IV tips and tricks

UM Review RN, ASN, RN · Oct 10, 2004

can u fluid resuscitate through a 22g? itll take at least an hour or two to get the liter of ns in.

We run it wide open and it takes about 15 minutes.

if you draw blood through a 22g, it will hemolyze frequently.

Our policy is that we don't do any labs through IVs unless it's just been placed.

blood through a 22g? are you kidding? ive seen it done, but always after lying that the transfusion takes 4 hours when it actually took 5.

This erroneous statement--and thoughtless accusation (boldface added by me)--is really why I had to respond. We can run blood way faster than that through a 22. We don't usually have to run it very fast because most of our patients have issues with fluid volume overload, but I know it can be done in those who can tolerate it, because I've done it. Our transfusions usually take three hours, but I've done a few transfusions with a 22 in two hours.

22s are pretty standard for our unit. We have a lot of elderly people here and they simply can't tolerate anything larger. We try to leave the AC site for labs or for CT scans with contrast. Otherwise, we just use 22s.

UM Review RN, ASN, RN · Oct 10, 2004

P.S. Almost forgot the tips: I find that establishing a little rapport with your patient can help them relax and therefore, make the veins easier to access.

The poor girl who was in too much pain with the fractures should probably have gotten an IM to hold her over before the IV was placed, and I do sympathize, because I'm a very hard stick myself.

So I go in making a promise to my patients--I will not dig around in your hand/arm for that vein. I will either get it on two tries or I won't, but I refuse to cause unnecessary pain. It should come as no surprise that most patients visibly relax when I tell them that.

I have them dangle their arm over the side of the bed and wiggle their fingers and I ask them about their family or something else that's distracting and soothing, as I set up my tape, my flush, and my supplies. I line it all up in the order I'll need it. Then I place the tourniquet and put on the gloves and scrub the area with the alcohol swab.

I usually get them on the first try.

It is also part of my ritual to bring 3 IV needles just in case--a 20 and two 22s. For some reason, if I only bring one, and feel like I have only one chance to get it, I blow it.

This only backfired on me once. I failed the first attempt, and the patient then asked me why I brought 3 needles if I usually got it on the first try. I then realized why she'd remained so tense.

When I told her, she laughed and relaxed enough for me to get the IV in. Veins have a tendency to try to hide in tense muscles, which is why relaxing is so crucial to the process.

Hope that helps.

CRNAsoon · Oct 10, 2004

I'm totally loving this thread ... Please keep the tips coming.

virmm1, LPN · Oct 11, 2004

Very informative.

virmm1, LPN · Oct 11, 2004

Very informative.

chris_at_lucas_RN, RN · Oct 14, 2004

I actually start my first RN job tomorrow night, and my duties (allegedly) are to draw blood for labs on research patients.

Of course I haven't done a stick in a year. :eek:

I really appreciate these tips--and I am more confident because I recognize that a lot of what is described here (helping the patient relax, using a BP cuff and gravity, feeling for the bouncy vessel as opposed to the tendon you can ID with ROM) I already do almost as second nature.

Thanks for all the tips, and especially for that IV website, gwenith....

RN92 · Oct 17, 2004

Ive been both a nurse and a patient: These are two important factors to remember (coming from a pts point of view):

1. When you wipe the IV site with Alcohol, please give it a chance to dry a little. It hurts worse when you are being stuck with a needle coated in alcohol. Besides, it takes at least 30 sec for alochol to work, anyway.

2. When removing a needle from someones arm - dont put pressure on site until the needle is out. Some lab techs have put pressure on the site before they remove the needle - this will not only tear the vein its in - but it really hurst and leaves major bruising

To the previous poster about most painful sites to stick - in my experience its usually the top of the hands. But every one is different.

claire_au · Oct 17, 2004

oh, and if a heroin addict says "thats not a good vein" , they are right.[/quote
You should always listen to IV advice from someone who could find a vein sitting in a dark alley in the pouring rain between their toes!!

hal248 · Oct 17, 2004

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!
------------------
Katharina Loock, RN, BSN
Department of Education
Wadley Regional Medical Center
1000 Pine Street
Texarkana,TX 75501

When I start my IV I have my Vacutaner barrel hooked up to the end of a dry extension set that I attach to the cathere. Catheter is then secured using a chevrion or what ever device you use to secure the IV catheter to the patient. Then draw the required blood, disconnect the barrel and flush the line with 10cc of Normal Saline, finish taping it in place. I have not had a single line pull out using this technique, and have only had 2 or 3 hemalized. blood samples. The mess is no greater then you would get putting the Extension set on with out drawing blood and less irritation to the vein, all of the manipulation from changing vials is absorbed by the extension set tubing.

lpnstudentin2010, LPN · Jun 1, 2005

Very informative thread. I think that is my major concern...I don't want to cause any more pain to a patient.

Use EMLA (if you have time). I am not a nurse but have had many IV's and EMLA works like a charm. You do not feel the needle enter. You may feel it being pushed into the vein further (like after it is already in the vein) but that just feel wierd does not hurt at all (and I even have a low pain threshold)

labman · Jun 1, 2005

I can't wait to start IV's. I am currently a phlebotomist I even learned some tricks that will help me with my job. I have been doing this for 2 years.

Just remember that practice makes perfect (really intiminating at first :uhoh3: ). I remember starting I was a mess. When starting don't get to upset if you miss a lot. It takes a lot of practice to hit veins.

-Remember to anchor the veins (pull back on the skin the skin) this really helps.

-Get a good feel. That is a big trick. Don't just go on looks. Veins should feel like a stretched latex tournequet (stretched rubber band).

-If you don't get it after 2 attemps ask someone else to go for it. After 2 tries you will have a very low chance on the third time.

That is all I can think of now. I hope this isn't just repeat or will help.

KENT

Cherre · Jun 2, 2005

I am shocked that the thoughts have changed on IV needle sizes.
Old school maybe, I would never even consider giving blood with any thing but an 18 gauge or larger.
I would like to see more studies on this. I always go for a 18 gauge, don't even consider a 20 or a 22.
Maybe it depends on the acuity of the pt? Or as previously stated the policy of the hopital?

I'm a nursing student, we've been taught that blood needs transfused by nothing smaller than a 20. We've had our IV certification class, unfortunately the class was a joke. It lasted less than an hour, we practiced on rubber blocks that had cannon size "veins". I haven't had a chance to try one yet, but I sure appreciate all the tips I can get.