blowing veins during IV starts - page 2
by queenjulie | 30,692 Views | 43 Comments
I've been a nurse for seven months, and I'm doing well, except that I suck at starting IVs. In school I was almost completely unable to do them, and I've improved to the point that now I virtually always can find and hit the vein... Read More
- 1Feb 16, '13 by akulahawkRN, ASN, RN, EMT-POne reason why some people are able to get an IV with their eyes closed is because they let their fingers be their eyes. They feel for the veins and that's why they can get the veins that people can't see. It all just takes practice. Starting a line really is an art because you have to just learn how to adapt the technique to individual variations and situations. You just have to see the variations...
The only patient that I have never been able to successfully start an IV in was a young man who had absolutely GREAT looking veins... that ended up being so fragile that they just shredded upon contact with the needle. A couple Nurses in the ED that day couldn't do it either. He ended up getting a central line.
This really is just one of those things you just have to do. Me? I just visualize what the needle bevel sees as I enter the skin and advance toward the vein. It's kind of a zen thing... be the needle. Just practice and practice and practice some more. Also, you have to approach the whole process from a positive standpoint that you will get the line started instead of that you hope that you'll get that line started.
- 0Feb 16, '13 by SwansonRNI'm a new grad as well. Not only am I bad at IV starts, but I'm also bad at blood draws I work in the ICU so a lot of times my patients will have central lines, so that only compounds to the problem. I've only gotten a few successful IVs and I often don't get blood on my first try. It's really embarrassing for me.
- 0all good advice...yes.... feel that vein. Yo do have to go after some veins that are not always the most desirable..... it is just a fact. Actaully that is all I ever do now it the difficult starts. When a new grad calls me for an IV start I usually will get an easy one and I am am happy to do it!
If the vein has a thick wall you need to use a larger gauge...not a small one such as a 22 gauge. otherwise you will just be chasing it around. So for thick walled vein ..go larger than a 22 gauge ...insert flush with the skin and make the poke 1/4th below where you see or feel the vein and feel the vein with your non dominate hand (train a finger) and once you are top of it increase your angle and then make a controlled quick jab into it. It works really well but just make sure you are on top of vein. So you are going to tunnel the catheter a bit so you need to use at least 1 1/4th inch catheter to do this trick.
- 0Feb 16, '13 by prnqdayI suck at them too, really bad. I worked in ICU before the ED so I didn't get much practice. I've gotten better in the ED, there were some days I got every IV start and others I got none. Just keep practicing. I'm going back to ICU soon, so I'll loose out on my practice again
- 1Feb 16, '13 by not.done.yet GuideQuote from iluvivtActually I said a surface vein is more prone to blowing, not a deeper one. I have only been a nurse a year so it definitely is not expert advice, just what I have observed in my own practice. I would love time with the IV team to improve my technique and obviously if my observations hold no water then it is a technique issue on my part that makes the surface veins blow for me. Thanks iluvuvt.Just an FYI and to share and not being confrontational..that is NEVER my desire. A deeper vein is NOT more prone to blowing! They are deeper of course, but that means they are usually larger so a deeper approach is needed. It is a matter of proper technique and feeling the vein and its quality and course PRIOR to prepping , They can be trickier to hit and that is why the previous poster thinks they blow more but this is not the case nor will you find any literature to support that claim.
- 0Forgive me then I must have misread it! Yes some can be but it also heavily depends on the quality of the vein, its size and many other patient factors. The elderly can be particularly vulnerable to this problem and thus the advice to ditch the tourniquet or put it on lightly. You can almost eliminate this from happening with good assessment, selection of a gauge suitable to vein, and good technique. This rarely happens to me anymore except on the frail elderly and those that have been on steriods for a long long time. What happens in a lot of those case is that it actually does not blow it just leaks out of the hole I used to get the cannula in. Thye are so frail it just does not even seal.