IV Cather kinking when advancing

[sreynolds]

I sometimes encounter an issue when advancing my IV catheter into the vein. I feel like I'm pretty good at finding veins and inserting the IV needle...and I've gotten really good at not blowing veins by trial and error. For example, I've learned to not use a tourniquet on the elderly, and I've learned how to adjust my angle to ensure I don't puncture the other side of the vein. But one issue I encounter that drives me INSANE, is sometimes, even when someone has AMAZINGLY veins, I'll go to advance, and the catheter does not advance easily and when it does, it kinks. Anyone else have a problem with this? Advice? Tips? It slows me down when I have to stick someone multiple times and This is one problem I can't seem to work out...any thoughts would be really really appreciated!

Sincerely,

Frustrated ER nurse

[akulahawkRN, ADN, RN, EMT-P]

I have found that if I don't get the catheter all the way inside the lumen, it will kink when I attempt to advance the catheter into the vein. The hard part is judging when that happens so that you have a needle that's inside the lumen far enough to allow the catheter to advance without kinking. I'm getting better at that too.

[wyosamRN]

Most of the time when this happens, the entire beveled tip of the catheter isn't all the way through the wall of the vein before advancing.

[WKShadowNP, DNP, APRN]

Stop pushing, you likely hit a valve. Attach the flush and float it in.

[IVRUS, BSN, RN]

An important point to remember is that the needle (in all ONC's) always protrudes out further than the IV catheter as it is what allows you to gain entry into the vein. Therefore, just getting a flash into your stylet doesn't mean that the IV catheter is within the tunica intima and so when you advance, you'll meet resistance if both the needle and the catheter aren't within the inner lumen of the blood vessel. What will help is when that flashback has occurred, immediately drop your angle flush with the skin and advance a mm or so to ensure both are where they should be before you advance the catheter into the vein.

Hope that helps.

[AZQuik]

An important point to remember is that the needle (in all ONC's) always protrudes out further than the IV catheter as it is what allows you to gain entry into the vein. Therefore, just getting a flash into your stylet doesn't mean that the IV catheter is within the tunica intima and so when you advance, you'll meet resistance if both the needle and the catheter aren't within the inner lumen of the blood vessel. What will help is when that flashback has occurred, immediately drop your angle flush with the skin and advance a mm or so to ensure both are where they should be before you advance the catheter into the vein.

Hope that helps.

This. Do it every time.

BSN GCU 2014.

Sent from my iPhone using allnurses

[NurseOnAMotorcycle, ASN, RN]

Also a possibility, don't retract the needle all the way if your iv catheter is still hanging way out. (My visual attached: I can't draw, I'm sorry!)

[emtb2rn, BSN, RN, EMT-B]

An important point to remember is that the needle (in all ONC's) always protrudes out further than the IV catheter as it is what allows you to gain entry into the vein. Therefore, just getting a flash into your stylet doesn't mean that the IV catheter is within the tunica intima and so when you advance, you'll meet resistance if both the needle and the catheter aren't within the inner lumen of the blood vessel. What will help is when that flashback has occurred, immediately drop your angle flush with the skin and advance a mm or so to ensure both are where they should be before you advance the catheter into the vein.

Hope that helps.

Again, this. Then float it in.

[iluvivt, BSN, RN]

Yes, something is wrong if your catheter is kinking and I bet it is happening with larger catheters and larger thick walled veins. IVRUS has the likely problem nailed,once you see the flashback in your chamber and sometimes feel the pop you MUST drop your angle and thread the entire unit a tad more so are ensuring the catheter is fully in the vein and not just the tip of the needle. WATCH your blood it should keep on coming into the flashback chamber (unless there is a spasm) and if it does not you most likely are not in the vein anymore and you lost it because you did not drop angle and advance. Look at the several gauges,especially the larger ones and you will see how much you need to thread them,look at the end of the cannula and then see how much longer the needle is.I tend to keep track of where I expect to hit the vein and try to do that i a straight section so I can safely thread it a bit more than actually needed.

A second possibility is that you have done a through and through puncture or you have hit from the side and went out the other side. I find a through and through easier to save than if I hit on the side. If you have done a through and through puncture and gone through the back wall you can very slowly pull it back until you flashback is seen again and blood once again is coming through into your flashback chamber and pull your needle back and reattempt threading. You have to be very quick to do this successfully. Are you using the introcan 3,which can be tricky since your flashback is limited?