How do you pick your vein for an IV?

Nurses General Nursing

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As a nursing student, I try to take every chance I get to practice IV's on patients, I still suck at it. Every time I start one, I get kind of nervous that I won't find the right vein, or that it will blow on me. My last clinical I got 3 out of 5 in, but this is not the usual for me. Any suggestions on getting it in the first try? And what veins to avoid? Any help is appreciated!

Specializes in LTC, Nursing Management, WCC.

I stay away from the AC because if it doesn't work you can not go distally on the same arm. Start at the hand and go up. Back of the hand is good for me. Feel, feel, feel... I have used a BP cuff in the past which works nicely. Also try to dangle the arm or use a warm wash cloth to get that vein to dilate.

The wrist one has ALWAYS wigged me out. It makes me shudder. If the patient doesn't throw up... I will. LOL

Specializes in Critical Care; Cardiac; Professional Development.

For a student I am pretty good at getting IVs. I feel for a nice chubby one.

The more experience you get, the more you'll find you're own ways of doing things. I work on pediatrics and if we want a needle larger than a 20g, we have to order it from central supply. I've started IV's anywhere from the feet to the scalp. With infants, a lot of times you have to go for what you "see", although most of the time no matter how old, you can feel an AC. I love the AC veins because a lot of time, you can also draw blood from it which saves the patient from another poke which is a big PLUS in the pediatric setting.

I don't know if I'm wierd but I personally love the feeling of getting an IV in a nice juicy vein! Am I the only one? LOL...And don't even get me started on accessing infusaports!!

Specializes in LTC, Nursing Management, WCC.

When talking to coworkers or strangers... do you ever catch yourself admiring the veins on the hands and arms. LOL

Specializes in Cardiovascular, ER.
Yes Fancy Pants, but you're working ER... If I were working emergency services and "pouring" in copious amounts of colloids and crystaloids I too would want a larger bore IV catheter... But that isn't the rule of thumb outside of a critical setting. One should always place the smallest gauge and length. So, 22g works great for most, and that 90 pound soaking wet female, she gets a 24g. Oh yeah, 22 for blood administration on the elderly too... Not in crisis mind you.

I see your point. Even on the floors though (for whatever reason) I had better luck with 20g than 22g. I also preferred them bc I could draw labs off the line if need be for usually about 12 hours. I have always avoided the hand iv's as well, if at all possible. Just a matter of preference I suppose :)

Specializes in Emergency/Trauma.
When talking to coworkers or strangers... do you ever catch yourself admiring the veins on the hands and arms. LOL

yes! my boyfriend gets so irritated with me always fondling the veins on his arms. they're perfect. i would LOVE to stick them.

Specializes in LTC Rehab Med/Surg.

If the choice is not obvious, I sometimes ask the pt where I'd have the best luck.

I hate the AC-s .... I went by feel as well, unless it's some nightcrawler I could see from the door. And didn't always use a tourniquet. I preferred starting at the lower forearm, and moving up (duh).....if I had to use the upper arm, that was fine- out of the way :)

Specializes in ER, progressive care.

You will have good days and bad. There are days where I can get patients who have REALLY crappy veins and days where I have patients with good veins but I keep blowing them, and then I can't start their IV.

Spend your time looking and make sure the lighting is adequate. Palpate, palpate, palpate! Sometimes the best veins are the ones you can feel but can't necessarily see. Sometimes you won't feel anything. Sometimes you have to go deeper (usually with the heavier patients) and others you have to go in more superficial.

Putting the extremity in a dependent position helps as well as placing a pillow underneath the arm (make sure you put chux over that though if you tend to make a mess, or else you might have to change the whole bed later!). I will also use two tourniquets (together, not one above and one below but I have seen nurses use that practice, too) - sometimes that helps the veins pop up. Alcohol pads will get them to pop up and betadyne can sometimes help those veins show. Using warmth (such as a warm towel) can also help get those veins pop.

Some patients have VERY fragile veins and sometimes I won't use a tourniquet on those patients if I know the vein is going to blow. I usually have to opt for a 24G on those patients. On everyone else, I try to aim for at least a 20G. If not, I opt for a 22G.

the more experience you get, the better you get :) Becoming good at IV's comes with time! I admit, I'm not the greatest, but again I have my good days and bad days. And I limit my sticks to 2, sometimes 1 if the patient is a very hard stick and I know after the first attempt I will not be able to get one in on the second attempt. After 2 sticks I call someone else.

Specializes in ER, progressive care.
I hate the AC-s .... I went by feel as well, unless it's some nightcrawler I could see from the door. And didn't always use a tourniquet. I preferred starting at the lower forearm, and moving up (duh).....if I had to use the upper arm, that was fine- out of the way :)

I hate the AC as well because the patient can never remember to keep their arm straight :rolleyes: But also if it infiltrates, you can't go distal to that site...

But sometimes the AC may be the only option you have!

Specializes in ER.
I love the forearm and upper wrist area( away from the bend).. I still cant get one in the AC no matter how often I try...

LOL, I thought it was just me. I have a lot of trouble with AC as well, and not sure if it's because as a pre op and oncology nurse we learned to start at the bottom, or if because on the floor I HATED AC IV sites (occlusion constantly).

I work ED now and rarely use AC. I love the forearm, or hand if nothing else and I know pt. is not being admitted, or sometimes when I've just emptied all my rooms and I have 3 or 4 new within 5 minutes I just go for the easiest and quickest-hand.

I really don't know why the AC is so difficult for me, I always feel like I am not palpating a vein, and wonder if it's a tendon, or it feels scarred, whatever.

I hate the AC as well because the patient can never remember to keep their arm straight :rolleyes: But also if it infiltrates, you can't go distal to that site...

But sometimes the AC may be the only option you have!

Yeah, that's true :)

I never liked to use anything in the hand, wrist, or AC.... we had a LOT Of older patients with lousy veins (COPD'ers w/steroids, along with just normal lousy veins), and those never seemed to last since many did forget to protect them. I loved the forearm, or upper arm. But, when there aren't many choices, ya go with what's waving at ya :D

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