Technique For Starting a Large Bore IV

From Medgadget:

In September's issue of Anesthesiology, Dr. Jonathan I. Stein of York Hospital (York, PA) describes a nifty technique for placing a large-bore IV in patients with suboptimal veins. The idea is based on the Bier block, a commonly performed intravenous block for extremities.

So here is the way to do it. A small-bore (20- to 24-gauge) hand or wrist IV started after applying a continuous-pressure tourniquet to the upper extremity. Without deflating the tourniquet, through the new IV, a crystalloid solution is given (usually 60 mls, according to Dr. Stein), to distend all veins of the upper extremity. Voila! Now you can place a monster catheter into the vein that wasn't even there five minutes ago. According to Dr. Stein, this technique is especially useful when one wants to have strong access but to avoid a central line, for example in patients for an elective c-section with placenta previa or accreta.