IV tips and tricks - page 15
Hi all, I am starting to compile a list of tips and tricks concerning starting venipuncture. The goal is to share experiences and tricks of the trade. Tips e.g. on how to find that elusive "best... Read More
May 29, '06I can only add my 2 cents, but these are a few things that I've picked up in the last couple of years that have made it so much easier for me.....
-On the little old ladies with extra skin, hold it taut! I have so many students who have problems with those IVs, simply because they don't pull the skin.
-If you absolutely must go for the AC in a kid, have your holder put one hand on the forearm and one on the upper arm, and pull back a little. Not enough to hurt, but it keeps the kid from rolling his arm.
-We had a 21 m girl last week who had great veins, but was the strongest 21m old I've ever seen! We tried to let mom hold her, but the kid was coming off the table and was still able to pull her hand back, and she d/c'd her line. We finally decided to bear hug her, and have someone else hold the forearm. (Does this make sense?) It worked like a charm.
-I second the trick of advancing a little more on adults after you get your blood return - that way you can be sure the needle is in the vein instead of just nicking the top.
-Advancing with the needle in (but not all the way) helps you get through valves; also the saline flush trick.
-On peds, I've found it is best to go low and slow. Once you get that blood return (which may be just a drop), pause, take a breath, and then advance your catheter slowly. For some reason, that little pause helps to not blow the vein.
-When a parent tells me I "only have one stick" I smile and say "Thank you for telling me that" (as long as they are not mean about it) and excuse myself for a moment. Step outside the room, take a breath, and then go back in and stick. Half of peds sticks is mental, and having all that pressure on you makes it ten times worse.
-I also lay down ground rules with parents as I'm setting things up. Mainly, I welcome parents in the room, but they need to conduct themselves in an "adult" manner. I ask any other family members to leave (grandparents, siblings, family friends, etc) unless they seem to be huge support systems for the parents/child. I welcome the child to be held in mom/dad's lap IF they can keep a good hold on the baby. Otherwise, I don't ask parents to be my second holder - i.e. holding the kid down on the bed; I hate the idea of a kid feeling this pain and looking up and to see his mom holding him on the bed. I also don't mind if parents want to stroke the kid's head or hold the other hand, but the second they're in my face or causing more drama, I ask them to sit or step out. Mainly, they need to facilitate, not hinder.
-On the same note, if mom/dad is going to step out for a procedure, make sure they go to the WR. I've come out of a few rooms to find a parent in tears outside the room - they stood there and listened to the kid screaming and crying, and instead of seeing what was happening, they imagined it - which is always so much worse!
These are just a few things I've picked up. I'm nowhere near an expert, but they've helped me out a lot.
Great thread, I've learned a lot!!
May 29, '06Quote from NurseEricaSomething else you can do is have an assistant place one open hand under the elbow and push the elbow up and toward the body with the palm of their hand while their other hand takes the wrist and rotates the forearm outward and into a position of pronation (with the inner part of the forearm facing upward and slightly out). They have to be gentle and not very aggressive as they could injure the joint. This puts the arm in hyperextension and locks the elbow very much like a splint would do so the arm isn't going anywhere. It also gives the person doing the sticking excellent access to the antecube.-If you absolutely must go for the AC in a kid, have your holder put one hand on the forearm and one on the upper arm, and pull back a little. Not enough to hurt, but it keeps the kid from rolling his arm.
Like the bear hug solution for squirmers!
Aug 29, '06Quote from TraumaInTheSlotYes THANK YOU (former Heroin addict here who really does know which vein is best to use :wink2: ) sorry I know that tip was given a while ago but I just had to concur with it. A number of times I have had a Nurse or a Doctor who need to draw blood or give medications to me IV and I tell them which vein to go into and they ignore me completely, pick a different vein and then end up rather annoyed and embarrassed when they have trouble and return to the initial vein I first pointed out.oh, and if a heroin addict says "thats not a good vein" , they are right.Last edit by WillowBrook on Aug 29, '06
Aug 29, '06thanks for reviving an old thread. just in time for my venipuncture lab coming up.:wink2:
Aug 29, '06Quote from AudreyfayThat vein is called the dummy vein. Any dummy can hit it. :chuckle
I also thought it was called the "interns vein"
There's also often a rarely used vein on the back of the forarm - you end up like standing on your head practically to insert the IV but its always a good place to check, often overlooked.
Aug 30, '06For tough IV starts, there is always the "wing and a prayer" approach that often works for me, and many other ER nurses I know. But, for REALLY tough sticks, we often now use our bedside ultra sound machine. It works great!!!: Find the vein, keep the probe over it gently and watch the screen while you guide the cannual into it.
Aug 30, '06Everytime I'm ready to say I've seen the whole of this site, I find a gem. Thank you for starting this thread and for the wonderful advice I've read so far! I cannot begin to say how greatful I am. I'll be starting IV's this semester, and though I wasn't freaking out just yet, I have found some easier techniques that will help me to probably not freak out at all. Thanks again!!!
Aug 30, '06Don't know if it's already been mentioned, but I love the UA veins on elderly folks who like to have "picking parties" with lines they can see. Thin, elderly men seem to have the best veins in the upper arms and IV sites there can easily be hidden with the gown. Out of sight, out of mind.
Also, I do tend to ask people if they have an arm that's particularly good for an IV and I will always feel that arm up first. As someone who has a very deep, flat right AC, I can appreciate what kind of hell it can be to have someone digging around that AC when there are huge veins elsewhere on my arms.
24s suck, even on infants.
Jul 12, '07Good information. I just recently Graduated......and it seems like when I was doing my clinicals and preceptorship, I couldn't miss...... but now that I graduated.... I can't hit the side of the barn..... I'm scared to death to of starting IV's in the hand....I'm going to try the suggestions tonigt and I'll let you know how it turned out....
Sep 23, '07IVs are a huge problem for me too. I feel so incompetent, though I have confidence in all of my other clinical skills. This is an amazing thread! Now I've got some new stuff to try to take my mind off my failing record.
Sep 23, '07From a patient, experienced w/long-term IVs, hand sets are THE worst for most patients. I recognize the need in many instances, BUT - I've yet to have a hand IV set that didn't leave me w/bruised nerves in that hand and/or wrist. I've had no problems w/IVs set anywhere else, long or short term. My longest experience w/constant IV was 8 weeks.
Apr 26, '08Thanks for all the wonderful tips!
I also found this sight that has tips on IV's, NGtubes, catheters and Peds IV's, I found it very helpful!!