IV Placement Hacks

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    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!

    IV Placement Hacks

    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?
    Last edit by Joe V on Oct 20
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    19 Comments

  3. by   SaltySarcasticSally
    These are great tips!

    I'm struggling with advancing the catheter into the vein. I was an LPN prior to being an RN and drew blood often so I'm confident about the initial stick. But having to advance the Cath once I get a flash is where I'm struggling. Ill get blood return then advance but then loose the vein and get nothing.

    It's super frustrating, any ideas what I could be doing wrong?
  4. by   JKL33
    Over the years, the single most frequent mistake I have observed is that of continuing to advance the needle along with the catheter once blood return is noticed. Then the problem is reported as, "I got in, but the catheter wouldn't advance".
  5. by   JKL33
    S.S. Sally,

    I hadn't seen your post before I answered; maybe a few more details will help your situation.

    Take the opportunity to look at your preferred IV catheter closely (you probably have done this, but once more won't hurt as you process this information). You will see that the tip of the needle extends through and beyond the end of the catheter itself. When inserting, you will achieve the beginning of a blood return when the tip of the needle punctures the vein. The caveat is that the catheter itself may not yet be inside the vein, right?, since the end of the catheter is not "at" the tip of the needle. So, you have to advance "just" far enough, probably millimeter or fraction of millimeter in order to ensure that the catheter itself has entered the vein, but not so much that the tip of the needle punctures through the vein. (If you go all the way through with the needle, that is the path the catheter must also follow).

    This ^ issue is why some nurses advise others to "flatten out" the angle once blood return is noticed - - it's an attempt to keep the tip of the needle in the vein as opposed to inadvertently pushing it through the vein while advancing the catheter.

    So take a look at your cath/needle set. See that tiny distance between the tip of the needle and the end of the catheter? That is the distance you're working with as far as how far you need to go in order to get the end of the catheter itself into the vein. Not going that far, or going beyond that distance with the needle after blood return is where problems arise in my observations.

    HTH.
  6. by   Cowboyardee
    Quote from SaltySarcasticSally
    These are great tips!

    I'm struggling with advancing the catheter into the vein. I was an LPN prior to being an RN and drew blood often so I'm confident about the initial stick. But having to advance the Cath once I get a flash is where I'm struggling. Ill get blood return then advance but then loose the vein and get nothing.

    It's super frustrating, any ideas what I could be doing wrong?
    It's a problem I had to overcome as well.

    Remember that the point of the needle is down and the bevel is facing up - so before you advance (and after achieving a flash), it often helps to tilt the needle upward just a tiny little bit to make sure you're not trying to push the catheter through the wall of the vein.

    Vein selection is another big factor here. Big veins are much easier to advance a catheter into than small ones; straight veins are much easier to advance than torturous ones. Recognizing valves also helps quit e a bit. Get as much blood flow to the vein as possible before you start as well - a tight tourniquet, lots of fist clenching, warm packs, etc - they all can help. In my experience, a lot of people who consistently have trouble starting IVs just don't spend enough time searching for, selecting, and prepping a site.
  7. by   Ashley Hay, BSN, RN
    Couldn't agree more with the answer below. It's a matter of advancing just a teeny tiny bit more, then advancing the catheter only (not the needle). Great in depth explanation!

    "Take the opportunity to look at your preferred IV catheter closely (you probably have done this, but once more won't hurt as you process this information). You will see that the tip of the needle extends through and beyond the end of the catheter itself. When inserting, you will achieve the beginning of a blood return when the tip of the needle punctures the vein. The caveat is that the catheter itself may not yet be inside the vein, right?, since the end of the catheter is not "at" the tip of the needle. So, you have to advance "just" far enough, probably millimeter or fraction of millimeter in order to ensure that the catheter itself has entered the vein, but not so much that the tip of the needle punctures through the vein. (If you go all the way through with the needle, that is the path the catheter must also follow). "

    HTH.[/QUOTE]
  8. by   Pepper The Cat
    One great tip I picked up from an anesthesiologist when he had to come to place an IV on a pt after multiple failed attempts. He had the pt dangle his arm over the end of the bed to fill the veins a bit more.
  9. by   Blackfoot12679
    Also with these tips, I would like to add these.

    1 have confidence, negativity brings doubt, and poor performance.

    2 if you can see it, it is attainable. Also it probably isn't deep.

    3 A turnakit isn't always necessary, especially with older veins or people on chronic steroids, the vasculature is more sensitive to blowing. Then don't use it and try a decent size IV and go SLOWER, cause it will take twice as long or longer to get a flash.

    Happy Stabbing
  10. by   SaltySarcasticSally
    Thanks all!! Great advice that I will be implementing.
  11. by   RobbiRN
    If you cannot find a vein through any of your usual methods, lower the hand and as much of the forearm as you can get in a large basin of very warm water for about five minutes. This is much more effective than simple dangling or local warm packs. It is time consuming, but it works. Look at your own veins before and after your next warm bath or shower and see the possibilities.
  12. by   MikeyT-c-IV
    Great article and awesome tips!

    This is the ultimate IV hack:

    vein_map-jpg
  13. by   DowntheRiver
    Quote from MikeyT-c-IV
    Great article and awesome tips!

    This is the ultimate IV hack:

    vein_map-jpg
    LOL, I wish! So I work in Oncology starting IVs all day, and I just trialed the AccuCath for my BD department and they used a portable ultrasound. It was wonderful and I wish we could have one all the time.

    Patients in the Oncology setting just have the worst veins. Do you have any tips for little old ladies whose skin bunches up? Usually I'll get in but even holding traction with my thumb is just sometimes not enough!
  14. by   SICUmurseCCRN
    SaltySarcasticSally once you get the flash try lowering your angle to 5 degrees or so and going in a pinch more before advancing this should help.
    Last edit by SICUmurseCCRN on Aug 25 : Reason: update

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