Help! How do I stop blowing very good veins?

  1. 0
    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 know is that I often go in flush with the skin. However about 5 months ago, I noticed a decline in my IV insertion rate. I never have a problem getting in the vein. However, nowadays, I blow all my good veins. I often get a good flash of blood, filling the catheter chamber but by the time I thread it through I’ve blown the vein. Sometimes, I blow the vein immediately after getting into it. I understand that we can’t avoid blowing veins when they’re weak, but I also blow very good, 20, 18G type veins. I am concerned because I know where to find the good rarely used veins. However, I know something has changed in my technique that’s causing me to blow these very good veins. One experienced RN on my floor told me that once I enter the vein, I might be pulling back the needle too soon or too late. I will like more suggestions on what I might be doing wrong.
    This has become my major stressor in nursing. I love the pace of nursing but I’ve definitely lost confidence in my IV skills, a very important nursing skill. Most of the time when I have a patient on continuous IVF, all I can think about is that I hope the IV last for the rest of my shift because it’s really difficult to find someone else to help place it. We often differ to the clinical specialist on my unit, who hasn’t been too forthcoming in helping me improve my skills.
    I’ve talked to our clinical educator, the specialist about having a session in the ER, PACU, GI and other units where IV insertion is a constant task. They continue to give me the run around about not being able to arrange this (something about labor laws and overtime even though they are aware I will be doing it on my own time).
    I will at least like to get the good veins and worry about difficult sticks later. I will definitely appreciate any tips from everyone. If anyone is in the Chicago area and have suggestions about where I can get good practice on my own time please I am very open to it.
    Thank you in advance.
    Last edit by TheCommuter on Jan 2, '11 : Reason: text too small

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  2. 19 Comments...

  3. 2
    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.
    sevensonnets and rabbitgirrl like this.
  4. 4
    Oh man, this is tuff to discuss here, would be much more productive to be discussing this in person, and even practicing on ourselves!

    I guess one point that I can think of is: once you hit the vein (and you are going slow during insertion) continue just a millimeter or two and THEN thread the cath through and not the needle. Don't thread the cath as soon as you see the flash of blood, you gotta move it just a teeny bit farther into the vein and then thread it. I know this is hard because sometimes you thread it too far and go out the other side of the vein. Just be very very careful.

    It takes a lot of practice to start IV's and people have streaks of good and bad luck with IV's. I am considered average at starting IV's, I'm nothing spectacular. But there was one day that I got FIVE hard stick in a row on our floor and now everyone thinks I"m wonderful. I know that I am not, I was just lucky that day! haha.

    Keep practicing!!
    turnforthenurseRN, Tina, RN, emtb2rn, and 1 other like this.
  5. 4
    A few suggestions:

    1) Make sure the bevel is facing upwards so that you don't blow the vein trying to advance.

    2) If you are inserting flush with the skin try a slightly more angled approach and when you get your flashback then drop it down flush.

    3) When you get the flash and drop the IV, advance the needle a "bit" more to firmly lodge it into the vein.

    4) When advancing the cannula are you experiencing resistance, pull it back and advance the needle a bit farther - you might be hitting a valve.

    5) Try a smaller gauge - I find it much easier to hit 22 than 20's, and 20's than 18's.

    6) Take a really deep breath before insertion and blow it out right before sticking the patient. When you get nervous you either get tense which limits the soft play of movement you can make (you tend to jab too hard) or you get jittery and the needle starts jumping around (hence blowing good veins).

    All I can think right now. Hope it helps. Just keep practicing and hopefully you will find someone who can watch you a few times to see what else they can pick up. You will get better - because you have the right mindset to keep practicing.

  6. 1
    If you want some good techniques on starting IVs Go talk to a couple of Paramedics. I was a Medic for 7 years and you HAVE to be able to get the IV on some of the worst patients in the worst conditions. So you get pretty good at them. I had a good tech. of kind of bowing the needle before breaking the skin and then pushing in over the vein and it would usually work pretty good. Can't do that with the big bores tho.
    rabbitgirrl likes this.
  7. 1
    I agree w/the others it does sound like you are going through the vein. Just take your time & go slow until you get the hang of it again......I like the veins you can feel not necessarily see. I do start flush w/the skin, get the flash & then stop... advance a tiny bit.... retract the needle......then advance. Good Luck!
    rabbitgirrl likes this.
  8. 2
    I learned to insert IVs on heart failure patients, so I'm sure you can imagine how difficult it was. I'm happy to say that now I can get blood from a stone.

    The technique that I have found works best for me is this...once you have accessed the vein and gotten blood back, pull back the needle a bit so that you expose the teflon angio-cath. You don't want to pull out so far that you can't advance the catheter, just enough that the needle no longer protrudes from the end. The blunt catheter is much less likely to puncture the vessel again.

    Hope this helps.
  9. 1
    Get the flash.... Remove the tourniquet.... Then thread....
    emtb2rn likes this.
  10. 2
    visually scoping for good veins, can be very misleading.
    i am definitely a feeler and feel for bounce.
    once you see the flash, retract a smidge, repo and advance slowly.
    and when possible, i try to NOT use a tourniquet...
    creates too much back pressure for borderline veins.

    every pt is different and often, it's just plain luck.

    rabbitgirrl and FireStarterRN like this.
  11. 2
    Be careful, get your flashback, advance slightly further and float it in, don't advance the needle, just float the cannula in

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