Consider this passage from a Nursing 2000 journal article titled: “Tips and tricks for pediatric I.V. insertion” http://findarticles.com/p/arti.....i_n8915169

“What size device should I use?
Choose the smallest-gauge catheter (24 or 22) in the shortest length to allow hemodilution of infusates by blood flow around the catheter. In neonates, administer I.V. fluids and medications, blood, and blood products via a 24-gauge I.V. device. In older children, a 24- or 22-gauge catheter works without increasing the risk of hemolysis. “

Although, I don’t have a problem with how the IV was started or the size of the IV, there are lots of things I do have a problem with in this video from a nursing perspective.

1.All pediatric medicines and IV fluids should be on IV pumps. This protects the child from accidental fluid overload and more precisely regulates how the infusion rate of medications. If the IV is not on an infusion pump then microdrip IV tubing and/or a soluset (aka a solutrol or volutrol) is used. These also protect the child from fluid overload and allow for more precise calculation of drip rate. Children will typically receive a slower IV rate than adults and less volume for the obvious reason that they are much smaller. http://www.accd.edu/sac/nursing/math/peds2.html
Neither a pump, nor a microdrip, nor a soluset, were used in this situation.

2.I have concerns about the amount of fluid given over this 2 hour and 10-15 minute period. It is hard for me to tell the exact sizes of the IV bags used from the video. There are 3 bags given, 2 of them look to be in the 50-100 cc range. I assume the 2 smaller bags are the glutathione and the “garlic and vinegar”. The third bag is much larger and the solution is yellow so I assume it is the DMPS. At the time in the video that this bag is shown, it looks to me like there is about 300 cc of fluid in that bag. Although, I must say I may be completely off since it is hard to tell from a video. I assume that the child received all this fluid since at the end of the video there are 3 IV lines and it is obvious that the IV bags are empty. My estimate then, and I want to repeat that I may be way off here, is that this child received 400 cc (possibly more since I’m not sure at what point in the infusion the yellow IV bag was shown) of IV fluid in 2 hours, which seems like a lot to me. To be honest, I’m not sure if it would be a problem or not in a healthy child.

3.It also concerns me that none of the IV bags appear to have labels on them that say what medications have been added, although it’s possible they are labeled on the back and I just can’t see it in the video. If there aren’t any labels this scares me for a couple of reasons. First, it means that these bags were mixed in the clinic, because no pharmacist would mix an IV bag without putting a label on it. I just wonder what kind of standards are used for mixing these bags. Secondly, all nurses have a fear of making a medication error and take all precautions possible to prevent errors. It is taught in nursing school, and it is on licensing exams, that all medications are labeled. I assume that this child is not the only patient in the clinic receiving medications, and I also assume that there are also adult patients there after looking at this doctor’s website: http://hamptonsmedicalspa.com/default.aspx I further assume that all patients don’t require the same dose of the medications this child was given. Thus it concerns me that errors might be made by giving a patient the wrong medication when bags are not labeled. Again, it is very possible the bags were labeled and I just couldn’t see it.

4.I looked for some infusion protocols for IV DMPS but was unable to find any. I have no idea what the potential complications might be for this type of infusion. I did find a protocol for giving CaEDTA which I thought was interesting if you compare it to the procedure that was described in the case where the child died when he received IV push EDTA. http://www.mainehealth.org/wor.....eline3.pdf I especially found it interesting that this treatment guideline says to give the medication over 24 hours, and that there should be continuous cardiac monitoring during the infusion.

5.This leads me to my final concern. I assume this clinic, and perhaps most IV chelation clinics are stand alone clinics not connected to a hospital. I would be concerned about the emergency equipment they have in the clinic, the number of personnel they have who are trained to deal with emergency situations, and the transit time to a hospital if that was required. There should be a crash cart in the clinic with a cardiac monitor and defibrillator, as well as emergency medications, and emergency equipment such as endotracheal tubes, and oxygen. Staff should be trained in PALS, including the physician. I would wonder if a doctor who has been trained in adult medicine has ever been involved in a pediatric resuscitation effort, much less directed such an effort.

I am 24. I am of reasonable height and weight-that is, larger than most children being subjected to this horrendous procedure.

AND. I have yet to find someone who can start an IV on me first shot. There’s been lots of opportunities to try, between dehydration (diabetes insipidus…when you’re sick even 2 gallons won’t do), migraine treatment, seizure precaution…the “best of the best” in one epilepsy center took three tries.

Anyone can do it, huh?

Does this kid have bigger veins than I do somehow? Or is it more likely that mom is playing fast and loose with his safety while praying at the alter of Normal?

In your opinion would a 20 guage needle be “large bore” enough to administer drugs and fluids for treatment in an emergency?

If the child is being chelated because misleading lab tests told the mom that the child is “heavy metal toxic” then it’s still patently wrong what they are doing. The doctor (not a pediatrician, not a toxicologist) is smart enough to know that the child doesn’t need to be chelated based on a mail order lab test result, but he’s making money off of chelation so he chelates kids, with the help of Nurse Nick, it would appear. If he gets hurt in any way by this, even if his veins are getting damaged from the weekly chelation (making it harder for Nick to get a vein each time)... it’s abuse. Telling the kid that he’s got all these bad metals in him when it’s not true is abuse, in my opinion. It’s all about making mom feel like she’s a hero and doing all she can do undo the damage done by the evil CDC et al. And the mom was promoting chelation by putting this video out there, encouraging others to do IV chelation in the process.

I still think they are claiming they put the vinegar and garlic in him with the IV fluid. To get rid of imaginary lead and aluminum.

First of all, although gloves should be used for IV insertion as part of Universal Precautions relating to all body fluids, sterile gloves are not used. The insertion site itself (where the needle actually punctures the skin) should be as sterile as possible, and a sterile covering for the insertion site is recommended, however the procedure does not require sterile gloves or other components of sterile technique. Wearing gloves during these procedures protects the health care worker from potential pathogens in the patient’s blood. Hand washing before and after the procedures protects the patient from pathogens. Protection from pathogens is also provided by cleansing the insertion site with alcohol and/or Betadine.

Medical facilities typically have Procedure Manuals outlining the protocol required for all medical procedures. I have located a couple of examples of these protocols for peripheral IV insertion online:

http://www.sh.lsuhsc.edu/polic.....g/I-49.pdf
5. Dons clean gloves*, selects appropriate site, applies tourniquet, and
preps site with alcohol.
NOTE: Do not palpate site after skin has been cleansed with antiseptic.
(*clean gloves are not sterile)

http://www.guideline.gov/summa.....8;nbr=4666
d. Wash hands: Good hand hygiene and standard precautions are used for insertion and IV maintenance; a new pair of disposable nonsterile gloves may be used in conjunction with a “no-touch” technique for peripheral IV insertion. With “no-touch” technique, the planned IV insertion site is not palpated after skin cleansing, unless sterile gloves are worn. Wash hands before and after IV catheter insertion and dressing change (O’Grady et al., 2002).

Obviously the nurse in the video is not wearing gloves at all which is actually not that surprising to me considering he is an older nurse. When I first learned how to start IV’s and draw blood we did not wear gloves. The recommendation to wear gloves during these kinds of procedures came with the advent of AIDS and Universal Precautions (now called Standard Precautions) in1985. Reference: http://www.corexcel.com/html/b.....2.ceus.htm

Many nurses, myself included, who learned how to access veins before the advent of Universal Precautions found it difficult to adjust to using gloves. This is because the “feel” of a vein, the bounciness and size is very important in deciding whether or not it would hold a needle or IV catheter. Also, many times veins are not visible, but on ly felt under the skin. Feeling a vein with a bare finger, vs. feeling it through a glove is very different. I did adjust to wearing gloves, although generally I would feel for a vein with a bare finger and then don gloves and clean the insertion site.

If you watch the video, you will see the nurse swab the index finger, middle finger, and thumb of his right hand before he inserts the angiocath (IV catheter). This technique offers the nurse no protection if there is leakage of blood from the catheter or insertion site, but it may offer as much protection to the patient from potential pathogens as clean gloves do. Consider that unsterile gloves are typically kept at the patient’s bedside in an open container, and no recommendations are given for using an antiseptic on the gloves before venous access procedures.

I also want to address the size of the venous access device. Although my eye sight is not as good as it used to be, it did not appear to me that the IV catheter used was a butterfly as I didn’t see any “wings” on it. IV catheters are color coded according to size, and these colors are standardized across brands. It looked to me like the IV catheter that was used in the video was pink which would make it a 20 gauge. Reference: http://www.umecopr.com/pages/m.....eters.html

Lastly, I just don’t even know what to say about the garlic and vinegar, surely they didn’t mean they are giving that IV! That’s craziness!

In the US - I don’t think anyone does. That’s their idea of freedom.

Pffft!

And outside the confines of the medical profession? Clearly a lot of the people practising the DAN! protocol – and all the other assorted quackery – are not medical doctors. I have heard of homeopaths practising chelation.

Who regulates these people?

It is too starved an argument for my sword frankly. Google lead poisoning prevalence.

The actual point:

Heavy metal toxicity is a real medical phenomenon given sufficient exposure
An infant or toddler with sufficient exposure to develop metal toxicity would almost certainly manifest significant developmental impairments
Given the famously vague criteria of DSM such a child would likely qualify as autistic
Stating that there is no evidence of metal toxicity as an underlying pathology in a patient presenting with autism is therefore dissembling at best.

You jump from a reasonable, supportable statement to an unsupportable generalization which defies common sense; presumably to cater to your bias. Your apparent cognition is the inverse of that of the mercury milita.

Who is making the fortune is this giant lucrative scam that you are promulgating (in a rather paranoid sounding manner I might add) DANs? DDI?.

A federal investigation is needed? Why? Exactly who are you trying to protect with your evocation of the nanny state? Within the medical profession there are methods to deal with those whose conduct is malpractice. I don’t see anything else required.

Wrong. There is not a widespread problem with lead poisoning in inner cities today. I see you don’t want to support your statement with data now.

The parents using these mail order labs are not even reporting high lead in most of their kids.

Besides the word hoax, scam is also appropriate here. Here’s an easy representation of what we see in autism in the US.
DAN!+ DDI labs = lucrative scam

Federal level investigation into this fraud/hoax/scam would be very appropriate.