Any tips for "spasmy" veins? Also, PIVs on chemo pts?

Specialties Infusion

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Specializes in L&D, infusion, urology.

I've had sticks where I get zero return, even though I KNOW I'm in the vein, and sure enough, a few seconds after I finally withdraw, it'll start bleeding like I was IN the vein. (GAH!!) Any tips to prevent this so the pt doesn't feel like a pincushion?

Also, any tips for pts on chemo? I do a PIV for fluids and antiemetics 3x/wk on one pt (has a port for chemo), and his poor veins are getting tough as he undergoes his chemo. He has great veins, but they're VERY finicky now, and there's basically ONE spot where we end up going that always works, but it's getting sensitive of course, so I'd love to go elsewhere.

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With regards to your chemo patient, is there a reason you can't use the port?

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Specializes in L&D, infusion, urology.

He hates having it accessed, and the last nurse apparently did something bad with it, so it's reserved for the chemo txs (per pt and chemo center).

Right now he's taking a holiday from my infusions. I hope for his sake he doesn't end up needing them anymore, but I think he may as he gets further into his chemo.

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Sometimes if i dont get an immediate flash, i slowly pull back on catheter or hook up a saline flush if it doesnt puff up and flushes easily..then move catheter a little and try to aspirate to see if you get blood return. I like to make sure i have a good vein...hot water, gravity, pushing on vein can get it to stiffen up. Also know your sites

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Specializes in Infusion Nursing, Home Health Infusion.

You are more likely puncturing the vein as you pull the cannula out then actually being in the vein especially if this is happening to you a lot. Yes....you can be in a vein and not have a blood return but this does not occur often. Here are some things to do that will help you if you think that is what is happening or to rule it out . If you are using an introcan or intima you can take the flashplug off so you will get and see your flashback a bit quicker. The insytes have a special feature that allows you see the flash through the cannula and you do not have to look at the flashback chamber,not to mention that you cannot take the flashplug off because if the nature of the shielded needle chamber.

You can also use some techniques to distend the vein prior to the venipuncture to get the vein as big as it can possibly get. Select a vein or two an apply a warm compress whether or not you think it needs it because it always will help.Place two tourniquets the high one first and always apply them with the arm hanging as low as you can get it. I never will apply a tourniquet if the patient has their arm propped up on a pillow as I notice it never traps as much blood in the vein when I compare it the arm held down as much as possible. Always approach the patient with a high degree of confidence,even if you have to fake it, If you seem stressed....it will rub off on the patient and they lose confidence and their veins can spasm and collapse.

I often see the veins of the young person with the very healthy looking veins spasm in the worst way. I have had a few PICCs literally stuck either going in or coming out due to a powerful spasm. Also form your venipuncture steps slowly while paying attention for the "pop" feeling so you know when to except the flash. If you really believe you are in the vein go ahead and try to thread it and flush it. If you are in the vein with no blood return you will often get it when you take the needle out. If you do not see it then there is a high likelihood you are NOT in the vein at all.

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Specializes in L&D, infusion, urology.
You are more likely puncturing the vein as you pull the cannula out then actually being in the vein especially if this is happening to you a lot. Yes....you can be in a vein and not have a blood return but this does not occur often. Here are some things to do that will help you if you think that is what is happening or to rule it out . If you are using an introcan or intima you can take the flashplug off so you will get and see your flashback a bit quicker. The insytes have a special feature that allows you see the flash through the cannula and you do not have to look at the flashback chamber,not to mention that you cannot take the flashplug off because if the nature of the shielded needle chamber.

You can also use some techniques to distend the vein prior to the venipuncture to get the vein as big as it can possibly get. Select a vein or two an apply a warm compress whether or not you think it needs it because it always will help.Place two tourniquets the high one first and always apply them with the arm hanging as low as you can get it. I never will apply a tourniquet if the patient has their arm propped up on a pillow as I notice it never traps as much blood in the vein when I compare it the arm held down as much as possible. Always approach the patient with a high degree of confidence,even if you have to fake it, If you seem stressed....it will rub off on the patient and they lose confidence and their veins can spasm and collapse.

I often see the veins of the young person with the very healthy looking veins spasm in the worst way. I have had a few PICCs literally stuck either going in or coming out due to a powerful spasm. Also form your venipuncture steps slowly while paying attention for the "pop" feeling so you know when to except the flash. If you really believe you are in the vein go ahead and try to thread it and flush it. If you are in the vein with no blood return you will often get it when you take the needle out. If you do not see it then there is a high likelihood you are NOT in the vein at all.

A lot of this I already do (I've never tried two tourniquets). I've done enough phlebotomy and IV therapy usually to know to pull back the cath a bit to see if I've gone through the vein (which, of course, happens). It's not that this is a common issue, per se, but it's more that it happened a few times in one visit with the same patient, where I usually never have trouble with her, even though she's not an easy stick. I believe that part of it was the inflammatory process, as she was having a "bad day" with her particular diagnoses, but I'll try more of these next time. I had her arm down, had her sipping warm water, and definitely didn't let her see me sweat (never let it show when I'm coming at someone with a needle!). I'm all about using gravity to my advantage. It was more that it took a few seconds for the site to start bleeding that made me think I hadn't gone through- usually those will start bleeding immediately. This one waited longer than that.

I can't think of the name of the IV caths Coram sends (I'll have to check the next time), but there isn't the flashplug I've seen on other caths.

I appreciate the input!

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Specializes in Neuro /Med-Surg.

You may be getting to close to a valve. Here is a great video of how to tell where the valves are.

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Specializes in L&D, infusion, urology.
You may be getting to close to a valve. Here is a great video of how to tell where the valves are.

Yes, this is certainly possible. I will check out the video. I can usually find them, but any little tips help. Thanks!

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This is a great tip, thanks for the link.

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I would educate the patient some more about the port and maybe even have the Dr. Talk to him. Ports are wonderful for oncology patients and usually a lot less poking. Most of my oncology patients don't even feel being stuck anymore. The whole idea of a port is for the patient to be stuck less and is so much more safer then administering chemo or other meds through a Iv. I am assuming this one bad experience has scared him. Hopefully you can talk him into giving it another try!

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Specializes in L&D, infusion, urology.
I would educate the patient some more about the port and maybe even have the Dr. Talk to him. Ports are wonderful for oncology patients and usually a lot less poking. Most of my oncology patients don't even feel being stuck anymore. The whole idea of a port is for the patient to be stuck less and is so much more safer then administering chemo or other meds through a Iv. I am assuming this one bad experience has scared him. Hopefully you can talk him into giving it another try!

Right now, he's trying a month off of the therapy I've been providing (which I think is good, really). He may be able to avoid the infusions altogether, though I'm guessing as his tx progresses, he may need it. He may adjust more to the port being accessed as he goes through more chemo. I'm not sure what the cancer center would think of it, especially with it being accessed 3x/week. He hates having the cath inserted beyond the tx, which I think is part of why he would rather stick with a PIV. He's able to DC the PIV himself, though I'm guessing with education he could probably do the same with the port. I can tell his veins are starting to "feel" the chemo. They're getting harder to stick.

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Is there any reason the port can't be left accessed, other than that he doesn't like it? If he's going in to the cancer center three times weekly, then he could just have the needle changed weekly and only have to be poked once per week.

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