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J U N E 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T
Ever get a flashback and then when you remove the needle
there's nothing? If you're using a valveless IV catheter — one
that has no valve to block the flow of blood when you're in
the vein — the "posterior wall perforation recovery maneu-
ver" might help you rescue what would be an otherwise lost
IV.
• Anatomy of the problem. You've punctured the vein with the needle and got-
ten a flashback. You've dropped the angle of the catheter and advanced it another 5
to 10 mm to make sure not just the needle tip is in the vein, but the catheter as well.
You've removed the needle or at least drawn it back maybe halfway out of the
catheter and, to your surprise, there's no more blood flashing back.
• What happened? Most likely you've perforated the posterior wall of the vein
and now the needle and the catheter are sitting in the tissue behind the vein.
• The rescue. Simply remove the needle completely, as demonstrated in the video
(osmag.net/SAQe3h), or withdraw the needle until it's halfway out of the catheter
sheath. Now slowly pull back the catheter until you get blood flashing back into the
catheter. As soon as you see blood in the catheter again, stop withdrawing the
catheter. Instead, push the catheter back in and half of the time you'll recover the pre-
viously lost IV. — John Murphy, MD
Dr. Murphy (jmurphy36@icloud.com) is a staff physician at the Bonnyville Health Centre in
Bonnyville, Alberta, Canada.
SAVING A FAILED ATTEMPT
How to Rescue an Otherwise Lost IV
See osmag.net/SAQe3h
for a video demonstration
of how to rescue an IV that
is otherwise lost.
z RESCUE OPERATION John Murphy, MD, demonstrates his "posterior wall perforation recovery maneuver."
