IV tips and tricks - page 19

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   nursemeow
    You can't remember using anything smaller than an 18g? really? wow.... #1 I'm not impressed....unless u are a trauma junkie, flight nurse, or medic why the obsession....I will certainly use from 14 to 18g in a TRUE emergency...but the average pt does not need that...yikes....


    Quote from TraumaInTheSlot
    Regardless, we have the opportunity to teach someone something, so lets take that opportunity.

    IV's just take practice, stick everyone you can until you feel comfortable. soon you will be able to do it with your hands tied behind your back. however, we all have our days when we cant miss and then theres days we couldnt hit a cannon with an angio cath.

    the first thing i tell everyone is that selecting a vein is never ever something you do with your eyes. you have to do it by feel. one vein might look good, but it is too frail. get to know your veins.

    a lot of people are afraid to use the bigger 18 and 16 gauges in the beginning. im the exact opposite, i cant remember the last time i used anything smaller than an 18 gauge. the needle is firmer and doesnt give as much.

    stay away from thick veins right below a bifurcation (where the thick vein turns into two small veins, like a junction in the road, these ivs almost always blow in the first hour)

    women have the "rule of thumb". theres almost always a vein that comes off of the thumb where the forearm begins. look around, youll see im right.

    any patient, and i mean any patient who has even the slightest chance of being a surgical patient, be it an AP or abd pain or trauma, should have a large bore iv 18g or less. the anesthesiologist will put a second larger line in if you dont.

    anyone receiving anticoagulant clot busting therapy like TPA or equivalent should have three lines, one 18 or 16 gauge for blood draws before the med is given. pop away.

    even if you dont know what you are doing, try and make it seem like you do. be professional, dont let your hands shake, and read your patient. their eyes can tell you alot.

    TIE THE TOURNIQUETTE TIGHT. DONT FORGET TO TAKE IT OFF!

    good luck if i think of more, ill post it later.
  2. by   RoyalNurse
    Does anyone use NTG cream for really hard to stick patients? I heard a rumor that's what the ER nurses are doing in my hospital.
  3. by   inteRN
    Don't shake...that like telling someone-- dont be hungry. suggestions??? shaking is my huge problem.
  4. by   GoldenFire5
    Quote from inteRN
    Don't shake...that like telling someone-- dont be hungry. suggestions??? shaking is my huge problem.
    Is your shaking due to nerves? I would say that the more you can make a routine of the whole process, the easier it will get. Set up your supplies the same way everytime. Palpate with the same finger everytime. Make the same sort of soothing comments (explaining what you're doing) to the patient everytime. Then the actual getting the IV into the vein will also start to feel part of the routine and you'll get faster and faster.

    When I was first starting, I would get blood return, get the IV in there, and say "very good!" to the patient while I finishing things off. They seemed to like it, but secretly I was congratulating myself on a good stick. Well.... I still sometimes do this.
  5. by   Christy1019
    Quote from veetach
    I beg to differ about the sizes of cannulas listed above. It used to be a trend years ago to throw the biggest IV into the patient that they can handle. Not so anymore. Chances of phlebitis increases with increased sizes of IV cannulas.

    I cannot imagine putting 16ga IV's into a patient in an emergency room. If this patient is a victim of multiple trauma or multiple GSW or stab wounds maybe. Usually those come in with larger bore IV's anyway.

    Our hospital has now become very adamant about not starting large bore IV's. Even our pre op patients go in with a #20 in. I can give any med (including blood) through a #22 if I need to, and believe it or not. A #22 is the recommended size to prevent phlebitis. We use #20's for CTA of chest and cardiac caths, and sometimes you cant even get a #20 in them. Go with whatever you can get.


    In my ER you generally get "the biggest that you can", not to say we throw 16g is people, but if you CAN do an 18g you do, however i work in downtown detroit where a large number of my pts are dialysis or IVDA with crap for veins and you get the best that you can. 18g, 16g and very rarely 14g are the goal in any trauma resus we get.
  6. by   Emergency RN
    Quote from RoyalNurse
    Does anyone use NTG cream for really hard to stick patients? I heard a rumor that's what the ER nurses are doing in my hospital.
    Between the various modern techniques (LED lights, sono, infrared) that are available, if one cannot get something peripherally, then it may be more clinically reliable to just go for central access instead. I would hesitate to use NTP (an old first year "intern's trick") as it requires a medical order, could have systemic vasoactive consequences, and may trigger an allergic response. If one can get the vein to locally dilate by chemical means, then it would be just as easy to do so with better tourniquet technique, transient heat, and lowering the arm.
  7. by   KungFuFtr
    when i start ivs, i'm careful about the power of suggestion. pain is very subjective. i don't tell them it will hurt.
    "will this hurt nurse...?"

    "yes, it will hurt and you will feel pain. if you can imagine...it will be a very sharp, piercing pain. this pain is very hot. you know, like getting stung by a hornet; however the stinger is much longer and thicker."


    when i set my supplies up i'll ask "so what are your thoughts on iv's?" if they tell me they are terrified of needles i'll ask... "so, how many tattoos do you have?" it seems that people who hate needles always have multiple tattoos. this usually breaks the ice and people laugh; an instant state change. i try to distract others by asking them to describe their ideal vacation (something pleasant). i'll have them close their eyes and get them into a more positive, relaxed state.
  8. by   Pixie.RN
    Quote from KungFuFtr
    It seems that people who hate needles always have multiple tattoos. This usually breaks the ice and people laugh; an instant state change.
    To be fair, as a heavily tattooed nurse, I can tell you that an IV needle/catheter and tattoo needles are nothing alike. But yes, it's a good icebreaker. Now, a piercing needle and an IV? Very similar. Piercing needles are generally 14g, so often bigger than the IVs we use -- generally. I will often point out to the pierced folks that what I'm using is actually smaller than what they're used to getting. They like to hear that!
  9. by   goodneighbor
    Saline lock tape trick: When preparing your anchoring tape at the beginning, take a strip of tape, sticky side up, turn the two ends inward and stick it to a clean surface. So now you have a semicircle of tape, secured, at the ends underneath. When you need it, spread your index and middle fingers and place them on the tape, like one-and-a- half inches apart, palm down. Now you can slide your fingers with the tape right under the catheter and then do that little cross thing with one across and one up. Then apply the transparent dressing.
  10. by   JessicRN
    Quote from IVRUS
    Please remember Infusion Nurses Society standards... "Always choose the SMALLEST guage and length IV catheter for the prescribed therapy."
    The key is NOT to go bigger. A 22 guage is most appropriate for that elderly patient, and for that 90 lb soaking wet 90y/o female, a 24 g may be appropriate. You want the smallest guage to allow for adequate blood flow around the IV catheter and decrease the damage to the smotth tunica intima. A 22 guage IV catheter can withstand infusion rates of up to 35ml/min or 2100cc/hr. If in doubt, look at the back of the package that your IV catheter came in. The flow rate is listed on it.
    Many patients have chronic conditions and lousy veins many have lots of valves all of which will take a smal gauge but not a large gauge. needle. if you keep blowing veins trying to get a large gauge IV in it you ruin the vein for others to try . The only time I use anything bigger then a 20 is for Chest CT and real trauma that will need multiple blood tranfusions and surgery Too many nurses think you need the largest IV gauge,. also 22 gauge does not kill hand veins can get around a valve and go through crooked veins easier with the more pliable 22 and not blow a vein.
    Also if the patient is like ours who come daily and sometimes several tiimes in a day the best thing to do is start low and move up. Remeber if you are lousy at veins my suggestion is to start with the easy ones, that will then give you the confidence to move on to the more difficult ones and will allow you to become more accurate. Nothing funner then trying to start an IV in the underside of a pt who has overdosed and is violent. Or that extremly anxious pt in respiratory distress who is flailing around.
  11. by   allthesmallthings
    Quote from Fergie
    Do not be afraid of the needle. I was taught to go in slightly to one side of the vein.
    Why is that?
  12. by   inteRN
    Quote from JessicRN
    Many patients have chronic conditions and lousy veins many have lots of valves all of which will take a smal gauge but not a large gauge. needle. if you keep blowing veins trying to get a large gauge IV in it you ruin the vein for others to try . The only time I use anything bigger then a 20 is for Chest CT and real trauma that will need multiple blood tranfusions and surgery Too many nurses think you need the largest IV gauge,. also 22 gauge does not kill hand veins can get around a valve and go through crooked veins easier with the more pliable 22 and not blow a vein.
    Also if the patient is like ours who come daily and sometimes several tiimes in a day the best thing to do is start low and move up. Remeber if you are lousy at veins my suggestion is to start with the easy ones, that will then give you the confidence to move on to the more difficult ones and will allow you to become more accurate. Nothing funner then trying to start an IV in the underside of a pt who has overdosed and is violent. Or that extremly anxious pt in respiratory distress who is flailing around.
    Thank you for the message!! I use a 20 on most healthy people, BUT I use a 22 on alot of my harder sticks and elderly patients and I seem to have more luck and the IV's last.
    But there is one RN whom I work with and she is one of those "ive been a RN for 30 years and I know everything about everything,etc" so she ALWAYS will start everyone (especially the hard sticks) with an 18 gauge. Almost to prove something. The same thing went through my mind--"isnt that too big and could impede flow?" I dont say anything but oh well....
  13. by   MissIt
    Quote from TraumaInTheSlot

    even if you dont know what you are doing, try and make it seem like you do. be professional, dont let your hands shake, and read your patient. their eyes can tell you alot.
    Is there any way to keep your hands from shaking? Tricks people use to get this under control?

close