IV tips and tricks

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.

Regardless, we have the opportunity to teach someone something, so lets take that opportunity.

IV's just take practice, stick everyone you can until you feel comfortable. soon you will be able to do it with your hands tied behind your back. however, we all have our days when we cant miss and then theres days we couldnt hit a cannon with an angio cath.

the first thing i tell everyone is that selecting a vein is never ever something you do with your eyes. you have to do it by feel. one vein might look good, but it is too frail. get to know your veins.

a lot of people are afraid to use the bigger 18 and 16 gauges in the beginning. im the exact opposite, i cant remember the last time i used anything smaller than an 18 gauge. the needle is firmer and doesnt give as much.

stay away from thick veins right below a bifurcation (where the thick vein turns into two small veins, like a junction in the road, these ivs almost always blow in the first hour)

women have the "rule of thumb". theres almost always a vein that comes off of the thumb where the forearm begins. look around, youll see im right.

any patient, and i mean any patient who has even the slightest chance of being a surgical patient, be it an AP or abd pain or trauma, should have a large bore iv 18g or less. the anesthesiologist will put a second larger line in if you dont.

anyone receiving anticoagulant clot busting therapy like TPA or equivalent should have three lines, one 18 or 16 gauge for blood draws before the med is given. pop away.

even if you dont know what you are doing, try and make it seem like you do. be professional, dont let your hands shake, and read your patient. their eyes can tell you alot.

TIE THE TOURNIQUETTE TIGHT. DONT FORGET TO TAKE IT OFF!

good luck if i think of more, ill post it later.

Don't shake...that like telling someone-- dont be hungry. suggestions??? shaking is my huge problem.

I beg to differ about the sizes of cannulas listed above. It used to be a trend years ago to throw the biggest IV into the patient that they can handle. Not so anymore. Chances of phlebitis increases with increased sizes of IV cannulas.

I cannot imagine putting 16ga IV's into a patient in an emergency room. If this patient is a victim of multiple trauma or multiple GSW or stab wounds maybe. Usually those come in with larger bore IV's anyway.

Our hospital has now become very adamant about not starting large bore IV's. Even our pre op patients go in with a #20 in. I can give any med (including blood) through a #22 if I need to, and believe it or not. A #22 is the recommended size to prevent phlebitis. We use #20's for CTA of chest and cardiac caths, and sometimes you cant even get a #20 in them. Go with whatever you can get.