Could I get some quick tips on IV starts?

[j_tay1981]

I've had marginal success with starting IV's, but lately it has been quite a dry spell. I think I may be overshooting the veins on some.

Do you guys and gals have techniques for starting them? At what angle do you insert the needle? How far?

And how do you get invisible veins to pop up?

All sage advice welcome!

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[jadelpn, LPN, EMT-B]

It is all in the feel. A vein--that you may not even be able to see--is bouncy like a rubber band. Extremity down. Agitate the skin with the alcohol pad. Sometimes you reall have to feel for a vein, even if deep.

On elderly people, their skin can be paper thin, therefore, veins that seem like you could get a 14 gauge in them from 50 feet away is not always the case. Their veins will be the ones that most often roll. If you take your non-dominant hand, secure the extremity with it, keep the skin somewhat taut with that hand, and dominant hand sticks and advances.

The angle needs to be closer to the skin--not going in like you would for a straight stick blood draw, or when you advance, you will blow the vein at that angle.

As a previous poster mentioned, don't shy away from the tough sticks. Really press and feel for the veins. Once you get good at feeling for where your options are, it will get better.

[klone, MSN, RN]

Personally, I prefer veins I can feel to the ones that I can see.

Me too, but I think that has come with a lot of experience. It's been my experience that newer nurses/nurses who are uncomfortable with IV starts look for veins that are visible, and nurses who are skilled at IV starts look for veins that are palpable.

When I do an IV start, I start at a more acute angle, and then as soon as I get into the vein, I become much more shallow as I advance it a little bit more/obtain flash. Once I've had flash, I advance the catheter, and only after the catheter advances do I retract the needle.

[Katie71275]

Glad to see this b/c as a new nurse I am not great at IV starts. I have the hardest time getting the catheter advanced and the needle pulled out at the same time. I also seem to have a hard time guaging how deep to go. Great tips btw. I work L&D and usually they have nice juicy veins, but not always and of course due to my inexperience i can't always get them, but hoping with practice!

[klone, MSN, RN]

Another tip - after you've advanced the catheter but before you pull out the needle, take a finger or thumb and press on the vein above where the catheter tip would be, THEN remove the needle. This helps prevent a big bloody mess (but not always, so I NEVER start an IV before putting down a chux first.

But really, the best thing you can do to get better is just practice practice practice. In L&D there are lots of opportunities - offer to start other RNs' IVs for them.

[Twinmom06, ASN, APN]

I think the type of device used is also important - in the hospital I work in we use Braun Introcan's - the needle doesn't retract, you have to physically pull it out of the catheter - I've lost several good starts that way because the catheter comes with it (due to inexperience)...

[TheCommuter, BSN, RN]

And how do you get invisible veins to pop up?

If it's not contraindicated, a little heat will cause 'hidden' veins to distend and rise and bounce upward. I usually place a hot pack on the area where I'd like to insert the peripheral IV and let it sit there for five minutes.

[j_tay1981]

If it's not contraindicated a little heat will cause 'hidden' veins to distend and rise and bounce upward. I usually place a hot pack on the area where I'd like to insert the peripheral IV and let it sit there for five minutes.[/quote']

Thanks! In what situations might a hot pack be contraindicated?

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[SaoirseRN]

I always use a manual BP cuff, inflated to about 90mmHg (less for tiny thin skinned folks) instead of a tourniquet. I can use a tourniquet if need be, but I find the BP cuff gentler on veins (they blow less often) and patients tell me it doesn't pinch as much.

My biggest tip though is to ask one of the IV gurus where you work to show you their tricks.

[TheCommuter, BSN, RN]

Thanks! In what situations might a hot pack be contraindicated?

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Well, we definitely do not want to place heat directly on top of or very close to a fresh surgical incision because it increases the likelihood of swelling and dehiscence.

[melizerd, ASN, RN]

When people say rub with alcohol, they mean RUB, not just wipe. Put a little elbow grease in to it (within reason of course )

Also on the heat/warmth thing. I often just wrap the arm (or arms if I'm unsure which I'll use) in a heated blanket for 5-10 min before starting.

On elderly patients I pull down below where I'm starting the IV and also hold slightly above where I'm starting, it sometimes helps those veins from rolling on you at the top and blowing the vein.

I've been lucky that the floors I've been on in school have allowed a lot of IV starting practice and awesome patients that allow a student to start them. Practice is the best way to get good at it.