Any tips for starting IVs?

KR · Jan 21, 2005

I love all the tips. I too have a rough time starting IV's sometimes. I especially love the BP cuff. I am going to have to try that one. Thanks.

weetziebat · Jan 21, 2005

things that have really helped me are to make sure i have the best possible light, to take my time, and be sure to have all the equipment ready to go. then once you've inserted the needle into the vein, bevel up, only put it in a little more than halfway and hook it up to the iv fluid. opening the clamp slightly allows the fluid to 'float' the needle in. otherwise i've seen the needle 'stick', blowing the site. personally, i've always prefered to use the veins on the inside forearm, but others are correct to say try the hand first cause you want to leave the upper veins if needed later.

vablueyes · Jan 21, 2005

Before I start an IV I always explain what I am about to do to the patient. You pick up immediately if they are nervous. I tell them "if you work with me, we can be finished in no time, and you will be suprised at how easy it is." Then once I have my vein selected, I tell them "at the count of three, I want you to take a deep breath." One, two, THREE...and when they breath in, I stick. It gives them something to think about, and for whatever reason, the vein seems to plump up just a bit more. They are always suprised that they didn't feel it, and almost always tell me I'm the best "stick" they have ever had. Then, if it was someone who has limited vein access, and if I get it on the first try (of course) I tell them to remember that this is their best vein, and to tell whomever has to stick them in the future, to avoid numerous sticks. I have won them over by then, and they trust me later when it's "foley time." It's all about confidence, anyhow, and if they have confidence in you, you will feel better about the procedure. And always remember, Somedays you aren't gonna get it, so don't fret. Good luck!!

allnurses Guide · Jan 21, 2005

Hi all. Tomorrow I am doing a clinical rotation with an IV therapist.
I am scared to death because I've only started one IV - and that was on a very cooperative classmate!
Does anyone have any tips/strategies that might help?
I would appreciate any feedback.
Thanks!

I just wanted to say that I too, am HORRIBLE at starting IV's. I have been an RN for a year and a half, and out of all of my IV attempts, I think maybe 20 percent of them have been successful. I am not kidding.

I'm getting better though. Last night I got this rather large older woman on the first try. It felt WONDERFUL! :)

PrisonrNurs · Jan 22, 2005

A good tip for patients with "rolling" veins: Use a hair pick! Lay the pic against the skin, with the vein between two of the teeth. It works like a charm and keeps the vein from rolling away while trying to insert the cannula.

gbrentrn · Jan 22, 2005

Practice, Practice, Practice!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :coollook:

nurse_wannabe · Jan 22, 2005

I just wanted to thank everyone so much for the wonderful tips!! :)

As an update, I was only able to attempt 1 measly IV start with the tech the other day. It was a real disappointment. Now I still feel inadequate!

Anyway, I did request that I get to spend more time with her at a later date, and I'm going to print out all of these fantastic tips for next time!

BETSRN · Jan 22, 2005

Hi all. Tomorrow I am doing a clinical rotation with an IV therapist.
I am scared to death because I've only started one IV - and that was on a very cooperative classmate!
Does anyone have any tips/strategies that might help?
I would appreciate any feedback.
Thanks!

Yes, let the IV Therapist know you are new at this and ask HER for advice, instead of us. It all depends on the equipment at your hospital. She'll show you and talk you through how she does it. Good luck. It's just a skill that takes practice. We all blow IV's on occasion and that will happen to you as well. You can be really good usually and then blow three in a row. It just happens. You'll get it. Good luck.

johnr1953 · Jan 22, 2005

I read most of the "tips" given in this thread - and have seen some excellent advice.

The BEST advice I can give (after 22+ years working Critical Care) is to learn to assess the site by FEEL, not by SIGHT. Attempting IV insertion by SIGHT seriously diminishes your success - particularly in obese patients, edematous patients, and patients with darker skin.

In relatively "healthy" patients, apply the touniquet firmly (check for the distal pulse to make sure it's not TOO firm). In less healthy or debilitated patients, such as those with "paper-thin" skin - use caution and a less-firm tourniquet, as too firm a tourniquet may cause the blood vessels to rupture or the vein to "blow" when the needle is inserted. (The suggestion of using a blood pressure cuff as the tourniquet, inflated to just above Diastolic pressure, found earlier in this thread, is an excellent one...)

Once you've applied the tourniquet, "Poke" (with your fingertips) at the site you're considering, rather than rubbing over the potential site. (If you rub over the skin, you will miss many available veins.)

Be sure to give the veins plently of time to fill - I've seen many good nurses skip this important step and decrease their success rate.

You should feel a "spongy cord" - which is usually the vein. With practice, you'll easily learn the differences of thin-walled vs thick-walled veins, veins that are sclerosed vs those that are not, veins that have many valves that might prevent threading the cannula, veins that move easily vs veins that do not, etc...

(Try this practice: Place a tourniquet on your own arm or the arm of a co-worker as described above. Start poking on a vein that you can see, then continue to poke as you move up the arm, beyond where the vein disappears from site under the skin. You should be able to trace the vein significantly further up the limb, identifying many more potential sites.)

By determining the site by feel, rather than sight, you'll locate veins with thicker walls that are less likely to infiltrate, and that are more deeply embedded in the tissue and are less likely to move. You'll also find that you'll significantly increase the number of useable sites, as many excellent potential sites simply -CANNOT- be seen.

I was fortunate to learn this very early in my career, while training/working as a Emergency Medical Technician. Out in the field, one rarely had the advantages of good lighting, optimum positioning, and all the other advantages of performing this procedure in a clinical setting.

By regularly practicing this approach, along with all of the other suggestions in this thread, you should increase your success rate to over 90%.

I sincerely hope you find this approach, along with the other suggestions in this thread, helpful in increasing your skills and success.

:) John

tinnnk · Jan 11, 2009

I work in radiology been doing IV's over 20 yrs and started with 18 G straights in OB, now doing PICC/MID lines also, totally different than starting IV's but yes it is important to have all your equipment ready. Once the tourniquet is on have the patient make a fist, they can pump the hand but once you get ready to stick the vein have then just hold the fist tight. Really as far as finding the vein it should be about feel......if you have veins that stick out of your arm or you know some guy with big veins, practice the feel of the vessel, of course with and without gloves.....but the vein to me feels like a soft, spongy, tube. Some ppl have veins you can see but if they aren't soft and spongy they are problably sclerosed from scar tissue and very difficult to access......

diane227, LPN, RN · Jan 11, 2009

I can give you one hint for older patients. I have them hang their arms off the side of the bed and I don't use a tourniquet. I keeps you from having the back pressure from the tourniquet so that the vein does not blow. I start IV's all the time without a tourniquet.

tinnnk · Jan 11, 2009

I have started them without tourniquets before also, the other day I placed a PICC line and found after I went to remove the tourniquet that I forgot to tie it......but it went in fine.........if you do things enough sometimes it's like you can do it in your sleep.......I really enjoy that part of my job alot. And your right hanging the arm down does help quite a bit.