IV tips and tricks - page 21

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   allthesmallthings
    Quote from Blueorchid
    I do have a question for people that like to move though. Was starting this 22 on a girl a couple days ago and set everything up only to get 2 seconds away from sticking her and she suddenly jerks her hand away to go "you're going to put THAT in?"

    Once I explained that its the plastic tube that goes in the vein and not the needle I got ready again and saw her tense up. When I stopped and said "I need you to hold your hand still" she wigged out. A nurse came in she didn't even know and she asked her to put the IV in. She started complaining about how "most nurses just stick the needle in- you hestitated" and I had to refrain from adding "well I would have if you hadn't jerked your hand away." Was it the request for her to hold her hand still? She ended up having a few psych issues but I'm mulling over the idea that asking someone not to move their hand instead of a "surprise jab!" might do more harm than good...
    I'm not sure that surprise jabs are the way to go; probably more times than not, with nervous people, they'll wind up jerking. Maybe a standard, for-all-sticks, firm but quick, no-nonsense "I need you to hold still," accompanied by firmly placing your non-poking hand on their extremity to hold down both the extremity and the vein before you poke anyone, whether or not you think they'll be nervous.
  2. by   allthesmallthings
    I wouldn't blame myself for the nervous lady, anyway, Blueorchid. Like you said, she had psych stuff going on. It's a reasonable assumption for an IV stick-ee to be able to wait a second while you do whatever you need to to poke her, including telling her to hold still. Maybe she was just trying to get some control of the situation.
  3. by   allthesmallthings
    Quote from LunahRN
    Typically that happens when you go out the back or side of the vein. Just be careful that, once you get a flash, you only advance the catheter just a smidgen (precise unit, I know ) more than the length of the bevel -- don't go sticking the whole needle in there. If you just advance slightly more than the length of the bevel, you should be able to thread the catheter in without going out the back/side/whatever of the vein.
    Quote from Grahamsmama
    What I was taught to do when that happens is to back out just a little and sometimes you can still save the IV.
    I just got 2 IV's in a row last night after keeping up with this thread for the past few days, and the ironic thing is, I followed both posts above, even though they seem to be contradictory! I pushed in "one bevel-length" past flashback; and then, if I got resistance when pushing in the catheter, pulled out a tiny bit and tried again.
    Earlier, when I read this, I just got confused about which one, pushing in or pulling out, would get me an IV, but they both worked! :') Am I finally getting "IV intuition"??
  4. by   Pixie.RN
    Really, both posts are just saying "don't go out the back of the vein." Sometimes you can pull back a little and re-advance and get past the part that's blown and preserve the IV. But if I have any doubts about whether or not an IV is really good -- especially if I'm going to be pushing any meds or if the patients needs IV contrast for a CT -- I pull it.

    Good job! It just takes time and practice.
  5. by   MissIt
    Quote from LunahRN
    Sometimes you can pull back a little and re-advance and get past the part that's blown and preserve the IV. But if I have any doubts about whether or not an IV is really good -- especially if I'm going to be pushing any meds or if the patients needs IV contrast for a CT -- I pull it.
    Definitely. When I said pull back a little and re-advance, I was more thinking that you'd hit the wall or something, not that you'd gone through the vein.

    Congratulations! The more you do, the more confident you'll become.
  6. by   Christy1019
    Quote from Blueorchid
    I do have a question for people that like to move though. Was starting this 22 on a girl a couple days ago and set everything up only to get 2 seconds away from sticking her and she suddenly jerks her hand away to go "you're going to put THAT in?"

    Once I explained that its the plastic tube that goes in the vein and not the needle I got ready again and saw her tense up. When I stopped and said "I need you to hold your hand still" she wigged out. A nurse came in she didn't even know and she asked her to put the IV in. She started complaining about how "most nurses just stick the needle in- you hestitated" and I had to refrain from adding "well I would have if you hadn't jerked your hand away." Was it the request for her to hold her hand still? She ended up having a few psych issues but I'm mulling over the idea that asking someone not to move their hand instead of a "surprise jab!" might do more harm than good...

    In my ER we have quite a large population of IVDA'ers/polysubstance users, psych pts, majority not being very cooperative with care, so its not always easy to find a decent vein, let alone have them hold still to actually get a chance to access it. I agree with blue orchid about getting everything set up out of their view, and also talking to them about anything other than what i'm about to do, and if they have a decent sized vein and don't require massive blood transfusion/drips/etc I'll tell them they can get a pretty little pink one which "isn't big at all" lol (i've noticed a lot of them will go for that thinking pink=small), if that hasn't worked and they decide to keep jerking at the last minute and they're giving me a hard time i'm not going to be as nice anymore, i'll tell them "Ok YOU came to the ER for help, THIS IV is part of how we are going to treat you, if you keep pulling away you are putting ME at risk for getting poked, which if that happens you WILL get more pokes to make sure you don't have any diseases I could've contracted from this poke, now are you going to cooperate so that i can get this IV on the first try and you can get the treatment YOU came here for?" (That little chat works about 80% of the time for me)
    Might sound harsh but playing nice nurse doesn't usually do it for a large percentage of our patients.
    For the genuinely scared pts who aren't trying to be a problem I of course take a whole different approach, but generally just talking with them about anything not hospital related and getting them to laugh will get the job done.
  7. by   NurseHotFlash
    If you don't want to help new nurses learn to start IVs, don't complain when they ask you to do one for them.
  8. by   hidesert
    In oncology I learned to hang the arm off the side of the bed for a few minutes and even better is to wrap the arms in warm blankets 10-15 mins, while they are hanging it off the bed too is great. Also tying the tourniquet and then setting up my tape, alcohol sponge or whatever, flush, talk to the patient, then the tourniquet is on for a couple of minutes. Remember that in ortho surgery they can keep a tourniquet on a limb for a very long time (like an hour) so a few extra minutes will not harm your patient.
  9. by   hidesert
    PS if the patient cannot hang the arm off the bed, sometimes just elevating the head of the bad 20 or 30 degrees really helps too.
  10. by   canoehead
    Remember the OP was asking about infants, that are sure to pull away and yell blue murder. Of course if you can calm their parents down, that's a plus.
  11. by   LMPhilbric
    Quote from hidesert
    In oncology I learned to hang the arm off the side of the bed for a few minutes and even better is to wrap the arms in warm blankets 10-15 mins, while they are hanging it off the bed too is great. Also tying the tourniquet and then setting up my tape, alcohol sponge or whatever, flush, talk to the patient, then the tourniquet is on for a couple of minutes. Remember that in ortho surgery they can keep a tourniquet on a limb for a very long time (like an hour) so a few extra minutes will not harm your patient.
    This is good advice unless you are going to be drawing blood at the same time you start the IV. The extra tourniquet time can cause a falsely elevated potassium level. For pts getting lab draws at the same time, tourniquet time should be kept to a minimum.
  12. by   kalaniana
    Some of my suggestions may be very obvious, however, some of those that are reading this may benefit...

    -The "best" veins are usually in the AC, this is where I start my search
    -Pumping the fist, warm blankets, 'slapping' the vein, and alcohol do help
    -Seeing a vein rarely means its a good one, a bouncy vein is the best
    -Poking the hand does hurt more, but use it if thats all you got
    -Do not poke where there is an obvious valve, poke under or above.. if you try to advance and are 'bumped' up against a valve, try to 'float' it in further with a flush of saline (this will help open the valve to advance)
    -Choose a straight rather than a curvy vein
    -I have the best luck poking right on top of the vein, others think its best to go at it from the side, find what works for you
    -If you are poking a child, you NEED a good arm holder

    And my number 1 suggestion, from my experience, DO NOT poke unless you are completely comfortable with your chosen vein, you will miss the majority of the time!
  13. by   IVRUS
    Quote from kalaniana
    Some of my suggestions may be very obvious, however, some of those that are reading this may benefit...

    -The "best" veins are usually in the AC, this is where I start my search
    -Pumping the fist, warm blankets, 'slapping' the vein, and alcohol do help
    -Seeing a vein rarely means its a good one, a bouncy vein is the best
    -Poking the hand does hurt more, but use it if thats all you got
    -Do not poke where there is an obvious valve, poke under or above.. if you try to advance and are 'bumped' up against a valve, try to 'float' it in further with a flush of saline (this will help open the valve to advance)
    -Choose a straight rather than a curvy vein
    -I have the best luck poking right on top of the vein, others think its best to go at it from the side, find what works for you
    -If you are poking a child, you NEED a good arm holder

    And my number 1 suggestion, from my experience, DO NOT poke unless you are completely comfortable with your chosen vein, you will miss the majority of the time!
    Well, I will have to disagree with you on a couple counts.
    #1. In an emergency setting, then yes, the ACF may be a quick and easy way to gain access to the venous system. However, if you start there and blow the vein what are you going to do since you shouldn't be going below a previously blown IV site to start again? Therefore, one should always start looking distally (metacarpal) and up.
    #2. DO NOT SLAP the vein! A four finger slap causes venous spasms and pain... two fingers tapped lightly above the vessel will get the histamine release and dilation you need.

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IV tips and tricks