I think I might have blown a vein?

[KG MSN RN CCRN CEN, MSN, RN]

I was practicing IV skills with a classmate, and I attempted to insert an IV. Everything went pretty good in the beginning from what I could tell. I went into the vein at about a 15 degree angle, got blood return, advanced just a little more, then advanced my catheter. But then I noticed that the skin around the area started swelling. I feel like I did everything correctly, and then that happened and it kind of scared me and lowered my self esteem. Does this sound like I blew the vein, or does this just happen to people?

[Medic6758]

Yep, it is blown. No worry though, I was a paramedic for 20 years and performed approx. 5 IV's per day per shift. During my many years, I have probably blown 100's if not 1000's. It is just something that occasionally happens. Just try not to make a habit of it and you will be okay.

[UnaNayeli]

I love your encouragement, Medic! Well done!

[KG MSN RN CCRN CEN, MSN, RN]

Even if there was no bruising, it would still be blown? Thanks for the feedback

[Medic6758]

The bruising will come later. What occurred was the needle went through the vein and swelled up from the blood. There will be times when everything appears good, but as soon as you attach and run the fluid, it swells up.

[KG MSN RN CCRN CEN, MSN, RN]

Okay,thank you. Besides me blowing the vein, do these steps sounds correct?

1) insert needle at 10-15 degree angle

2) get blood return

3) pop tourniquet

4) lower needle parallel to vein

5) insert needle just a little bit more

6) thread catheter

I think I missed step 4 of lowering the needle, so when I inserted just a little bit more, I went through the vein.

I'm determined to get this correctly though.

[SionainnRN]

Once I have a flash I thread the catheter, no need to advance the needle anymore, you're already in. And if you're drawing labs leave the tourniquet on till you're done and are ready to flush. At least that's how I do it.

[KG MSN RN CCRN CEN, MSN, RN]

I believe that is what I did wrong then. I got flash, then went in a bit further when I should've just threaded the needle. Thank you!

[akulahawkRN, ADN, RN, EMT-P]

Okay,thank you. Besides me blowing the vein, do these steps sounds correct?

1) insert needle at 10-15 degree angle

4) lower needle parallel to vein

2) get blood return

5) insert needle just a little bit more

6) thread catheter & occlude the tip

3) pop tourniquet

7) connect tubing and flush...

I think I missed step 4 of lowering the needle, so when I inserted just a little bit more, I went through the vein.

I'm determined to get this correctly though.

I rearranged the steps for you. Done smoothly, the movement of inserting an IV looks kind of like a flattened "J" instead of a distinctly two angle approach. Once through the vessel wall and you get a flash, you only need to advance the needle about the distance of the bevel... about 2-3 mm. You just want the bevel in the lumen. The catheter can then slide past the bevel into the vein without tearing it at that point.

And yes, you did perf the vein and probably catheterized the tissue beyond it. That's why the skin around the vein puffed up. Vein blown. Don't worry about it. Anyone that's started an IV (or a few) will blow veins from time to time.

[featherzRN, MSN]

Even if you did it 100% right, the vein can still blow! Stuff happens - you sound like you are very motivated to learn and you'll do fine. No worries. :)

[akulahawkRN, ADN, RN, EMT-P]

Even if you did it 100% right, the vein can still blow! Stuff happens - you sound like you are very motivated to learn and you'll do fine. No worries. :)

Very true. I had a patient whose veins were so fragile that every peripheral IV attempt resulted in a shredded vein. Not just blown... shredded. He was 23...

[meanmaryjean, DNP, RN]

If I had a nickel for every vein I've blown in 35 years, I'd have a crap TON of nickels.