one in forever.”

“Ohh, that’s okay, we all get ruts,” The paramedic called out from the back.

“No. This is more than a rut. I learned on one catheter, and then we used another type during clinical, and those have two completely different finesses to them. Now that we use the first catheter type here, I can’t seem to get the hang of it again.”

“You’ll figure it out again. You’ve just got it in your head now that you can’t do it. Cut that out. You gotta have confidence,” The I-tech said.

“Fake it til ya make it?” I asked.

“Hey, fake confidence is still confidence,” He replied. “You’re gonna get this one. Trust me, when the pressure’s really on, and the guy really needs a line, you will somehow find a way.”

Not long afterwards, the medic and I found ourselves on either side of the patient, bouncing down the road to the landing zone. Alcohol swab in hand, I searched up on down her cold, sweaty arm for something, anything, that I could stick. This was my first patient who, without a doubt, needed an IV. I traced my fingers down her arm, poking and tapping where I hoped to find veins. I was starting to get worried when…oh, Perfect!  I could feel that spongy rebound under my fingertips in the crook of her arm. If I looked at it at just the right angle, I could almost make out a tiny raised section of the vein, making it that much easier to go for. I watched for a steady straight-away in the road, painted the vein with the alcohol wipe, and uncapped the needle. As discreetly as possible, I took a deep breath to both steady my nerves and strengthen my courage. I raised my voice and said to our deteriorating patient, “Okay! Big pinch in your arm, ready? One, two, three!”

A smile tried to edge its way onto my face as I watched the flash chamber fill with blood. I couldn’t believe it…when it actually really mattered, I got it! Knowing I wasn’t done yet, I leveled out, and advanced the catheter. I heard the click of the needle into the safety cap, and knew I was in. It flushed beautifully, and was secured with a tegaderm and (probably too much) tape. I even made the stupid little chevron out of tape. I worked to keep myself from visibly shaking from the excitement. No one was coaching me through, or watching over my shoulder, or setting up any of my equipment. For the first time, I got it done all by myself–and when it counted for something, too.

When we watched the helicopter take off with our patient inside, there was something extra satisfying knowing they were using the line that I had started. Those medications could help preserve the patient’s life.

I turned to an ear-to-ear grin on my partner’s face. “What did I tell you? When you need to get it, you’ll get it! Right? Right???”

“Fake confidence is still confidence!” I replied, a huge smile stretching across my face.

The medic clapped my back, saying, “Hey, congratulations on doing your job.”

“Would you hush? Let me enjoy my glow.”

“Well, glow and clean up the back. You and the medic trashed that place,” The EMT-I interrupted. “Then we’re getting a celebratory coffee. Good job, kid. Well done.”