IV tips and tricks

Specialties Emergency

Published

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 vein", would be greatly appreciated. (and if you have a few that are not to be taken entirely serious those would be welcome as well).

Please answer me directly - no need to clutter up the board with this. I will post the text once it is finished.

Thanks in advance!

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Katharina Loock, RN, BSN

Department of Education

Wadley Regional Medical Center

1000 Pine Street

Texarkana,TX 75501

Specializes in ER.

How can you avoid blowing the vein?? It seems I have that problem alot

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

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.

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Specializes in ER.

thank you! no one at work has really been able to explain that well to me! Also, how come alot of the time you get a flash but the catheter wont advance?? is it valves maybe??

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Could be a valve, or you could be right up against the vein wall, or you could have already gone out of the back or side of the vein with the needle.

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What I was taught to do when that happens is to back out just a little and sometimes you can still save the IV.

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Specializes in ER.

Yeah..its so hard to know what you are doing wrong without "seeing" it. Are they're any websites or anything that actually show the mechanics of IV starting? Not necessarily the technique but maybe pictures of the needle going into the vein and the catheter advancing, problems, etc....

I know, a weird question, but thats how I learn best.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

I dunno ... I just kind of visualize it in my head. When I look at the vein I'm going to cannulate, I also consider the length of the IV catheter I'm using, and where I want it to end up in the vein, when I consider where I want to start to pierce the skin. That way I don't end up with the tip up against a valve when I can feel or see them.

Have you tried YouTube for any videos?

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Specializes in ER.

YES..today i did look all over the internet for good videos but not much luck. do you know of any?

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Specializes in Trauma ICU.

Still a relative newbie at IVs (in my ER we can start them as techs) but just my :twocents::

-I like to set up things in advance where the patient can't see it (really learned this one the hard way) and throw on a tourniquet to go hunting for the vein. When I tell them I'm just looking first if they get a weird look on their face I add "you wouldn't build a house on a swamp would you? its like real estate, location is everything" (learned that from some youtube video) and it usually gets a laugh.

I've yet to master the float technique but I'm getting there. Also...I can't imagine someone letting anybody stick them with needles 6 times...2 is my limit. But...I feel like we all have to learn somewhere (still trying to figure out how to finagle this...I'm far from perfect and I really want to get better but I don't want to be a pincushion either!) Still...a no go at 2 and I find the IV queen on the floor.

~~~~~~~~~~~~~~~~

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...

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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.

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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.

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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.

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"??

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