Any tips for starting IVs?

stbernardclub · Jan 20, 2005

And don't forget to apply pressure and inch or so after i.v. incertion to stop blood from flowing out before you apply your heplock.

NurseFirst · Jan 20, 2005

approach the vein at a shallow angle. don't let the catheter tip slide over the needle. don't forget to take off the tournaquet! take time to look carefully for a good vein. try and anchor the vein from both top and bottom. use a small cannula, esp while learning. diabetics have thick vein walls, use a smaller cannula for them.

anchoring above is no longer recommended due to the increased possibility of self-inflicted needle sticks if pt moves (or possibly inadvertent pt needle sticks)

nursefirst

jhushon · Jan 20, 2005

If you have the option, schedule a day in outpatient surg. These patients are generally healthy with good veins. A few successful sticks and your cofidence level will increase. I always recommend this to new nurses and medics.

Nitengale326 · Jan 20, 2005

Practice is the key. Do whatever you can to learn by feel. I learned by sight and have not been able to grasp the "feel" of the vein for those difficult starts. Get your equipment together outside the room and take in enough supplies to try twice. That is my limit. Also you have to have a positive attitude. If you go in there with the mindset..."I'm not going to get it"... chances are you won't. At least that has been my experience. Learn which patients you can and which ones you cannot do. I personally have difficulty starting african americans ... remember I stick by site. Unless they have a garden hose it just ain't gonna happen. I also have trouble with obese peeps. Those veins are deep. Let your co-workers know you want all the possible sticks available. Volunteer with the IV team if one is available. Volunteer with an EMS team is allowed in your area. If you can start those in the field, you will learn tons! Good luck and just remember practice is key.

TexasNS · Jan 20, 2005

I wish I would have thought to search for a thread like this a year ago.

I am a nursing student in my last semester and thankfully I have been lucky enough to have been working as a Extern in a local hospital so I get tons of skills practice. There is nothing like just sticking everybody you can.

The one thing that has helped me more than anything else is going for the "feelers" first. I go for the ones I cant see but can feel first and if I miss those then I go for a shallower sight vein. Those feelers are larger and your site usually last longer. Remeber "I am going to start your IV." NOT "I am going to TRY and start your IV" Confidence builds confidence in your patient and in you

Sunflower66 · Jan 20, 2005

Here is a nice trick, take a manual BP cuff and inflate it to 15-20 mmHg past the diastolic pressure to allow arterial flow but not venous return and watch the veins engorge....hope this helps
Mike

I do agree with you on this one for sure Mike! This works wonderful on patients who are very dehydrated. One our nursing supervisors swears by this method too. :)

Vivian IVT · Jan 20, 2005

Great tips here!!:) I found a few I can use in my practice as I am a member of an IV Team at a DC Hospital and here are a few tips I have not found mentioned that might also help.First, Lighting is very important..If possible the more lighting the better.Some of the patients rooms have terrible lighting. Secondly, a wide Penrose Drain; the tubular kind not the flat is (I think) byfar the best tourniquet to use.It does not slip,stays in position either on top of the patients gown and on the arm..And thirdly, it helps to wipe a non-white skintone with alcohol from A/C, on the back and on the top of the arm to 3 inches above the wrist, the veins show up very very nicely, but at times finding a vein by feel is the only way..Another tip I just thought of, as the catherter is advanced with the Right Index finger(being right handed) , and the thourniquet is being released with the left hand; when the trigger is hit to withdrawal the stylette into the barrel place your left thumb where the end of the catheter is in the vein as this prevents the leakage of blood from the catheter until the extention can be added. I also try to avoid the A/C as this is the labs territory but at times it is the only spot available. One place that I always avoid is the inner wrist and as this area is very innervated,the veins are short, delicate and small and if infiltration occurs nerve damage may take place.

Most of my team members and I use 20ga 1 inch catheters as these are easier to work with but some of the more experienced IV members prefer the 20 ga 1.16 inch as they feel more of the catherter is in the vein and has less of a chance of getting dislodged. For women in Labor the 18 ga 1.16ga is the standard to use and is required..It is rare that we have to use a 20ga but it does occur, then we have no choice..With regards to Contrast for CT scans , 20ga or larger, but we usually use 20ga..This size seems to be adequate..And for Blood Transfusions..A 20 ga is used but at times a 22ga is the only size vein available esp on the elderly and Blood will usually infuse with out a problem. The site just needs to be monitered more closely..

Alternateing arms helps in preventing a patients one arm from be coming too painful and sore if they are stuck a few times in the same arrm.. The patient usually wants the catherter placed in the non-dominate arm all the time, but if they are informed why the arms are alternated they will co-operate..but there are a few who insist and there are Patients rights..

But if all else fails.. Thank God for PICCS and Midlines ...

Hope some of the tips and info helped...But as said before..."It Just Takes Practice"

VivianRNIVT...

SmilingBluEyes · Jan 20, 2005

Where is Gwenith when we need her? She has a GREAT link to an IV tips site. If anyone knows this one, I would love to see it posted....I lost it from my favorites list.

chris_at_lucas_RN, RN · Jan 20, 2005

Where is Gwenith when we need her? She has a GREAT link to an IV tips site. If anyone knows this one, I would love to see it posted....I lost it from my favorites list.

I believe this is it.

http://www.enw.org/IVStarts.htm

CHATSDALE · Jan 20, 2005

visualize yourself going thru each step in procedure successfully

make a mental check list of the things that you will need swab , tourniquet, needle, tubing etc don't let patient see that this is what yo are doing...yikes

if this is your first stick on thes patient. find the vein you are going for and tourniquet close to site of insertion..feel skin and the bounce of the vein before you swab

if you are following someone who did not achieve a patent stick...you are going to have a tense pt to begin with...talk to them while you apply a warm compress. let arm hang down off bed for a few minutes, and the b/p cuff is a manificiant idea...

start on back of hand and work your way up with subsequent sites...leaves good veins for others when an iv needs to be d/c and restarted

Gampopa · Jan 20, 2005

Although I am a student here's a couple of things I've learned. Remember to give a twist to the cath before inserting to free it from the needle. Also, I would not recommend stabilizing the vein proximal from the insertion site. A fellow student in my class did this during her first med/sur rotation and inadvertantly went through the vein and stuck the thumb she was using to stabilize proximal to the insertion site. Ends up patient was HIV + . She had to go through anti viral therapy for several weeks and in addition she was pregnant :uhoh3: . She did not contract HIV but you can imagine the anxiety her and her husband have gone through :crying2: .

wikiwicked · Jan 21, 2005

Don't hesititate. Swoop, scoop, and go. Keep an attitude that YOU are the only one there that can get it - there is no one else. Also, talk to the patient, forget any one else in the room. Putting the patient at ease will help you less edgy and able to do the job!:)