IV starts

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    Last edit by Chuckie on Jan 17, '03
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  2. 10 Comments

  3. by   P_RN
    Excellent advice....but i never use a tourniquet on little old lady skin. And getting down on bended knee with a prayer for success has helped me many a day.

    Blood WILL run through a 22 but I still go for a #20-1 1/2 inch. The 22s we had were only 1". Not cost efficient to carry 2 different lengths (The BOSSLADY said.)

    I "grew-up" using #21 butterflies. No one else did...so when we were made to take over phlebotomy...guess who did the best right off the bat. Tee Hee.


    I've never worked in a place with an IV team. Do you have to wait for them always? What would happen if you went ahead and started a line? Would they refuse to come anymore? Do they hang ALL the bags and blood etc.

    Sheesh I think I'd rather have some extra Nurses on the unit rather than a come and go team.
  4. by   CEN35
    No IV team here........

    Although I see some of your points.......like too big of a cather in to small of a vein, doesn't help...............a 22G for blood? Never......I have done 20's...........and its ok......but not always sufficient or quick enough......personally never goes less than an 18 if they might need blood or lots of fluids........like the GIB's and esophogeal varices, or septic people. If it's more of a cardogenic issue.........usually twin caths 18/20's........or too big for them......20/22's

    me
  5. by   JillR
    We were just talking about iv starts at work at work the other night. The information we got was that you can run blood through a 22 g but the blood must be run through slowly. I don't know it I would risk it, but when you have no other choice. I dont know.

    I pull up a chair and talk to the patient and it they will me that he right hand is usually thy luckyest, I will look thier first. I also try very hard to as far awat from the hand as much as possible, as the have a tendency to go bad faster, just because they are so positiional. If you can hit a vein where the y connects to different veins,them you are in luck, just go in right at the y and will get it more often than not. Stay away from those huge rollers,unless you are able to trap then without losing then, you will spreding alot of time just following them arround. Sometimes when trying to trap these veins they flattrn out then dissappear, just like they know you were coming.

    My rule of thumb when attenpting IV

    1.preferrably above the hands-----for obvious reason
    2,Must be able to FEEL and possibly see the vein
    3.vein must me straight enough to accomidate the canulla,with no hard bumps {valvues}IN the middle.
    4.If, when touching the vein and this particular vein has the ability to move from onside od the wrist ti the other, it will miraculouly continues to do so when a needle is chasing it, Don't bother.
    5when you do get a good blood return, but cannot sem to advace the cathetor, try running some saline throouhg it, this just mighf open a valve eough to let the canulla through.

    evetthing else is practice and luck

    good luck
  6. by   nurs4kids
    Well guys, to be honest, you can run blood through as small as 24ga..do it all the time in kids. Very rarely do we have the delight of having larger than a 22ga for blood. Chuckie, were did you get the smallest catheter in the largest vein??? That's a new one to me. A larger catheter in an appropriately sized vein will last much longer than a small catheter in a large vein. We don't have IV therapy on nights, either. We routinely run vanc through hand, scalp and foot IV's with very little infiltration problems (average IV when getting vanc lasts 48-72hours).
  7. by   debbyed
    1. I always use a rolling stool. Too old to get down on bended knee. (Well I could get down but not to sure about getting up.

    2. Usually use a BP cuff on Little old people.

    3. I work ER, Everybody gets an 18 if at all possible, and some get 16's. ( I save the 14's for the drunks and the overdoses)
  8. by   canoehead
    Of course you can run blood through a 24, peds does it all the time, and blood cells are so small they are invisible, they can get through that big honking hole in the 24 lined up like the rockettes. However men will always persist in thinking that bigger is better nothing women say will convince them otherwise.

    The reason to put a small IV in a large vein is that the small canula is less likely to sit on the side of the vein and cause phlebitis. However a longer cannula is better than short, bringing the end of the cannula away from the initial injury site.
  9. by   Zee_RN
    LOL, Canoehead! Ijust loved that "get through that big honking hole ... lined up like Rockettes" line. Hehe. I never thought of it that way, but you're right!
  10. by   Julie Ann
    I have worked mainly in smaller hospitals where the unit and ED nurses become the IV team......I was taught that you always go above the hand for any drug that is a vesacant.....vanco,dopamine ect....and we couldn't use pumps for blood although in the last two jobs I have worked they have and I haven't seem any ill effects.

    I like to use a B/p cuff it seems like pt are calmer with the starts. And make them laugh and talk it keeps them off the floor (figuritively) I never had a woman faint but have seem a few guys bite the dust
  11. by   KRVRN
    I work NICU and we commonly run blood through 25 gauges into a little hand the size of a quarter. We do, however run it quite slow. I've infused 15cc of PRBC's over 3 hours (then followed it by 0.1mg of lasix to pull off the excess fluid, LOL). We start all our own IV's and hope for luck. And you almost NEVER get a blood return with the little guys.
  12. by   misti_z
    P--
    I've never worked in a place with an IV team. Do you have to wait for them always? What would happen if you went ahead and started a line? Would they refuse to come anymore? Do they hang ALL the bags and blood etc.
    We have a IV team, day and night. If I feel comfortable starting an IV, I do it. And that is okay to do. During the day there are 4 IV nurses and at night sometimes 2 that divide the hospital. They carry voice pagers, you tell them your location, never the room number. They are usually there in 15 minutes, at the most, on nights. When you page if you say: I've got blood hanging (infiltrated during infusion), or for pain med. They try their best to arrive faster. They are not allowed to reconnect tubing or hang bags of anything. During a code the IV team comes and ensures that there is an IV and also they push the meds, it's wonderful the nurses are lifesavers...no pun intended They also maintain a 'Hit List' meaning that they have tried multiple times and the patient has NO veins. Many of my patients are on the hit list--renal ! When the IV team nurse decides the patients has no viable vien s/he makes a note in the doctor's progress notes telling them to consider line placement, and it usually happens

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