Need some advice on how to start an IV on pt with severe edema

[heparinized]

Hi everyone.

I have been an avid reader of AN, and this time I have decided to create an account and join the community.

So listen, last week.. I have this hard stick pt who had a severe edema on her upper extremities. She has severe renal failure, and her mediport was clotted so as a student nurse, I have to start a peripheral line.

My challenge was, I could never find a vein on this big, chunky woman... I have tried all my best, but it wasn't my day.

I would love to hear some tips on how can I successfully start an IV on this type of pt.

Thank you very much!

-Heparinized,SPN

[Music in My Heart]

If you've got access to a vascular ultrasound, bust it out. It's sure helpful to find those veins that are simply too deep or too flooded to see or feel. they also have a scale on 'em so you have an idea of how deep the vein actually is and how big it actually is.

[Music in My Heart]

Exactly why I have a file on my laptop with pics of shirtless men-i.e David Beckham, etc., though this pic of Angelina Jolie is educational as well.

http://thesuperficial.com/2007/01/12/angelina-jolie-veins.jpg

Holy cow... now this gal's got some veins. I could pop a 14 into her blindfolded and wearing thick leather gloves.

[nerdtonurse?, BSN, RN]

When I've got a person with +4 edema, I get a manual BP cuff, put it midforearm, and pump it up, then let it sit there for about a minute while I get cannula and J loop ready. The BP cuff is pushing all of the fluid out of the area. The second you deflate the cuff, swoop in and feel for the vein -- they'll plump back up first.

The only bad thing about whatever trick you use with the fluffy ones is that it's very easy for the IV to infiltrate -- There are folks where there's just so much swelling I know I've probably only got the tip of the cannula in the vein. If they're getting anything serious, like levophed or IV pushes of anything that can cause necrosis if it infiltrates, try to get a doc to write for a central line. If not, watch that site like a hawk.

[beckster_01, BSN, RN]

First of all, to the OP: Don't get discouraged. For most people it will take a good year before you become semi-decent at those tough sticks, unless you are super talented or put them in constantly (Pre-An, ED, Endoscopy). As far as patients with edema, the only thing I can add to previous posts is that hot packs work wonders :)

[heparinized]

Thank you all very much for these vast information yall shared. I will definitely put this all in my pocket so whenever I have a hard stick, I know what to do now.

[amber_energy_RN]

The lower the albumin level, the tougher the stick. My supervisor gave me a good tip: Use two tourniquets, one in the usual place, the other about three inches above that. Works well with hands to really concentrate blood in a small area. You might also have a colleague pull back the skin and hold it taught. When all else fails, I look along the ring finger, along the feet, between the armpit and