AC IV starts

[LetItBe_12]

I need some advice or tips on AC IV starting. As a floor nurse I rarely even try to use the AC vein do to patient comfort or depending on the patient some never keep there arm straight. But there are some times when you really need to have an AC IV and sometimes I have trouble with them.

I would say I am actually pretty good/decent at starting ivs and I am successful a good amount of the time. I usually start them in the forearm- just seems to always be my go to spot. I don't usually like the hand or wrist because I feel like they can be easy to loose depending on how much the patient is moving or how orientated they are.

I know the AC is the biggest vein and seems like it should be easy to get but the few times I do actually try there I seem to miss them way more than when I use the forearm for some reason. I don't know if I just need more practice with them to get comfortable. But I have trouble deciding where to start my stick because at times I feel like I feel different veins going in different directions in the AC. I also don't know if I'm going in at the wrong angle.

Any tips from more experienced nurses or ER staff that do more AC insertions?

Thanks

[kskarzin91]

Isn't an IV on the antecubital incomfortable?

They can be. Patients will complain about them on the floor a lot if its been in for a day or two. (Not speaking on a bad IV, I'm talking flush fine with good blood return IV's) they just tend to get pinched. It's a highly movable joint in an Alert pt.

I hear a lot of floor nurses complain and say they stick AC in the er because that's the only thing they can hit down there but experiencing both sides, ER, floor, and ICU for that matter I alway reply with in an emergency I'm going with best chance for access and AC is normally it. You know it's there where forearm vein location can vary greatly. Plus that Pt who has great veins now might not have before fluids. Most ER nurses are the best stick in house btw.

We don't have an IV team at my hospital or lab techs to do draws so floor nurses do all of them and get pretty good within a month or two on the floor. On a typically night I normally do 6+ lab draws and replaced 3-4 IVs. I rarely go for AC because we can't placed lines above it typically and if the AC blows I'm hesitant to use anything below it so its my last resort. I'll go for hand if I can over an AC. I can alway move up later. And a lot of our renal PT seem to only have hand veins left by the time we get them because the arm opposite the graft site has been used over and over for IV access during previous hospital stays. If they have a temp HD cath with a pigtail we can use for labs draws/meds I do a little happy dance inside.

[MaudKennedy]

They can be. Patients will complain about them on the floor a lot if its been in for a day or two. (Not speaking on a bad IV, I'm talking flush fine with good blood return IV's) they just tend to get pinched. It's a highly movable joint in an Alert pt.

I hear a lot of floor nurses complain and say they stick AC in the er because that's the only thing they can hit down there but experiencing both sides, ER, floor, and ICU for that matter I alway reply with in an emergency I'm going with best chance for access and AC is normally it. You know it's there where forearm vein location can vary greatly. Plus that Pt who has great veins now might not have before fluids. Most ER nurses are the best stick in house btw.

We don't have an IV team at my hospital or lab techs to do draws so floor nurses do all of them and get pretty good within a month or two on the floor. On a typically night I normally do 6+ lab draws and replaced 3-4 IVs. I rarely go for AC because we can't placed lines above it typically and if the AC blows I'm hesitant to use anything below it so its my last resort. I'll go for hand if I can over an AC. I can alway move up later. And a lot of our renal PT seem to only have hand veins left by the time we get them because the arm opposite the graft site has been used over and over for IV access during previous hospital stays. If they have a temp HD cath with a pigtail we can use for labs draws/meds I do a little happy dance inside.

Thanks for the information,that's really helpful :)