IV start on obese pt

I say lucky patient.....there is never a reason to torture a patient. If you felt nothing, you did the right thing. As for the others giving you the eye...everybody misses.

Most obese patients are very difficult, the wrist is the easiest spot. Why the 18 unless they were emergent? Is this your facilities base insertion?
If so, perhaps they need to be enlightened. Part of doing no harm is using the size that is minmally invasive for the task at hand. Fragile veins, especially in sick people do not require an 18g at every admission-the iv should match the potential treatment.

I know this has been a contentious issue in the past, but evidence based practice speaks volumes, just because we always did it that way,does not!
My hospital has a number of autoimmune, dialysis and cancer patients with horrible veins! We use doppler and our practice is to insert what you need in the foreseeable future. Obviously, if an 18 g is required than do it....but...if all you can get is a 22g, you can always use that to sedate the patient as the central line is inserted : ) Catch my drift?

Maisy

Don't take it personally.....Sometimes we can't get them....sometimes we can......It's not the end of the world!....she got an IV

I'm usually great at IV starts, but there are times I couldn't hit the broad side of a barn. There have also been times when another nurse has asked me to try on a hard stick, I've put the tourniquet on, seen a great vein, popped it off to leave the room to get supplies, come back in, and the vein that was just there is nowhere to be seen. Sometimes for whatever reason veins just don't cooperate with us, but will for other nurses.

As far as the not being able to advance, I find that oftentimes "floating" the catheter in with a saline flush helps. And be sure to pop the tourniquet off before flushing after you have the catheter in.

http://en.wikipedia.org/wiki/Anatomical_snuff_box
even if you cant see it, feel it.....it is there the cephalic vein......

Obese pt's in TX are usually hard sticks. After a couple of nurses attempts and a charge nurse attempt we called the house supervisor who got it on the second try just last week. Keep having faith in yourself.

The nurse that started the IV for you picked one of the worst places to put an IV....so do not feel bad (especially if she put it in the volar wrist. HALF of ALL IV related complications occur at areas of flexion (that includes the ACF. That is a pretty high number so try to avoid if possible or go above or below the area of flexion. I have been instructing nurses for 22 years on how to start IVs and although there are many mistakes or misses that can happen,,,I will give you my opinion on the ones I see over nad over again.


1. Do not pierce the skin with a too sharp angle..usually all you need is a 20 30 degree angle. Once you hit the vein...immediately drop your angle flush to the skin and advance the catheter as a unit about at least 1/8 of an inch. This is critical for your success as your needle can be in the vein (since it is longer) and not the catheter, If you do not advance it once you get your flashback and then pull your needle back all you did was puncture a vein and then pull out the needle.

2. Select the shortest smallest catheter that will meet the patients needs

3. Do not underestimate the power of a heat pack or warm bath blanket. OK to use a BP cuff set slightly below pts diastolic



try these things and see if your success improves and try to be very specific about why you are failing and I can give you more tips. What catheter are you using as some will require some slight modification in you technique.

You are welcome. Try to always do the easy ones and then once you get really good at the easy ones push the envelope even more and begin to try harder ones. What device are you using so I can give you some more tips? Believe me ....I have lots and lots. The next thing is always ask yourself why you missed so in similar situations you will not make the same mistake....that is how I always advanced my practice and my reputation in the process (that was an added benefit....I just did it to be a better nurse and get the job done!!!)

Does your unit have a Venoscope you can use to aide in hard IV starts? Our unit has one and oh god it is the best device that was ever made, I'm on an oncology unit and our patients of course practically have no veins but using the venoscope most of the time enables me to be able to get an IV of some sort in them. I'm thinking about actually purchasing one for myself simply because I work per diem at a facility where we don't have one of these gadgets available. Here's a link where you can learn more about them if you like http://www.venoscope.com