Tips and tricks from an experienced IV RN, from tourniquet placement and vein stabilization to choice of dressing and site care. Let’s get your PIV game on point!
NursesGeneral NursingArticle
We all have our strong suits. What's yours? Maybe it's code management, mediport access, or another technical skill that requires just the right amount knowledge and finesse. There's always that "go-to" nurse on every unit. Staff turn to the expert on the floor for their experience with a specific issue. One who has perfected his/her technique over years of experience. Let's make you that nurse!
Get in There!
Obtaining and maintaining viable IV access is a learned skill. One that every nurse may not have mastered or even practice on a regular basis, depending on the area in which they work. Some hospitals have IV teams. A great resource, ensuring minimal attempts for the patient. However, it can prevent many nurses from ever even trying to place their own IVs for patients.
Unfortunately, trying (even when unsuccessful several times at first) is the only way to learn and hone your craft. As with many skills learned on the job, practice makes perfect. An important thing to remember is that no one expects you to have a perfect batting average when you first start. But your patients don't need to know that it's only your second time. Go into your patient's room with confidence. Decreasing their fears as much as possible can bring down the anxiety levels all around, making for a much more controlled and potentially successful attempt.
Tourniquet Use
The purpose of the tourniquet is to occlude blood flow and cause the vein to fill, making it easier to insert the catheter. I've seen many nurses generously place a tourniquet too loosely or use a folded paper towel to decrease patient discomfort. In truth, yes it is mildly uncomfortable - but temporary and necessary to ensure proper technique and possibly save your patient from another painful IV stick.
It's important to move the tourniquet depending on the site of choice. For example, if you're intending to use the antecubital (usually the most prominent vein in the middle of the arm on the opposite side of the elbow) you'll want to place the tourniquet on the bicep area, about 3-4 inches above the intended IV site. If you're attempting a vein in the hand or wrist, place the tourniquet instead on the forearm, 3-4 inches above the intended site of insertion. Time of tourniquet use should be restricted to under 2 minutes.
No Veins in Sight
Placing an IV correctly can be hard enough but especially so when there is perceivably little to work with. I like to go by feel, not just sight. When you are tapping around looking for IV sites, the vein should feel springy and kind of rubbery. I sometimes think of it like a rubber band injected with a bit of water. Working in Oncology, many of my patients have difficulty with IV access as time passes with their treatment regimen - hardening of veins from chemotherapy, dehydration can make veins incredibly small, and pediatric oncology patients (some only a few months old) can be incredibly challenging. Not to fear...there are ways to help coax those veins out of hiding!
Having a patient take some controlled deep breaths before insertion can increase blood flow, filling the veins (and decreasing their anxiety too!), leading to more IV site possibilities. Warming your patient can also help. Dry or moist heat can be used and both are effective. Examples of this include wrapping warm dry blankets or warm moist towels around the patient's arms. Of course, heat packs could also be considered for use. Some hospitals have a vein light available for use. It's not my favorite and I've only used it a handful of times in my career. Some nurses love it and the extra visual component it brings. Use what works for you.
When I'm really out of luck finding a vein for use, I like to go for the basilic vein. It's a nice big vein located on the opposite side of where you would normally look...on the backside of the forearm. It's not a frequently used site and therefore, usually in pretty good shape (lack of scar tissue & limited valves to avoid). Give it a try!
If you've used all of your resources above and still cannot locate a vein, do not blind stick. Digging an IV around under the skin unnecessarily can cause potential tissue and even nerve damage, not mention unsightly bruising. An important rule to keep in mind (even if it's not specifically stated in your hospital policy), don't attempt an IV more than twice on the same patient. Getting a fresh set of eyes and hands from another nurse is best at this point. Don't stress, you'll get it next time!
Vein Stabilization
Holding down the vein you intend to stick is crucial - those little things can be wiggly! This is the number one reason I see novice nurses missing IV's. Once your tourniquet is in place and your site is cleansed take your non-dominant hand and with one finger (I find the thumb works best, so you can wrap your hand around the patient's arm for more control) apply moderate pressure about two inches below your intended site and pull down just slightly. Now that your selected vein is anchored, fire away! A slow and steady insertion...see a bit of blood flashback and voilà , you're in! Continue to advance the catheter, promptly remove the tourniquet and use your dressing of choice.
I hope you find these tips helpful in increasing your success rate for IV placement. What are your favorite IV hacks, tips and tricks?
