Help! How do I stop blowing very good veins? - page 2

by bagbaje26 26,408 Views | 19 Comments

I have been a RN for 1.5 years now. When I started nursing, I was pretty decent in placing IVs, probably not with placing difficult sticks. I knew the mechanics of it, but was probably not aware of my particular technique. All I... Read More


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    Lots of good advice in this thread!

    You could just be going through a dry spell. It happens to everyone. You'll pick back up :spin:

    Try to feel for veins instead of relying on veins you can see. Good veins have a nice spongy feel. Try to notice where the vein tracks to.

    Sometimes its best to use the tourniquet to look and find/feel a vein, then remove just prior to sticking, just as earle58 explained. If you use one, as soon as you get a flash remove the tourniquet.

    As soon as you get a flash, advance the stylet just slightly further then stop and advance your catheter as you retract the stylet a bit at the same time. Most of the time I float the cannula in (flushing with saline gently as you advance after you remove the stylet) especially if I think I am hitting a valve or if the patient's veins are fragile.

    Finally, if you think you can hit a vein at all, please do your patient and other staff members a favor and try to at least start a 20g. Where I work, in ICU, a 22g is almost useless. (I know sometimes it cannot be helped, access is access, just making a point...)
    srahamim likes this.
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    Thank you so much everyone. All these tips Iíve put together at my work place. Two days after I read your responses, I was able to place a 22G in an older lady with very fragile veins. Today, I placed a 20G in a pt that was considered a difficult stick. Thank you, thank you, thank you everybody. Thanks to everyone Iíve been able to pay attention to my own technique. I am no longer sticking patients with the fear that Iíll blow the vein. Itís amazing what a couple of successful incidents will do to my confidence level. Ö
    Please keep the tips coming. There are some new grads on this forum that are also devouring these tips.
    Bosede
    cherrymaryRN and Cinquefoil like this.
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    Good for you! oh yeh, best to learn on the sedated pts as well!!!, Keep your CONFIDENCE, everyone has a slump, don't let it get your confidence, that's really self-defeating and self-perpetuating, I Know I can, I know I can...
  4. 0
    Very few of these tips will work on kids... even if you have someone who can anticipate their reactions, they'll make it impossible for you to get that tourniquet off and still have the tip of the stylet under the skin!
  5. 0
    Quote from FireStarterRN
    Try not using a tourniquet. It really helps with the older folk. You don't really need a tourniquet to start an IV. You don't need the vein to stand up, you just need to know where the vein is.
    I also rarely use a tourniquet. Good advice given to me while I was also going through a dry spell. By keeping an extremity below heart level while I get supplies set up, I found veins do not blow as often on the elderly.
    Might use tourniquets on younger.
    But I am terrible at those deep veins on the obese patient, and have stopped even attempting IVs on obese, dark skinned patients- I really need veins that jump up and down screaming "pick me- pick me!"
    Have used a veinoscope a few times and love them.
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    I can't believe it! I'm having the EXACT same problem. I've been a nurse for a year and a half, was average at getting IVs, and then all of a sudden--I blow EVERY vein. And I get stressed about it too, just like you. Getting the flash of blood isn't the problem, and I can usually find veins in those who don't have many veins...but then I blow 'em, and then they're out of veins.

    Sooo...thanks for posting this thread, and thank you for all of the responses. I will try some of these techniques tomorrow. Good luck to you!
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    Usually when nurses say they have blown a vein they have done a through and through puncture or have nicked the veins side wall causing the vein to lose blood and a hematoma forms....So to prevent thatremember that every step in the process is important and never assume any attempt at venous cannulation will be easy. So do what needs to be done to increase your success

    This is how I do it...its sounds long but after 29 yrs I am fast at it

    1. I take a look a quick look at both arms (if applicable).then choose the best one for more assessment. I also always want to know what we will infusing and why That may make a difference about the size and location I may select.
    2. I apply the tourniquet fairly high in the upper third of the upper arm. I always unsnap the gown so I do not forget to pop the touniquet. Keep the pts arm dependent when you apply it.
    3 Then I look at what is filling....feel the veins for fullness and quality..look for soft bouncy veins that are not tortuous and avoid areas of flexion and the wrist. A huge number of IV therapy lawsuits are related to IV insertion in 2 areas...one is the distal cephalic above the thumb over the radial bone for approx 2 inches and the inner aspect of the wrist. There are large superficial nerves in these 2 areas....also even the deepest peripheral veins can be hit with no greater than a 15 degree angle. I will also apply heat if I see a good vein but it still needs to fill a bit more and it works fast
    4. Select your vein and determine at what point you will access it...if you have an inch long catheter..detemine where the tip will end up if the entire catheter will be threaded..so you are able to thread the entire catheter...line it up and attempt to access the vein from the top wall...you can also do a side entry but need to be very fairly skilled not to advance through the vein wall
    5 perform your venipunture at no greater than a 15 degree angle and once you get a blood return ...drop your angle flush to the skin....Always advance about 1/8th of an inch further to make certain you are well into the vein. The tip of the needle can be in the vein and you will be getting your flashback and if you pull your needle back before advancing it more....you will most likely pull the needle out of the vein and you will not be able to advance the cannula over it...so always advance a bit once you get your flashback.
    6 now pull your needle back and advance the catheter into the vein..it should feel smooth and your blood return should still be present.
    7 you never ever want to recannulate and with most safety catheters you can not do that anyway..but what you can do if you have advanced of out of the vein..is (its a bit messy so have some gauze ready and open) to try and save it....pull back the catheter very very slowly until you get a brisk blood return..then advance..watch to make sure blood return is still coming. This usually works on my first try and sometimes my second..after that your chance of saving the stick is not good..remember to only touch the hub to advance...and small catheters tend to buckle and you sometimes only get one chance at it
    Coffee Nurse and cherrymaryRN like this.
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    Super helpful thread for new grads, thanks!!! At first I was terrified of trying, but now that I'm getting the hang of it I can't wait to stick somebody - although I try not to let them see the gleam of excitement in my eyes! None of the other nurses even want to try starting them, we always call the same one or two people out of another department for IV sticks which I think is a shame, so I'm determined to get good at it. We get a lot of super dehydrated folks in our urgent care center so it's always a challenge, and these tips are awesome. Thanks!
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    You don't say what age patient you are dealing with here but from my experience, with people who are quite elderly and have fragile skin, I don't use a tourniquet. I use gravity. I have them hang the extremity off the side of the bed. I also use this with people that are young, and who have huge veins, who are out in the sun a lot (tough skin) or who weight lift. I just have them hang their arms off the side of the bed. I find that the back pressure of the tourniquet can cause the vein to blow. The only time I use a tourniquet is with a person who is overweight.
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    What type of flushes are you using?

    Our facility has prefilled saline flushes, but you have to make sure that you push some of the saline out, because the force behind it will cause you to blow a vein if you don't.

    When I float to an adult unit, they usually have me stick difficult adults because I am used to sticking threads for veins...the biggest mistake I see made is that they push the flush too fast or they don't fill the barrel of the catheter with saline which causes an air pocket...which will also cause the vein to blow.


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