How to deal with rolling veins?

[nurs1ng]

In starting an IV, how do you deal with a rolling vein? I try to stabilize the vein below the insertion site with my thumb, but I feel when it comes to the actual stick, my thumb gets in the way when I lower the angle of the IV (after the flash).

Thanks for any help!

[dah doh, BSN, RN]

You could try to cup you hand around from under the arm and pull skin taunt with thumb and 3 middle fingers gripping laterally away from each other. The vein will flatten but will stabilize. Or look for a bifurcated vein that has an upside down "Y" look...the branches stabilize the straight portion. You can also try the downward thumb with a little lateral tautness with the middle fingers. Make sure you check both extremities for the best vein.

[K+MgSO4, BSN]

A second tornique below the site.

If it is a person who has a lot of skin........ push the skin up above the tornique gently. (old lady arms!)

[iluvivt, BSN, RN]

Yes I know exactly what you are talking about and there are a couple of things you can try. Please keep in mind that the traction that you may need to apply can vary based upon the location of the vein,the quality of the skin (how flabby it is or how loose it is) and the quality of the vein (ie. thick walled). Also upward as well as downward traction may be needed.

You always want to perform downward traction without flattening out the vein so ONLY pull down and not out to the sides. I actually use all my fingers and pull down from behind the intended site. You need to scoot your thumb over away from where you will drop the angle of your cannula once you see your flashback in the flashback chamber becuase as you have probbaly found out you can lose the access and be unable to thread it if you drop your traction before you have a chance to advance it once the flashback is observed. (not always but often). You may not even need your thumb as in most case your other fingers will do the job really well!

Before you tie your tourniquet pull up on any loose skin before you tie it. This works really well on pts with recent weight loss and the women with a lot of loose skin. The women with a lot of loose skin can be the most challenging.

Experiment with an assistant holding upward traction for you while you hold slight downward traction with your thumb totally to the side of the intended insertion site. Once you try that and see the benefit PM me and I will try to explain a technique I developed. it is kind of difficult to explain and will not make much sense to you unless you can start getting IVs with someone holding upward traction for you.

On thick rolling veins use the sharpest catheter in your orificenal and try to access the vein from the top not the side. So insert almost flush with the skin or low angle and slide the cannula under the skin and when lined up over the vein slightly increase your angle and enter from the top. If you are just chasing a rolling vein from the side they tend to keep scooting over.

It is challenging to describe and much easier to show someone so I hope I explained it well.

Are you using a one handed techniques as it is much easier to maintain traction if you do it that way?

[KPHIL71]

All great responses. Most superficial veins roll fairly easily with the older patient population. A Site Rite can be very beneficial in this population. Not only does it provide really nice US imaging but it allows you to access deeper and larger veins. These veins rarely role being they are stabalized better by the surrounding tissue. It may take a while to gain the prerequisite dexterity involved with having both hands occupied, but once you do, it becomes fairly routine.

[SaoirseRN]

You have obviously figured out that you should never be in your own way! I never anchor the skin below the insertion site because then your other hand really is in the way.

Depending on what works best for that particular arm, I either pull down on the skin from beneath the arm, or pull up from well above my insertion site. I try both approaches well and wiggle the intended vein with my finger to see how anchored it is (then will go about the process of cleansing the site, actually inserting the IV).

For hands, you can have them bend their wrist down and hold onto your fingers, which draws the skin taught, and if need be your thumb can pull down a bit more to make sure it's stable. In this case, with their fingers around yours and their wrist bent, your thumb remains out of the way.