[glb1960]

Hey all you smart nurses out there, I need some more IV start tricks for this home care pt. I've been working with. She has been getting weekly IV treatments and I started working with her 2 months ago. The first 6 times I had no trouble getting a line in. The last three have been terrible. When I get near the vein, poof, it's gone or the vein won't stand up at all, no matter what I try. Hot packs, lying, sitting, standing, pushing fluids (no caffine) hours before I get there, EMLA cream, exercising to get her BP up, BP cuff in place of the tourniquet, squeezing and not squeezing a ball.

Help!!! I know this group has some tricks I haven't heard of yet. Please share them so this ladies treatments can continue.
.:mortarboard:

[Crocuta]

Originally Posted by glb1960

Help!!! I know this group has some tricks I haven't heard of yet. Please share them so this ladies treatments can continue.
.:mortarboard:

You may have to start going for veins that aren't readily palpable, but there's no way to explain that in writing. You sound like an experienced nurse. Perhaps you should have someone from your facility even more experienced than you come and take a look. Also, if this patient has extended IV therapy planned, if may be better for her to discuss a midline or PICC with her PCP. Midlines can be left in for up to six weeks and PICC's for up to a year with weekly dressing changes. Selection depends on the infusion therapy ordered. She might appreciate not getting poked multiple times every week.

[Dabuggy]

I can't help you but I do appreciate those tips that you mentioned,

Thank you

Dabuggy

[TeleRNer]

Compare one arm to the next...sometimes blown veins on one arm are positioned simularly to the other arm.
Slap the baby! When hunting for veins it is important to slap the skin, veins rise to this occasion.
Procede with caution when you get a flash of blood with an elderly client...don't necessarily thread the catheter all the way, possibly midway, for doing the other may blow the vein.
Push saline gently in an IV start to gently push past valves that are stuck in the vein to further advance the catheter.
Look for veins on the upper arm and chest near the clavical, shoulder sometimes, these can prove to be viable and good.
And if all these tips fail...don't think twice to ordering an ultrasound guided PICC or peripheral vein start.
Use a Venascope at your place of work if one is provided and turn off all the lights so you can see all the veins!
Also if you find a vein it is sometimes necessary to position ones finger above or beside it to prevent the undesirable rolling effect of big juicy veins...good luck!!!!

[enfermeraSG]

PICC line sure sounds reasonable to me. The best tips (including your own!) have been posted. Aside from those, the only other thing that I can think of is to position the arm hanging down, milk towards the fingertips and then apply one tourniquet proximally and one distally. Sometimes this last ditch attempt works to hold more blood in the extremity. Learned that from an excellent CRNA. Good luck, SG

[glb1960]

YES IN DEED!!! I Knew there was a ton of smarts out there. Thank you, thank you, thank you! This pt. had a PICC line during her acute phase and appearently had some trouble with it and refuses suggestions for another one. What is a "midline"? I haven't heard of that one. Is that something a homecare RN can put in place? Can it go in the AC? The IV meds she is getting burn a little and I need a bigger vein, like the one in the AC, so it is not so painful. The doc won't/can't add any lidocaine to the IV solution. Do these midlines need any special dressings, like statlocks or just a tagederm? Unfortunately, ultrasound and venoscope are not options in this very small company. This is just a small side job I was asked to do because this pt. lives far from the metro area near me and one of the other RN's on staff there was a classmate of mine and remembered I lived not far from her area. My full time job is in a hospital.

Again, thank you, Crocuta, TetlRNer and enfermerasg.
Gary

[PANurseRN1]

No slapping! That causes the vein to rise breifly but then constrict. It's far more effective to gently tap the vein, use friction such as rubbing with an alcohol wipe or gently stroke the vein in the opposite direction of blood flow.

Slapping...no no!

[PANurseRN1]

How much longer is she going to be getting IV therapy? Sounds like she'd be a good candidate for a medi-port if it's going to be long-term. Actually, I'm surprised this wasn't done after an unsuccessful PICC.