IV insertion-met resistance?

Specialties Infusion

Published

I am a nursing student and attempted to start an IV on an older patient today. She said that she can sometimes be a hard stick. I took my time and picked a vein in her hand that was kind of bouncy (the "bounciest" I could find) but also small and thin. I inserted the needle, advanced the catheter, and got blood return. About halfway through advancing the catheter, I met resistance. I attached my saline but didn't get blood return. The nurse with me told me to retract the needle and helped me try to advance just the catheter a little deeper. Then I attached the saline and didn't get blood return, and then tried to advance again and flush and a small bubble appeared. We removed the catheter and my nurse tried another vein. So my question is what could I have done differently? Did I hit a valve? Or was I too superficial? My other question is should I advanced with the needle still in there or would that not have made a difference?

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Specializes in PACU, pre/postoperative, ortho.

Sounds like a valve to me. When I hit one like that, I can once in a great while advance it if I twirl the hub as I go but I've never been able to "float" it in like some people can. Sounds like the vein blew (the bubble) when you forced the flush in. Best advice I have is to try to recognize where potential valves are so you can avoid them, usually near bifurcations. If the vein is fairly visible, you can find a valve by occluding the vein higher up, "strip" the blood from the vein & watch as it refills; presence of a valve will keep the vein from refilling. There are some YouTube videos, I think, that can show you better what I mean.

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Specializes in Cardiac (adult), CC, Peds, MH/Substance.

Sounds like either a valve, or that you went through the vein. Both get a flash, then resistance when advancing. Next time try pulling out a little then letting saline flow , and see if you can advance then. A lot of the time when you pull back it'll bring it back into the vein or away from the valve, then the saline sometimes opens the valve if you were hitting one.

It's kinda hard to explain typing, much easier to show. Practice bunches with people who are good at IVs watching and offering advice. They all will disagree with each other about the best way to approach issues, but eventually you'll fill your bag with tricks that work for you.

I've been doing this for a while, and I'm still learning new IV tricks.

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Specializes in PICU, Sedation/Radiology, PACU.

If you advanced too far with the needle inserted, you likely went through the vein. In the future, advance the needle until you get a blood flash back, change the angle of your needle so you are at about a 15 degree angle from the skin, and advance just a tiny bit more to make sure your catheter is fully in the vein. Then retract the needle and advance the catheter the rest of the way.

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Random side comment - but when you are a student nurse, how do you practice putting in IVs in the classroom? Please don't tell me you have to practice on each other :arghh: Please tell me there's a rubber hand.....!!! :nailbiting:

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Union-Jack, during skills practice we have rubber hands/arms with fake blood running through them to practice on :) thanks everyone for your help!

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