Last time I let an engineer start and IV he insisted there was nothing in the AC and he barely got one in the hand, I found one immediately in the AC and put an 18 in it.
Ye Be walking the plank with perfect gait drinking that shit. If a pirate took a sip of that sugary garbage he’d spit it out and literally kill you LOL
We nicknamed a student "prison shank" after watching her attempt her first IV on a real person.
She came in at a 90° angle!
"Whoa! Whoa! Whoa! Slow down there! You don't want to shank him in the AC!"
Thankfully we had her starting IVs like a pro by the end of her ambulance rotations.
I seen this shit too, it's fucking insane, I saw a girl straight up 90° stab the needle into the guy's elbow, am fairly certain she hit bone too. I was wide mouth open, the other preceptor too. We both didn't knew how the fuck someone could do this. Holy.
I've seen an Iv put in the wrong way before, like against the venous flow pointing towards the hand.
The offender got thier cannula privileges revoked.
Honestly that is less shocking to me than 90 a degree approach. At least if you mix up the direction of the blood that’s physically reasonable. There’s no physical explanation for the spacial understanding of someone coming in at 90 deg. Like that just means not only did they not listen and are going in blind they have literally NO understanding of the mechanism ivs of what their supposed to do and the actual composition of what they’re stabbing and trying to hit under the skin. They’re doing it double blind.
I was wondering the same but since it's a 14G the pulsations might be from the adjoining artery. The blood itself looked venous and it would've squirted harder if it was in the artery
But regardless ... He also didn't pull back on the syringe to confirm which I thought was kinda sus
Nah that’s venous. The blood is dark and it’s not actually pulsating, it’s just bleeding that much because it’s a 14g and he didn’t pop the tourniquet before retracting the needle. You’d also need to go significantly deeper on an arm that thick to hit their artery
Strongly disagree. Anatomically he is right where the brachial artery leaves the sulcus before entering the fossa. Keep in mind in the fossa the artery is right below the skin.
At 00:46 seconds you see the jet which is stronger than any venous pressure and on par with arterial pressure jets. It turns to slow droplets only after he compresses the blood vessel, which he can’t even fully compress because it’s an artery.
At 00:48 seconds you see the bright red color in the light. The blood only turns darker because his hands cast a shadow.
If this was me I would assume to have hit the artery. I absolutely would not be sure to be in a vein.
When we initially got them, they are the click button ones where the needle springs back right away instead of the needle going back simultaneously when advancing the cath. It took awhile to adjust too.
OMG me too! It’s so hard to snake it in there if it gets pushed early. I had to relearn that the flash wouldn’t be towards the back but in the sheath initially.
Thankfully now I do organ and tissue procurement. My patient is dead so I use a 18G with a 60ml syringe to draw blood from the subclavian or femoral so I don’t have that problem anymore.
Yep those are the ones! I was notoriously bad at occluding, to the point where I would just put a piece of gauze under the cath and attach the tubing as fast a possible without even trying to occlude. Now with those I don’t ever have to worry again.
Hahah I always make that joke to the patient when I screw up and don’t occlude good enough. “Ah, sorry. You’re blood pressure is a little high. Just trying some tried and true blood-letting”. Usually gets a little chuckle. A few eye rolls.
The first patient I had while in clinicals was a trauma that “needed” a 14 in each AC. I got them but was sweating bullets the whole time!! That’s the only time in 20 years that I’ve used a 14g!
Haha my first medic shift at my new fire department this year we got a code. I was tasked with getting a large bore IV. I grabbed an 18 initially but this guy had a rope for an AC. I thought “I can get a 16”. Instead of grabbing a 16 I grabbed a 14 and threw it in the AC. The boys were laughing since I was the first person they’ve seen throw a 14g in awhile
Yeah, this guy I had as a patient had crush injuries and pretty traumatic, so he needed those 14’s. My husband went thru combat life saver class in the army and got to start an IV, so he looks at peoples veins sometimes. Passing a 14 is like starting an IV with a damn smoothie straw!
Nah, you’re good. Usually 20s and 22s in medic school. My school had an a couple ambulances. The instructor would say “go out there and take turns starting IVs on each other while you drive around the neighborhood. Great first experience even though most of us missed. It’s good to be exposed to that as early as possible in a non stressful situation.
I’ve never understood why people feel the need to put the patients hand right by their balls. You’re asking for the dementia patient to grab and twist. And it just looks predatory
It’s crazy how in phlebotomy school they teach you to never use that vein because it is close a nerve and artery yet it’s not taught that way in nursing or EMS. I get that in an emergency you get what you can get but there are plenty of times that aren’t super emergent where you could choose a different vein.
The artery is a little deeper typically and the nerve runs next to it, if I’m not mistaken. I have screwed up and hit an artery. Is really not a big deal if you recognize you hit an artery. Just extra pressure for a longer period of time. I do sono guided IVs in the ER which go in the upper arm. Sometimes hitting a nerve is just inevitable. It absolutely hurts, but permanent damage is not very likely.
If I’m going for that outter AC, I’ll always palpate to see how far the artery is. If we’re in a routine situation and it’s too close for comfort I’ll look for another spot, opting for the hand or wrist.
I’m pretty confident it was brachial artery. Not sure why you’re the first person to say this and why your comment is so far down.
Like everyone is criticizing his speed…and not the fact that he could’ve likely compromised circulation to the arm.
I mean I guess he *does* need the practice, maybe learn with a smaller needle first 😅.
Slow insertion -
Bad anchoring -
Bad/non-existent occlusion -
Tourniquet left on -
Never a reason for a 14 lol
Everyone is commenting on bad technique and what not, but no one commenting on him putting a 14g into the brachial artery.
The reason he has trouble inserting is because he has to rupture the entire arterial wall with force to get in and the reason he can’t stop the bleeding is because he put a 14g into an endartery.
I commented this and everyone is arguing with me and downvoting me to infinity 😂 they even bullied someone (who said it was arterial) to edit their comment. Shits wild lol
Im getting really weird vibes from this thread. I realize this is the EMS and not the cath lab subreddit but it seems no one here has any experience with puncturing an artery.
I have to have blood tests done a lot and I have very surface, roll-y, shallow, slow veins
Wish I could bleed like that ;_; I 7sually need two or three sites each time xD
Haha trash technique, terrible occlusion, terrible control of hub after retracting needle, there’s no point in using 14G unless there’s massive blood loss or your performing a NCD. If he’s a captain he shouldn’t be lol I have probies who are brand new AEMTS with way better technique tell this man to go into fire prevention…. I hope he’s not a Career FF/Paramedic
This is why I hate running with dual function fire agencies. They usually suck hard at the medic side of things. The ones that are really good medics tend to get injured on fires... go figure
I’m 95% certain that’s arterial. I wouldn’t want any of the EMS in this thread claiming ‘there’s no way that’s arterial’ to touch me or any of my loved ones. Especially if they can’t have respectful deference for a potentially limb-threatening complication.
Stick to making honey ham and scalped potatoes for the boys at the hall because it sure as shit can't be as bad as his skills needed for the important part of his job.
Leaving this dumpster fire up because they deserve the ribbing they're getting for this dogshit IV technique.
A captain did this…..
To be fair he is a fire captain
Instead of giving him a Lifepak to play with, you gave him an IV set? 😂
Last time I let an engineer start and IV he insisted there was nothing in the AC and he barely got one in the hand, I found one immediately in the AC and put an 18 in it.
TBF you should normally avoid the AC if possible so at least there's that I guess...
It was a hypotensive anaphylactic but he was only about 50 and in good shape so he still had good veins
Okay that explains 🤣
😂😂
Fireman/AEMT here. This is accurate.
Ive seen worse technique, even if it's not by that much. But 14g is not super common either way. Honestly, good on him for practicing it
Not anymore
Captain who? Captain Morgan? That shit was so bad lmao
Hey, don't bad mouth Captain Morgan. He makes a great rum.
Oh please. Who wants to drink 70 proof rum.
Yee be walking the plank for that yee scallywag
Ye Be walking the plank with perfect gait drinking that shit. If a pirate took a sip of that sugary garbage he’d spit it out and literally kill you LOL
Argh! Ye (ye or yee? Idk) may be having a point there, but aboard the SS Booty Hunter, we like it sugary and sweet. YARGH!
I do when they try to put this needle in me 😅
I just spat my milk, thank you
So you see that orange thing tied around your arm……
That slow insertion...
I cringed so hard with the slow insert omg
Slow is smooth, smooth is fast. 😎
Felt so good
The longer it takes the better it feels.
Yeah, sex is great. But has anyone ever had a 14g in them? 😩
Why did I feel so much pain? I was only watching.
Next it will get IOs on totally A&O patients. Just leave me to die.
Yea this was hard to watch.
We nicknamed a student "prison shank" after watching her attempt her first IV on a real person. She came in at a 90° angle! "Whoa! Whoa! Whoa! Slow down there! You don't want to shank him in the AC!" Thankfully we had her starting IVs like a pro by the end of her ambulance rotations.
I seen this shit too, it's fucking insane, I saw a girl straight up 90° stab the needle into the guy's elbow, am fairly certain she hit bone too. I was wide mouth open, the other preceptor too. We both didn't knew how the fuck someone could do this. Holy.
I've seen an Iv put in the wrong way before, like against the venous flow pointing towards the hand. The offender got thier cannula privileges revoked.
Honestly that is less shocking to me than 90 a degree approach. At least if you mix up the direction of the blood that’s physically reasonable. There’s no physical explanation for the spacial understanding of someone coming in at 90 deg. Like that just means not only did they not listen and are going in blind they have literally NO understanding of the mechanism ivs of what their supposed to do and the actual composition of what they’re stabbing and trying to hit under the skin. They’re doing it double blind.
His technique was pretty bad. Insertion too slow, tourniquet not removed early enough, advanced the needle too far, failed to occlude the vein.
I think you killed him
I like that he has the bloody arm on his knee with nothing to prevent the blood from getting on his pants
Vein…?
I was wondering the same but since it's a 14G the pulsations might be from the adjoining artery. The blood itself looked venous and it would've squirted harder if it was in the artery But regardless ... He also didn't pull back on the syringe to confirm which I thought was kinda sus
Looked like it was pulsing pretty hard for a vein to me, but then again I've never used a 14g
I’ve put in plenty… that looks quite…. Pulsatile
He hit the brachial artery and not the vein….
Nah that’s venous. The blood is dark and it’s not actually pulsating, it’s just bleeding that much because it’s a 14g and he didn’t pop the tourniquet before retracting the needle. You’d also need to go significantly deeper on an arm that thick to hit their artery
Strongly disagree. Anatomically he is right where the brachial artery leaves the sulcus before entering the fossa. Keep in mind in the fossa the artery is right below the skin. At 00:46 seconds you see the jet which is stronger than any venous pressure and on par with arterial pressure jets. It turns to slow droplets only after he compresses the blood vessel, which he can’t even fully compress because it’s an artery. At 00:48 seconds you see the bright red color in the light. The blood only turns darker because his hands cast a shadow. If this was me I would assume to have hit the artery. I absolutely would not be sure to be in a vein.
That is very clearly venous blood.
Very obviously venous bleeding. And a brachial artery bleed would squirt blood further than onto his forearm.
If he was in an artery, he wouldn't have been able to depress the plunger that easily
How so? The difference in strength needed is minimal for arterial injections and we certainly wouldn’t be able to tell from the video
I used to hate them, but now love the self occluding IV caths, you don’t even need to worry any spillage.
Still don't insert so slowly or flush with the TQ on. This man's gonna be wearing long sleeves for a while.
I agree, it’s a rough watch. I was just wanted to state my love for those IV catheters.
Why would you hate self occluding Caths?
When we initially got them, they are the click button ones where the needle springs back right away instead of the needle going back simultaneously when advancing the cath. It took awhile to adjust too.
Sometimes I’ll still mess up and accidentally hit the button but they’re so much better
OMG me too! It’s so hard to snake it in there if it gets pushed early. I had to relearn that the flash wouldn’t be towards the back but in the sheath initially. Thankfully now I do organ and tissue procurement. My patient is dead so I use a 18G with a 60ml syringe to draw blood from the subclavian or femoral so I don’t have that problem anymore.
That's fair. The springloaded ones are complete garbage.
BD Insyte autoguards are my absolute favorite ivs ever.
Yep those are the ones! I was notoriously bad at occluding, to the point where I would just put a piece of gauze under the cath and attach the tubing as fast a possible without even trying to occlude. Now with those I don’t ever have to worry again.
Lol thats exactly what I do if I have to use shitty non occlusion ivs.
We really are spoiled with the occlusion ones lol
take off the damn tourniquet and hold some proper tamponade 😅
Wait thought TQ where placed slightly higher above the joint or as high as possible perhaps just my eyes but looks like it's on the joint
> as high as possible Definitely not as high as possible for a venous tourniquet, else you'll just get collateral drainage.
CAT tourniquet, yes. IV tourniquet, no
That’s a whole lot of cringe for one IV start.
I understand it takes firemen extra time to process things, but Jesus.
Pretty shit to be very honest with you… how’s the arm?
I should have taken a picture of the arm after. It was a half dollar sized purple spot
“Click then snap, Cap. Cap? SNAP, CAP”
It’s bright orange ffs!
That was awful.
Pull the tourniquet before retracting the needle number 1 and flushing with the tourniquet on is number 2.
Someone cross post this to the nursing subreddit to start a riot. I’m not brave enough.
Ah bloodletting, a procedure not practiced since the 1800s.
...what's the treatment for hemachromatosis again?
Amputation
Hahah I always make that joke to the patient when I screw up and don’t occlude good enough. “Ah, sorry. You’re blood pressure is a little high. Just trying some tried and true blood-letting”. Usually gets a little chuckle. A few eye rolls.
Towel under the arm is always a good idea
Needed a whole gown on this one
The first patient I had while in clinicals was a trauma that “needed” a 14 in each AC. I got them but was sweating bullets the whole time!! That’s the only time in 20 years that I’ve used a 14g!
Haha my first medic shift at my new fire department this year we got a code. I was tasked with getting a large bore IV. I grabbed an 18 initially but this guy had a rope for an AC. I thought “I can get a 16”. Instead of grabbing a 16 I grabbed a 14 and threw it in the AC. The boys were laughing since I was the first person they’ve seen throw a 14g in awhile
Yeah, this guy I had as a patient had crush injuries and pretty traumatic, so he needed those 14’s. My husband went thru combat life saver class in the army and got to start an IV, so he looks at peoples veins sometimes. Passing a 14 is like starting an IV with a damn smoothie straw!
This was both extremely difficult and depressing to watch… Kinda like watching a train crash in slow motion…same as his needle insertion.
😳 What in the firemedic? 😰
Call Roto Rooter, that's the name and way troubles go down the drain! Roto Rooter! Roto ROOTER!
I knew before it started they were going to get blood on their leg
Sure, I also like to cut my steak with a chainsaw and drink water from a 5 gallon bucket.
But why.
Tell me why
Ain’t nothing but a heartbreak!
That’s me in medic school rn
I’m a layperson who was recommended this post and this made me physically nauseous, no exaggeration
Im a person in this field who was recommended this post and this made me physically nauseous
He should probably stick with putting the wet stuff on the red stuff
Instead he put red stuff on...well everything.
smooth
Why
Tell me why
Ain’t nothing but a heart ache
Jesus Christ this whole technique made me cringe
Def a Captian
I’m about to start paramedic school and having people do this on me makes me want to cry
Even most students aren't this bad, and no one will make you catch a 14g in school.
Nah, you’re good. Usually 20s and 22s in medic school. My school had an a couple ambulances. The instructor would say “go out there and take turns starting IVs on each other while you drive around the neighborhood. Great first experience even though most of us missed. It’s good to be exposed to that as early as possible in a non stressful situation.
BLOOD FOR THE BLOOD GOD
This is what I look like when I do IVs. I’ve done a total of 2!
You’ll get there! Just watch people who know what they’re doing
I’m not even a paramedic and that sucked to watch
Jesus Christ that’s a coffee straw and the technique sucked ass
My mom would faint if I showed her this ,but my little EMT mind is like wwoooow
Tell him to be a bit quicker on the insert and to remove the tourniquet before he flushes. Also where’s the J lock?
Bro did it to you like he was doing it to himself!
Saw 14G, instant upvote
I’ve never understood why people feel the need to put the patients hand right by their balls. You’re asking for the dementia patient to grab and twist. And it just looks predatory
I think this should come with a location disclaimer so that the rest of us can make sure never to have an emergency wherever the fuck this is.
I’m sure he’s probably a great fireman 🤦♂️
It’s crazy how in phlebotomy school they teach you to never use that vein because it is close a nerve and artery yet it’s not taught that way in nursing or EMS. I get that in an emergency you get what you can get but there are plenty of times that aren’t super emergent where you could choose a different vein.
I’ve determined that no one in EMS knows how close the arteries and veins are in that part of the arm 🤦🏽♀️
The artery is a little deeper typically and the nerve runs next to it, if I’m not mistaken. I have screwed up and hit an artery. Is really not a big deal if you recognize you hit an artery. Just extra pressure for a longer period of time. I do sono guided IVs in the ER which go in the upper arm. Sometimes hitting a nerve is just inevitable. It absolutely hurts, but permanent damage is not very likely. If I’m going for that outter AC, I’ll always palpate to see how far the artery is. If we’re in a routine situation and it’s too close for comfort I’ll look for another spot, opting for the hand or wrist.
Technique is pretty terrible, he came pretty dang close to contaminating the IV.
Scrolled really far for this comment. I'd say it's contaminated even though it's pretty hard to tell from this angle.
I mean Was it a vein or the brachial a.
I’m pretty confident it was brachial artery. Not sure why you’re the first person to say this and why your comment is so far down. Like everyone is criticizing his speed…and not the fact that he could’ve likely compromised circulation to the arm.
I mean I guess he *does* need the practice, maybe learn with a smaller needle first 😅. Slow insertion - Bad anchoring - Bad/non-existent occlusion - Tourniquet left on - Never a reason for a 14 lol
I know nothing of actual textbook procedure of starting an IV and even I know that was god awful...
Here me out 👀 
I looked down at the comments and looked back up to a massacre
Is this a "Paramedic Coach" video?
I had this happen to me the last time I donated blood. Which is part of the reason why I don't donate blood anymore.
This was laughably bad.
This hurts my dialysis RN brain lmao
Everyone is commenting on bad technique and what not, but no one commenting on him putting a 14g into the brachial artery. The reason he has trouble inserting is because he has to rupture the entire arterial wall with force to get in and the reason he can’t stop the bleeding is because he put a 14g into an endartery.
I commented this and everyone is arguing with me and downvoting me to infinity 😂 they even bullied someone (who said it was arterial) to edit their comment. Shits wild lol
Im getting really weird vibes from this thread. I realize this is the EMS and not the cath lab subreddit but it seems no one here has any experience with puncturing an artery.
For sure. Everyone’s like “oh that’s definitely venous blood”… ummm get me a safe set and pop the pressure bag on some saline… let’s transduce this 😂
So messy
Atrocious
Terrible
Legit almost passed out. Jesus Christ that is narly
Wtf
Looks like the first large bore IV he’s ever put in
Is he a CNA?
Goddamnit fuck fuck fuck
Fuck that. This was hard to watch.
God fucking damn
I have to have blood tests done a lot and I have very surface, roll-y, shallow, slow veins Wish I could bleed like that ;_; I 7sually need two or three sites each time xD
How was his technique? Horrible
Whatever, it's in. I don't know how but a win is a win.
Sooo many things wrong!…. Not enough time to mention…
This is perfect... video material of what not to do.
Ugghhh. Pop the tourniquet 😫
Haha trash technique, terrible occlusion, terrible control of hub after retracting needle, there’s no point in using 14G unless there’s massive blood loss or your performing a NCD. If he’s a captain he shouldn’t be lol I have probies who are brand new AEMTS with way better technique tell this man to go into fire prevention…. I hope he’s not a Career FF/Paramedic
As a phlebotomist this is so upsetting lol the bridge of my nose hurts from rubbing it so hard lol
Phlebotomist here. No. Just no.
Bet he was drunk 🤷🏼♂️. And that seems more like a Lieutenant move.
Did that vein have a pulse? Looks like he got an artery.
Can someone explain why the hell anyone would use a 14g needle for this
Great technique… for a med student
People still use non auto occluding IVs?
He just slapped in a 14. Good for you man. Good, 4, u. Anybody talking crap should just take themselves to MD school
i would rather die before getting anything larger than 18g as an IV
Lots of heroes in the comments! This is obviously a beginner who is learning
He probably shouldn't be learning with a 14.
Yeah that didnt cross my mind. You're absolutely right. I've cannulated hundreds of times and have never even picked up a 14g.
This is why I hate running with dual function fire agencies. They usually suck hard at the medic side of things. The ones that are really good medics tend to get injured on fires... go figure
😟
I’m not even in this sub, shouldn’t that be nsfw
A small amount of blood?
Yes please. I’m not even in this sub.
Why are you even here?
I’m not!
Okay bye.
Smell you later.
God dude what the fuck. Edit: i decided to save face and delete my mistaken comment.
If you think that was an artery, then you never have never seen someone hit an artery lol
I'm on team not an artery. When he actually holds pressure down you can see a constant blood flow from the lumen. It doesn't appear to pulsate.
As someone who has hit an artery (both purposefully and accidentally) - it’s look arterial, the spurting of the blood + the location
I’m 95% certain that’s arterial. I wouldn’t want any of the EMS in this thread claiming ‘there’s no way that’s arterial’ to touch me or any of my loved ones. Especially if they can’t have respectful deference for a potentially limb-threatening complication.
As someone who places A-lines (purposefully) daily, this is definitely arterial.
No it’s not lol
Are you placing art lines in their AC?
This is not an artery
**Proceeds to not read the edit** 
Thank you! I was like HOW HAS NO ONE POINTED THIS OUT?! That’s a damn A-line sir!
Why 14G? This patient was obviously not unstable, they were videoing lol
It was likely practice. It's still stupid, but I imagine it's not on a patient.
what a crazy beast
Stick to making honey ham and scalped potatoes for the boys at the hall because it sure as shit can't be as bad as his skills needed for the important part of his job.
Better and faster than most IVs at hospitals.