IV tips and tricks

[Q

Someone mentioned using a bifurcation as a natural anchor. I like to go in right below the bifurction and hit the vein where it splits rather than going on top of the vein. You might have to advance the needle slightly further to get through some valves, but its a pretty sure bet.[/quote]

I agree, I almost always have success when I go in below the bifurcation

We had to learn how to put in an iv with the lights out in the room so you could feel the vein only...Interesting...I still turn on the lights...Also, if people remember granulex or the spray used for decubitus ulcers to increase circulation, that also helps...With autogard brand ivs catheters, you will not feel the pop we feel or felt with quick caths...I agree, so what if a topic has been discussed before. If it is an opportunity for learning, go for it....For my warm compresses, I place a heated face cloth or towel that has been warmed in the microwave or wrap it in a chux as one would for an iv infiltrate and leave the hand down....That usually works for me..AND, as has been said, if someone with bad veins or who is a difficult stick, I believe them...Even in labor and delivery where large gauge ivs are preferred, if I think I will miss with an eighteen I will go for a twenty and, by the way, for those of you using the autoguard brand, their twenty gauge is the size of our old eighteens..AND, if someone has difficult veins, the larger gauge needle can cause more damage, and I speak of autoguard because we use them now....So, I had to attend a conference...

Actually, through the autoguard, blood runs as well as an eighteen or more....

A lot of times blood "Hemolyzes" when the lab takes awhile to get to it....We hand carry our specs to the lab on babies or absolutely needed draws...Somehow they NEVER hemolyze then...And , if it is between four or five sticks or a perfectly good twenty gauge, I am going with the patient rather than the anesthesiologist preference. Unless of course, we need two sites or things are more serious....The patient comes first.

My 20 yen......if a 22 g is all you can get, then use a 22g gage. Run in a little fluid then try again with a bigger needle. If you really need a largebore IV and they have no good access, I frequently have success with an EJ stick. But check with your department guidelines about putting one of these in first.
EJ's are really simple to do. If the patient's condition allows it, stand at the head of the bed and turn the patient head to the opposite side of the body where you want to place the EJ. This will flatten out the neck area making it easier to see the external jugular (or if you're in Michigan, the external "juggulo".....you down with the ?) Locate the external jugular (this is a fairly shallow vein and may or may not be distended depending on a variety of factors). It crosses the sternomastoid in the superficial fascia, traverses the posterior triangle and then pierces the deep fascia to enter the subclavian vein in the chest.
Again, if the patient's condition allows, placing the pt in trendelenburg position can distend the vein, making it more visible. Prep the site and insert the needle towards the heart. Then do the "dirty bird" cause you got a big ole line in that patient!

Now as far as getting lines into people, nothing' worse than spending an hour to get a good line and have the patient pull it out. What do you use to secure the site? Veni-gard? Op-sites? IV-loc? A big patch of tape?
What kind of splints do you use on pediatric patients? My hospital's kinda low-budget so I'm currently using the 3 popcicle and 4*4 guaze method and securing the whole mess above and below the joint/IV site with tape.
This was previously posted on an old thread too, but worth mentioning....you can use a little local anesthetic, buffered lido or EMLA cream to numb the pain of the IV stick and your patient will be very grateful for it.

popcicle = tongue depressor, ahem.

I don't want to repeat everything that was said before. My one tip is when you get a blood return, don't immediately advance, go in a hair further then advance. When I first was starting iv's I would advance as soon as I hit the vein and then it would blow. This works for me....usually

Beth

Actually, that's not true--I used to work for BD and taught InSyte Auto Guard to health care workers all over the country. What you MAY be seeing is the fact that IAG 18s come in more than one LENGTH--so you may be seeing an 18 that is LONGER than your previous brand, and perceiving it as BIGGER--that is, looking like a 16. But, IVs are standardized everywhere in the world--18G is green, 20 is pink, 22 is blue, 24 is yellow--regardless of brand. I agree with those who point out that you have to consider the situation and the patient. I trained as a corpsman during the Vietnam era, so we learned on 18s, 16s and 14s--we were learning to address trauma situations. I, personally, like to start large bore IVs, but I have worked with many a fine anesthesiologist who routinely only put in 22s. If the patient needed more fluid, or faster, he could always speed up the drip rate. If more vigorous fluid, or blood, resucitation was needed, or we ran into problems, it only takes a second to start a second, bigger IV.

When I worked home infusion, they often gave blood through 24 G IVs. Remember, this is not a truama situation, and there is no rush. For those who think it cannot be done, or is "asinine--"--check the INS (Infusion Nurses' Society) standards and guidelines.

I have run into people who say they hate the InSyte Auto Guard. It usually means they have not been trained to use it properly. Let me give you some tips here that might come in handy.

Here are a couple of tricks to avoid blowing the vein, (IAG is sharper than most other IV catheters--the sharper the catheter, the less to the vein accessed)

---Before you start, hold onto the catheter hub where it attaches to the clear flash chamber (just above the button.) You will see a slight notch there. BE CAREFUL NOT TO PRESS THE BUTTON!!!

---With the opposite hand, grasp the clear flash chamber at its base, and twist it--NOT THE CATHETER ITSELF-- to the right, a full circle, (360 degrees) until you hear a slight "click." You have brought it all the way back where you started, to that "notch." (The notch is just above the button; again, be careful not to press the button.)

We taught this step by saying "take it for a spin. " This action will loosen the heat seal between the catheter and the stylet, and allow the catheter to "glide" off the stylet easier. If you neglect this step, the catheter may feel "sticky" when you attempt to advance it off the stylet, and may cause you to inadvertently "blow" the vein when you struggle with it.

---Here is the most important step: Remember, your approach should be LOW AND SLOW.
---Place your thumb and index finger on the little "grooves" on the side of the flash chamber (created for that very reason.)
---Angle the catheter, bevel up, at approximately 15 to 30 degrees above the skin.
---Stick, (just enough to get the catheter tip in) stop, lower the catheter almost flush with the skin.
---As IAG's stylet is sharper than some of the other brands, and thus cannulation less traumatic, you will not feel a POP as you enter the vein as you do with some other brands--that "pop" with other brands is trauma to the vein from a stylet that is not sharp enough.
---It may take a bit longer than some other brands to see the flash in the chamber--but if you have successfully accessed the vein, it will appear. Be patient.
---Now ADVANCE THE ENTIRE UNIT--not just the catheter--approximately 1/8".
---This is important with ANY IV catheter, to make sure a good portion of the actual catheter is in the vein--not just the tip of the stylet.
---Go ahead and thread your catheter off the stylet.
---Push the button, stabilize your catheter, put digital pressure above your tourniquet, (this will cut down on "back-bleeding") and pull your tourniquet. ----Dress IV site according to institutional policy.

FYI: the 22s and 24s have a "divet" cut into the tip of the stylet, which allow you to see a drop of blood IN THE CATHETER before you see it as a flashback in the chamber.

Another FYI: One of the most common reasons for the complaint of "I got a flash, but the catheter won't thread" is failure to advance the entire unit another 1/8" into the vein before threading the catheter off the stylet--it means that only the tip of the stylet is in the vein, and not the tip of catheter itself.

stevierae - thanks for the tips. Will try this weekend with a new technique!

Thanks for the info but I have to say I disagree for the most part. Appreciate the info, however...