IV's to Blow or Not to Blow...That is the Question

  1. 0
    i'm a new rn...2 days into "orientation" in the emergency center. we do a lot of ivs and draw blood frequently.
    my question is why do i keep blowing veins and what can i do differently to stop blowing veins. i've messed up wonderful sites because they blow.

    all feedback is greatly appreciated!

    oh! also what is the best way to draw blood from a saline lock?
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  3. 10 Comments so far...

  4. 0
    If you're only 2 days into orientation, you might have just run into people with fragile veins. Are you blowing them as you start them, or are these IV's that are already established?

    One common mistake and something to be careful of when starting an IV is to watch the angle of entry; you might be piercing the opposite vein wall.

    I'm pretty good at IV's and was on the night shift IV call team at my old hospital. But it's kind of hard to tell you what you're doing wrong without seeing you in action...

    Try shadowing someone who is a "good stick" and watch carefully what they are doing as compared to your technique.

    My gut feeling is to give it some time. And don't shy away from trying. You'll only get better with practice
    Last edit by Emmanuel Goldstein on Jul 24, '07
  5. 0
    Most nursing textbooks recommend advancing 1/4" after getting a flash of blood. Unfortunately this only works for patients with huge veins. Try to drop the bevel as low as seems reasonable (15% or so) and advance gently directly into the vein. Immediately upon getting a flash STOP. Assess the situation. Was it just a flash or is their a good gush of blood? If it is a good flow then very gently advance the catheter. If it is just a drop or two of blood then you may need to advance further, etc. When I have watched nursing students blow vein after vein they are almost all advancing the needle after getting a flash of blood. Be careful not to do this unless the patient has very tough/huge veins. Remember, practice makes perfect! I'm sure you will do great.
  6. 0
    I don't advance the needle after the flash in a "fragile vein" sort of situation. I stop when I get flash, then push the cath only further. I have had lot less blowing doing this, with fragile folks. Hope that made since!
  7. 0
    Drawing blood from a lock: tie the tourniquet above the site. With a syringe of NS (3-5 mls), inject the NS, then wait a few seconds and pull out 5 mls. Discard this blood. With an empty syringe draw however much you need. Inject 3-5 mls of NS to clear the lock and clamp it off.

    IV's: if the vein isn't fragile, make sure you're anchoring it before you poke---with your thumb on the vein below your insertion site, pull the skin taut slightly. Pierce the skin and vein; when you get a flash angle the cath down slightly and advance just a tad. Then anchor the hub (you can let go of the skin here) and disconnect the cath from the needle. Advance the cath alone and pull the needle out.

    If it's a little old lady with fragile veins, try starting it without the tourniquet.....there might be too much back pressure.
  8. 0
    Another tip on drawing blood from the lock - the bigger gauge IV in there the better. You can almost always get blood out of an 18, maybe half the time on a 20 gauge, and very rarely from anything smaller.

    If the blood is flowing very slowly, don't even bother sending it to the lab. It will be hemolyzed. Just stick with a butterfly needle.
  9. 0
    another tip (i was quite blown away by this, he he!) is if you see your vein blown, try advancing the catheter further, no kidding...i've seen this done and sure enough the catheter went through the blown portion of the vein and hooked back into a durable segment...and apirated and saline infused without infiltration, crazy but true story...ok. maybe not protocol but wow cool! and the iv held for two shifts!
    Quote from crissrn27
    i don't advance the needle after the flash in a "fragile vein" sort of situation. i stop when i get flash, then push the cath only further. i have had lot less blowing doing this, with fragile folks. hope that made since!
    i agree, this is a cool tip and it has worked for me too. nothing worse than having an old lady kavetching when your trying your darndest and veins blow left and right.
    Last edit by CaLLaCoDe on Jul 24, '07
  10. 1
    check this informative site out:

    http://enw.org/IVStarts.htm
    athena55 likes this.
  11. 0
    Something that's helped me lots is this: once you have blood flashback, as someone else said, STOP. Reach up and untie the tourniquet with the other hand. Then I don't put the needle any further in unless it's some huge vein. I put the whole thing lower down to the skin - this usually involves taking my index finger out from under it- and with my other index nail, yes it's short but there, I advance only the catheter. I was about to say "only the pink part" but they are different colors. I'm just very fond of 20's if I can get 'em in.

    Then if it doesn't stick going in, I'm good and can attach saline, aspirate and flush, etc, and finish up. If it sticks going in, I hold it right there, attach extension set with saline, and gently push saline ahead of the catheter and attempt to float it on in. If there is a chance at all, that'll help, such as on dehydrated people. It's only worked for me once, I know someone for whom this works all the time. My luck is such that if I'm gonna be trying to float something, they move.
  12. 0
    you are "blowing" veins because you are puncturing the vein with the needle and then somehow the needle is getting maneuvered out of the vein or punctured through the other side of the vein so that blood spills out into the surrounding tissues. this can happen if the vein is not stabilized and you merely manage to nick the side of the vein enough to create a puncture, but never successfully get the needle into the lumen of the vein because it rolls away from you. a "blow" is a bleed into the surrounding tissues. shortly afterward the patient will have a hematoma and bruise as a result.

    the way you correct this is to make sure you are aiming your needle in the same direction and depth of the vein. this takes practice because you have to visualize in your mind where the vein is as you can't really see it. you can, however, feel it and you should learn to palpate these engorged veins to learn the direction they are going. also, remember that you are, in effect, sliding a needle into a long narrow tube. the fit has to be nearly perfect. it you are slightly off--"blow".

    here is a thread on the er nurses forum that many nurses have contributed to where you should find lots of helpful hints


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