IV tips and tricks

so what Im getting from the last 3 or so posts is that adults commonly get an 18 or higher. If you can't get a stick, time to switch to a new site, not a new smaller gauge. In the case of elderly patients with fragile veins and skin, I have been taught to use a 20 to 22. You guys are saying its a waste to infuse fluids through a 22. This is good to know. My preceptor uses 20's for elderly patients and hates to have to use a 22, but has. Im really going to concentrate on trying to keep the gauge size as large as possible so the patient get the most effective infusion rate. Thanks

I often have to use a 22 on our pts. Our pts in our community have a multitude of diseases that predisposition them to having rotten veins. It's not ideal, but better than having nothing. If elderly pts are an issue, try not using a tourniquet. This is especially true if they have those huge bulgey veins that blow as soon as they are touched.

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.

I understand it's best not to stick an unnecessarily huge IV in someone; however, I hate to use 22s for the simple fact that if for some reason that patient ends up needing blood or blood products, I'm going to have to stick them yet again. I know every hospital is different on this, but our ER's protocol is to not give blood/blood products in anything less than a 20g. And 90 yr old granny's weakness could be due to being severely anemic...so you really never know when you'll need a slightly bigger IV.

Just my opinion.

If you are "pouring" that blood in a short time frame, then I would agree to have a larger lumen catheter, however, most of the elderly can not take blood infusions at a fast rate, and usually it's infused over 3-4 hours.
A 22 gauge IV catheter is quite appropriate in this situation. Perhaps your ER manager can check out references that review that fact in the AABB (American Association Of Blood Banks) manual and then subsequently your policies can change to reflect the appropriateness of care.

Some good points in several of the replys however I would like to add bit of knowledge to the subject. Dont always use a tournequet...with some patients having one on will ause the vein to blow as you start the angiocath. Do not have the patient pump their hands, much better to take and alcohol pad and rub the site briskly but not too hard and this will cause the vein to stand up for you and the minimal heat form the friction is all you need. Always place your angiocath on top of the vein and do not "slide" it into the patient but advance in short brisk jerk like motions until you feel the "pop" (remember this are "short") Learn the main anatomy of the vein layout and feel for your veins. In patients that are dark skinned you may never see a vein and have to know how to feel for them..with out touch you are many times lost. Even in fair skinned patient if you are only able to see veins and not know how to feel for them you will probably miss a huge vein someplace that has never been tried...also with someone who gets poked a lot always look on the backside of the forearm...simply because it is away from the nurses starting the iv it is often not even examined...there are some big viens back there my friends. Placeig the cath on top of the vein eliminates a lot of the side action you get from veins if they are hard to enter and you are attempting a sideways stick. But whatever works for you best stick with it. and Practice Practice Practice

I only have one more point about IV insertion. Sometimes you hit a valve it you did not blow the vein (there is blood return. sometimes you can "float through the vein" remove the needle if you have an extension atach it then attach a fluid filled syringe) just pull back on the IV sheath until you get blood flow then an inject some fluid very slowly in the vein if the vein does not blow up flush some more and slowly advance the sheath. It works about 50% of the time if you take your time.
The other thing is when you do an AC you cannot see valves, if you hit one and can't advance the sheath, do not feel bad it is not your fault . Hand veins are different you if you see a lump it is probable a valve, try to avoid it.
If you stick a pt and hit a valve or you miss totally do not remove the IV. Sometimes you can restick the pt using a vein above the first one or very close to it.If you remove the first IV you have to tape it thus blocking the whole area. Once you get the vein then you can take out the one or ones you missed.

I really stink at IV insertion. I can get a flash every time. When I go to flush it ends up being a bad insertion. I can do blood draws with my eyes closed and I am often called on for those that others can't get. What gives?

praying helps

I am about to graduate as an RN. I am looking for just this kind of information because I am a new nurse. This is education and like the next poster said, an opportunity to teach. Why would you say something so rude? Maybe you are too advanced and experienced for this website. I love this site and welcome the information and experience I receive from nurses that have been working for many years. Sorry it is making you yawn but I NEED this and there are many of us that welcome the "ad nauseum" information. You must be the best nurse going.