How do you pick your vein for an IV?

  1. 0 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!
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  3. Visit  Chandra Lancaster} profile page

    About Chandra Lancaster

    From 'Twin Falls, Idaho'; Joined Oct '11; Posts: 6.

    53 Comments so far...

  4. Visit  FancypantsRN} profile page
    1
    I go for the ones that I can feel (not necessarily see). The squishier, the better. I have the most success with AC and back of the forearm. For me, the larger the gauge, the more stable the placement. I almost never use a 22g, all are 20g or 18g.

    As with a lot of skills, the more you practice, the better you get
    xtxrn likes this.
  5. Visit  BuckyBadgerRN} profile page
    3
    Quote from Chandra Lancaster
    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!

    Avoid any "vein" with a pulse!!!

    No seriously, trust your fingertips. Try and pick a nice one with your eyes, and then palpate, palpate, palpate. I spend a lot of time without gloves checking sites. Ask the pt if there is a good spot, where other nurses have had success, try not to let the ones who tell you "I'm a hard stick" rattle you.
    I like the back of the hand b/c I can curl their fingers into my hand and really hold things steady. Otherwise you can usually find a nice one on the back of the forearm--nice and fat! I try to avoid a/c just because you always have to worry about them occluding it when they bend their arm, but of course that's usually a great spot!!
  6. Visit  brownbook} profile page
    0
    There are a lot of threads about starting IV's. Yet still I think of hints that may not get mentioned, since you asked about picking a vein over specific technique advice.

    My laziness, or problem, is sometimes I see a "yeah, this looks okay" vein on one side, set out my start kit on that side, look closer and maybe have second thoughts. But am too lazy to get up, step away, take another GOOD look at the other arm, and re-think the whole thing.

    I hate it when I blow an "it really wasn't that great" vein then look at the other arm and see a good easy one! So take the time to really look at both arms, hand, AC's etc.

    Last week we had a repeat customer. Two weeks ago our best IV nurses (of which I am NOT a member) had been unable to start his IV. The anesthesiologists could not start it. It took about two hours to get an IV in this relatively normal healthy man!

    When he came back I admitted him, not realizing at first who he was! The first thing he asked was if he could sit in the chair instead of getting right into the gurney because he had a bad back. I said sure. I let him sit in the chair when I started his IV (even after realizing who he was). I got right in! All I can think is last time he was in pain, getting more anxious, and his veins just kept shutting down due to pain and anxiety!
  7. Visit  Sun0408} profile page
    1
    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...
    hoopschick likes this.
  8. Visit  apocatastasis} profile page
    3
    If you're having trouble threading the catheter, remember that when you get a flash, advance the needle just a little further before you try to float the catheter. The needle's tip comes before the actual start of the catheter, and if you try to advance the catheter at first flash, you'll likely be trying to advance the catheter into the wall of the vein... often resulting in a failed IV start (one cause of, "I got the flash but I couldn't thread the catheter")
  9. Visit  That Guy} profile page
    1
    I love the "tooth brush vein" It is the one that goes along the back of the arm when you flex your elbow. I will often have the pt flex their elbow and go in that way. People think I am crazy when they see me do it, but it works great a lot of the time.
    turnforthenurseRN likes this.
  10. Visit  Chandra Lancaster} profile page
    0
    I am not understanding where the "tooth brush" vein is, sorry I should probably understand what you are saying but don't quite. Thank you all very much for the input! I do need more practice and often feel people's veins just to try to get a feel for it. My boyfriend is my guinea pig for feeling good veins
  11. Visit  IVRUS} profile page
    3
    Quote from FancypantsRN
    I go for the ones that I can feel (not necessarily see). The squishier, the better. I have the most success with AC and back of the forearm. For me, the larger the gauge, the more stable the placement. I almost never use a 22g, all are 20g or 18g.

    As with a lot of skills, the more you practice, the better you get
    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.
    swtpea48, RN2MSNasap, and I<3H2O like this.
  12. Visit  That Guy} profile page
    3
    Its usually the basilic if you had to give it a name.
  13. Visit  RedCell} profile page
    0
    Quote from Chandra Lancaster
    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!
    I pick the one that is the best fit for my 3/4" 14 gauge. Typically that will be either the cephalic vein or somewhere in the dorsal venous network.
  14. Visit  DroogieRN} profile page
    4
    The vein along the medial side of the wrist, just below the thumb, is awesome for me usually -- sorry, the name of it escapes me. It's often very palpable even without a tourniquet. I've heard it is called "the dummy vein," because any dummy can hit it.

    I will first look to place a 20g, but that's just not always possible. On my floor at least, we use a 24g as a last resort. I hate using the AC personally, especially if the patient maintains a running IV, simply because every little bend of the arm means endless beeping.

    Another tip I have found useful: on those fragile, elderly veins that blow if you even look at them funny -- instead of using that tight tourniquet, use a BP cuff inflated to about 20 mmHg above the patient's normal systolic. I have found that the veins will seldom blow that way. And when you see that first flash, hold steady and don't move to advance the catheter until the flash moves down the tubing about halfway.

    Works for me! Hope that makes some sense. And practice, practice, practice!
    Chandra Lancaster, Horseshoe, elprup, and 1 other like this.
  15. Visit  PsychNurseWannaBe} profile page
    0
    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


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