IV tips and tricks - page 18

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

  1. by   roses1130j
    No way, through the nipple? I guess whatever works. For some reason I feel like if I attempted anything like that in my ED, the other RNs would look at me like I was a nut. I have yet had a situation where I have had to go beyond the upper extremities. I had a 600 ilb patient and after 10 trys he was given a central line. Does anyone have any tips/tricks for obese pt's and IV insertion?
  2. by   Daytonite
    Quote from roses1130j
    Does anyone have any tips/tricks for obese pt's and IV insertion?
    We had a 500 pound guy that came in a lot and only a few of us could get an IV in him.
    (1) Know your major vein locations and how to feel for a vein. I always went for one of his radial or basilic veins.
    (2) I got 2 inch cannula IVs from one of the anesthesiologists that I used exclusively for obese patients. Because you end up going deeper you need a longer catheter. These short 1-inch things just aren't practical for these people.
    (3) Try wrapping their arm in an ACE wrap and elevating the arm for 15 minutes. Remove the ACE and then apply the tourniquet and see what pops up.
  3. by   okienurse68
    A good trick for finding veins on people with deep veins or who are try is to use 2 tourniquets one about six inches below the first. It's amazing the number of veins that will surface from the increased vascular pressure that the second tourniquet creates.
  4. by   AtomicWoman
    OK, I feel like a total idiot for asking the most basic question in the world. But next week we have our IV lecture (first semester of NS), and I can't find the answer to a burning question I have: Why do we put medications intraVENOUSly, and not intra-arterially? Is it because the arterial system is too high-pressure? I am mortified to ask this question, but I can't tell you how many books I've looked at and Google searches I've done. I'm probably not putting in the right search term.

    Thanks!
  5. by   okienurse68
    Because of the back pressure and because an accidental air bolus is much more dangerous arterially than venous. It is estimated that unless the patient has an unknown heart defect it would take approximately 60 cc of air in a venous line to hurt them whereas 1/100th of that would harm you arterially. I know that in nursing school they are anal retentive about getting absolutely every bubble out of your IV tubing but in actuallity it's not totally critical just recommended.
  6. by   FlyingScot
    Not only that but can you imagine sending "Amphoterrible" directly to some poor patient's right hand.
  7. by   chris_at_lucas_RN
    Don't be mortified! It's a great question. And using your critical thinking skills, you have arrived at the answer. More reasons include that arteries are usually pretty deep and harder to find. Plus, you would have to tourniquet distal to the site you are going to stick.

    Great thinking--a very good skill for a student nurse!
  8. by   chris_at_lucas_RN
    Quote from okienurse68
    I know that in nursing school they are anal retentive about getting absolutely every bubble out of your IV tubing but in actuallity it's not totally critical just recommended.
    And patients never quite believe you when you say it doesn't matter, they (and their families) just watch the slow march of that little bubble.

    I have thought it takes less time to evacuate the bubbles by priming properly than to try to reassure people that it is OK for you not to have to.

    It doesn't take much to learn to prime a line really well.
  9. by   chris_at_lucas_RN
    Quote from FlyingScot
    Not only that but can you imagine sending "Amphoterrible" directly to some poor patient's right hand.
    I'm not sure that is prevented by using veins rather than arteries....
  10. by   AtomicWoman
    Thanks to all who answered my question!
  11. by   HikingNinja
    Quote from IVRUS
    If you are "pouring" that blood in a short time frame, then I would agree to have a larger lumen catheter, however, most of the elderly can not take blood infusions at a fast rate, and usually it's infused over 3-4 hours.
    A 22 gauge IV catheter is quite appropriate in this situation. Perhaps your ER manager can check out references that review that fact in the AABB (American Association Of Blood Banks) manual and then subsequently your policies can change to reflect the appropriateness of care.
    Our hospital system policy is 20g for blood and IV contrast CTs. Because we never know who's going to get contrast or blood when they enter we usually just opt for 20g to be safe. I've only ever used 22 a handful of times. I don't even know where we keep the 24s as no one uses them. In the beginning I opted to use 22s on a couple of pts. One ended up needing adenosine (so she got an 18g anyway) and the other ended up needing a CT with IV contrast (so she got a 20g). I hate to stick people multiple times so now, like most of my coworkers I go to large bore usually 18s when I can. Nothing smaller than a 20.

    D
  12. by   80sNurse
    co-worker helped me the other night with this after I struck out x2 on the fragile veins of a 90-something pt:

    inflate BP cuff & sometimes vein appears that didn't using regular tounqt. May need 2 people tho if need to inflate more than once

    it worked: got a 20g and a second site for cultures (phew!)
  13. by   hherrn
    If you have a Phillips monitor set up, it may have a venipuncture setting for the bp cuff. Works great.

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