IV tips and tricks

what's an ad nauseam?

Thank you, i got it

ad nauseum is a Latin phrase that means "to such a degree or extent as to produce nausea" (from Taber's Cyclopedic Medical Dictionary, 18th Edition)

To respond to the post about EMLA. I work in peds and although EMLA is wonderful, it vasoconstricts and makes big, juicy veins hard to stick. It is great for lumbar punctures, accessing PAC etc. We did use EMLA for some IV starts, you just had to pick the right vein. Also, EMLA takes an hour to work, so if you need access immediately, you cannot use it.

You hear it in reference to something repeated over and over to the point where you want to throw up.

Great thread, I am always learning something new on this site

Here are a few things I've learned in the last 12 years of starting IVs on all ages...mostly the young.


. If the baby's asleep and wakes when you flush the IV...it's probably bad.
. If the left arm has an IV infusing and it's twice the size of the right arm (assuming no preexisting conditions)...it's probably bad. But check the TAPE JOB. Too tight on the tape will send an IV south very quickly.
. If you're having trouble with an IV, break it down - take the tape off CAREFULLY and try to find out if the catheter is still in the vein - or in the skin for that matter. Sometimes over time the catheter can kink, especially with active children. Reflush, retape.
. Flush your IVs frequently when establishing them. Both right when you hook up your tubing, and during the taping/securing process. You have no idea how strong little arms and hands can be and they can wiggle that catheter out of that vein like nobody's business.
During an attempt at an IV on a little one, you have to have someone who knows how to effectively immobilize a little one. You have to pretty well immobilize little ones - and that can be difficult. Swaddle the baby and leave out only the extremity you're working on, if possible.
. CHECK YOUR IVs FREQUENTLY!! "It looked fine this morning but I didn't flush it...umm..duh!!
. Try your best not to "overtape" your site. It is a royal PITA to tear down all that tape 20 minutes / 2 days after you started it. Less is more...as long as it's secure.
. Use a padded board to immobizilize the extremity. Tape securely but not tight enough to occlude circulation - it's easy to do (taping too tightly, that is).
. Double side your tape for patients with sensitive skin (babies) / patients with tons of hair. In this instance, use your tape mostly on the skin directly around the insertion site, if you need it at all. We use a Tegaderm and silk tape for a chevron, if necessary.
. Discretion is necessary when establishing an IV. Don't put a 24 gauge in a kid who's 10 years old, has great veins, and is gonna get gentamycin for a week. Use common sense. If he can tolerate a 22, or even a 20, give it to him.
. Use whatever pre IV anesthetics your institution allows. We have cold spray and EMLA cream. Both work well, but be advised EMLA has a tendency to make veins disappear -and it gives the skin a "waxy" feel, which can make palpating a vein you found 1 hour earlier a very tricky ordeal.
. IF THE SITE IS COLD, YOU'RE GONNA BE HARD PRESSED TO FIND A VEIN. Warm the area up with a warm pack first if necessary. Cold extremities = no veins.
. Start distally. Look for IVs in the patients hands before moving up the arm. Try to avoid the AC if at all possible, unless it's critical and you need fast access, or if the patient just doesn't have anything else...it happens more often than you know.
. Don't put an IV in a 16 year old girl's right hand IF SHE'S RIGHT HANDED unless you just can't find anything anywhere else. This goes for ALL children/ adults who are at the age where the dominant hand does most of the work. Also true of infants who suck "that thumb". Again, unless you have no other options.
Be aware that some infusions, like Potassium, sting when infusing, especially to small veins. Antibiotics like gentamycin are caustic to veins as well. Keep this in mind when assessing your patient's response to therapy.
Look everywhere for the best access. A large vein in the saph is better than a small vein in the hand, at least for the purposes of the attempt. It's far easier to his a large target with a small needle than to try and force a catheter thru a tiny vein.
If your patient may require fast acting meds (Adenosine), or if they're in any way unstable, try to establish an IV as close to the heart as possible. Closer to the heart means faster action...and if your patient's HR is 220..they're not exactly Kings of Perfusion.
If you're going to be the one starting the IVs and you don't have much experience...practice on your coworkers before you come in and stick my child. Also, if you have the option - start small...work with the healthier kids before moving on to attempts on the truly sick ones. That way I don't have to worry about you blowing 2 veins I could have used for access.
Last but not least, know your limits!!! If you stick twice and aren't successful - FIND SOMEONE ELSE. Preferably someone with more experience/ or someone you trust.

vamedic4
Children's - Dallas

[quote]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.[End Quote]

From a patient with LOTS of experience being on the receiving end of IVs, AMEN, RN92, AMEN! I really hate the hand sets as the most uncomfortable. If they are going to be in any length of time at all I'm not wild about the inside of the elbow. I'm gonna be using that arm and bending that elbow!

And - even for just a blood draw, most definitely, please, get the needle OUT BEFORE applying pressure. Thanks to all you for being so caring and so diligent.

Is this the case w/all CT contrast procedures or just w/CT angio? Thanks for the tip about the AC or higher. In the future I will ask for higher.

I am in shock here...NURSES are putting in central lines!!!!! WOW not in my part of town. We just clean them...