IV tips and tricks

shoulder and chest veins are often overlooked on hard sticks.....and when you get iv drug users (females), nipple veins work to. i literally had a female pt. slapping her breast to help me find a good one, since you can't really adequately use a tourniquet there. they aren't ideal, obviously........but when they're just to receive pain meds and then be on their merry way, it will suffice. also with peds...especially on the really little ones...the best thing you can do is get the right person or persons to help hold the little one. that's the hardest part about it. and if your hospital carries them, the little 24g's come in two different sizes with most companies. some hospitals don't purchase both sizes, but there is a .75 and .5in length catheter. i love those .5's....they're GREAT for those little 3dayers!

No way, through the nipple? I guess whatever works. For some reason I feel like if I attempted anything like that in my ED, the other RNs would look at me like I was a nut. I have yet had a situation where I have had to go beyond the upper extremities. I had a 600 ilb patient and after 10 trys he was given a central line. Does anyone have any tips/tricks for obese pt's and IV insertion?

We had a 500 pound guy that came in a lot and only a few of us could get an IV in him.

(1) Know your major vein locations and how to feel for a vein. I always went for one of his radial or basilic veins.
(2) I got 2 inch cannula IVs from one of the anesthesiologists that I used exclusively for obese patients. Because you end up going deeper you need a longer catheter. These short 1-inch things just aren't practical for these people.
(3) Try wrapping their arm in an ACE wrap and elevating the arm for 15 minutes. Remove the ACE and then apply the tourniquet and see what pops up.

A good trick for finding veins on people with deep veins or who are try is to use 2 tourniquets one about six inches below the first. It's amazing the number of veins that will surface from the increased vascular pressure that the second tourniquet creates.

OK, I feel like a total idiot for asking the most basic question in the world. But next week we have our IV lecture (first semester of NS), and I can't find the answer to a burning question I have: Why do we put medications intraVENOUSly, and not intra-arterially? Is it because the arterial system is too high-pressure? I am mortified to ask this question, but I can't tell you how many books I've looked at and Google searches I've done. I'm probably not putting in the right search term.

Thanks!

Because of the back pressure and because an accidental air bolus is much more dangerous arterially than venous. It is estimated that unless the patient has an unknown heart defect it would take approximately 60 cc of air in a venous line to hurt them whereas 1/100th of that would harm you arterially. I know that in nursing school they are anal retentive about getting absolutely every bubble out of your IV tubing but in actuallity it's not totally critical just recommended.

Not only that but can you imagine sending "Amphoterrible" directly to some poor patient's right hand.

Don't be mortified! It's a great question. And using your critical thinking skills, you have arrived at the answer. More reasons include that arteries are usually pretty deep and harder to find. Plus, you would have to tourniquet distal to the site you are going to stick.

Great thinking--a very good skill for a student nurse!

And patients never quite believe you when you say it doesn't matter, they (and their families) just watch the slow march of that little bubble.

I have thought it takes less time to evacuate the bubbles by priming properly than to try to reassure people that it is OK for you not to have to.

It doesn't take much to learn to prime a line really well.

I'm not sure that is prevented by using veins rather than arteries....