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
  2. Visit  bagbaje26 profile page

    About bagbaje26

    From 'Chicago'; Joined Feb '09; Posts: 13; Likes: 7.

    19 Comments so far...

  3. Visit  FireStarterRN profile page
    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. Visit  Magsulfate profile page
    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. Visit  patwil73 profile page
    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.

    Pat
  6. Visit  Sniper RN profile page
    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. Visit  crb613 profile page
    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. Visit  HolyRomanOne profile page
    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. Visit  WhoNeedsaShot? profile page
    1
    Get the flash.... Remove the tourniquet.... Then thread....
    emtb2rn likes this.
  10. Visit  leslie :-D profile page
    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.

    leslie
    rabbitgirrl and FireStarterRN like this.
  11. Visit  GrumpyRN63 profile page
    2
    Be careful, get your flashback, advance slightly further and float it in, don't advance the needle, just float the cannula in
  12. Visit  nursbee04 profile page
    1
    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.
  13. Visit  bagbaje26 profile page
    2
    Thank you so much everyone. All these tips I've 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 I've been able to pay attention to my own technique. I am no longer sticking patients with the fear that I'll blow the vein. It's amazing what a couple of successful incidents will do to my confidence level. ...
    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.
  14. Visit  GrumpyRN63 profile page
    0
    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...


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