IV tips

fgoff · Aug 25, 2006

Try this Site

http://www.aic.cuhk.edu.hk/web8/Very%20BASIC%20venous%20cannulation.htm

or look the web site of the brand of angio caths you use.

B&D has a short by well done video on line that I use in my IV class.

AngelsRN · Aug 25, 2006

I am actually looking for something related to finding veins in someone when they dont just stand out for you. The mechanics of starting the IV I am fine with, it is finding the veins that I am having difficulty with bec most of my patients have terrible squiggly veins.

fgoff · Aug 25, 2006

Oh! Try Here: http://venepuncture.20megsfree.com/custom.html

The one I like the best is to let gravity do the work, it also helps relax the arm!

There might be some older post on here that would help. Try a search???

I have one on ER sticks but I can't locate it. I'll keep looking for ... & send it later.???

Good Luck

vamedic4, EMT-P · Aug 25, 2006

I posted a somewhat lengthy post on IVs in the peds forum..do a search and see if it helps you.

vamedic4

about to pick up child #1

Daytonite, BSN, RN · Aug 26, 2006

check out this thread in the er forum of allnurses. it has lots on information and advice on starting ivs.

https://allnurses.com/forums/f18/iv-tips-tricks-3793.html - iv tips and tricks

KLeigh · Oct 9, 2006

Hi there! I thought I'd offer a few tips that I have found useful in finding veins/starting IVs. Sorry if I end up repeating what has already been said (I haven't had a chance to check out all of the suggested resources yet).

-Is that the ACF or a stretch mark or a scar or a tendon? It FEELS like a vein...I think.... One trick a charge nurse of mine showed me, if you're unsure about whether one of those "mystery bumps under the skin" is actually a vein is to keep one finger on the "vein" while the tourniquet is tightly in place, then use your other hand to release the tourniquet, while leaving your finger on the "vein". Does the "vein" immediately disappear upon release of the tourniquet? If so, you're golden! The blood rushed out of it when the tourniquet was removed, and you felt the pressure being relieved. However, if the "vein" still feels exactly the same as it did before, then it's probably just a darn stretch mark, scar, tendon, mystery bump that you won't be able to get blood from so keep searching....When I first started with IVs, that helped me out a lot. Hope that made sense!

-If possible, warm up that arm! One floor I worked on kept heating pads around strictly for starting IVs, but on other floors I would improvise and use a warm washcloth inside a plastic baggie or something (be careful, obviously, so you don't burn anyone). I know this isn't always practical or within your time constraints, but often it is worth it to warm up the patient's arm rather than having to stick the patients several times. I mean, the body's cooling mechanism involves dilating the veins and pushing them closer to the skin's surface, which is just what we need for an easier IV insertion. And, by all means, multi-task....While your patient is "warming up", that's when you'll be out there preparing all of your IV stuff: have everything set up (alcohol swaps or chloroprep opened and accessible, tape strips peeled, flushes prepared, etc.) and at your side when you go in to stick the patient, and always bring a couple of catheters along, as well (hehe I feel like it "jinxes" me if I don't bring at least 2)

-Use a B/P cuff as a tourniquet If you aren't finding any veins with a normal tourniquet, try using a manual BP cuff (actually, an automated one would work, too, but it's much more annoying). You can almost always find a vein this way. Of course, do not leave the cuff inflated for long periods of time without giving the patient a break (hehe I just have to throw in my little disclaimers...I know you nurses realize this stuff, but just making sure you know I'm not being cruel or reckless!).

-Where to check You can check places like the hand, which is usually better for smaller guage needles (but hand veins can tend to roll, and personally I think they are not as good as the fore arm or AC), or the wrist (if you turn the hand on its side and follow the thumb upwards to the wrist, you'll notice a vein right there. This is almost always a nice big one, but unfortunately can sometimes tend to be rollers. The top of the wrist is nice, too, on some people, but not often on people with tough veins). The upper inside of the forearm is a sensitive area, and hurts more for the patient, but is usually a place where you can find straight veins (although these are often smaller ones). The AC (the antecubital fossa, right inside the crease of the elbow) is almost always a quick, sure-shot place for most patients, can handle a large ga., and hardly ever rolls, but you'd have to be sure to secure the site very well, and sometimes use an armboard (hehe actually, there's a new post up that talks about not liking IVs in the AC, so start IVs here at your own risk...) Basically, the problem is that, if the patient bends the arm too much, the site can become bad, so it is a perfectly valid point, but sometimes you have to do what you have to do. There are usually veins you can find on either side of the crease of the elbow, as well as above the elbow, on the upper arm, and those veins, although not as commonly used, can actually hold higher guaged catheters quite well, I've found.

-Always feel--never go by "look" alone You just have to feel the bounce of a good vein, and use your finger to feel where it travels. I am not sure if some people use sight as a technique of finding veins, but in my opinion, it would limit one's ability to start IVs in darker skinned patients, or patients with deeper veins. It is sometimes helpful to make a pen mark at the starting point of the vein, then follow the vein with your finger, and mark another spot, roughly an inch or so along its path, to guide you when you're ready for insertion (of course, the bottom mark will disappear when you clean the site, before insertion, but it can still help out when you're a beginner).

-Practice, practice, practice...and just remember, THREADING A PIECE OF STEEL INTO ANOTHER HUMAN'S VEIN IS A LEARNED SKILL...IT'S TOTALLY NORMAL NOT TO BE GOOD AT IT INITIALLY :wink2: I used to absolutely hate starting IVs...I was so afraid of them, and then I thought I would just never, ever get the hang of them, and that something was wrong with me as a nurse. But eventually--and I don't know exactly when--I realized that I had stopped having mini anxiety attacks when I read that the MD orders required me to start an IV. You just have to do them over and over and over again, and you'll eventually become faster and better at them. I have also learned that certain nurses have certain IV "niches". For instance, I can't catch a rolling vein to save my life, but my coworker Marie sure can--no rolling vein can escape her IV catheter. However, Marie can't, for the life of her, start an IV in a very large patient, while I seem to have a knack for finding deep veins in large patients (hold the catheter just like a pencil!! no joke--try it, and you'll never go back to skinny patients!).

Well, hopefully there was something in that long message that you'll find helpful!! Good luck to you! :)

Daytonite, BSN, RN · Oct 9, 2006

-If possible, warm up that arm! One floor I worked on kept heating pads around strictly for starting IVs, but on other floors I would improvise and use a warm washcloth inside a plastic baggie or something (be careful, obviously, so you don't burn anyone). I know this isn't always practical or within your time constraints, but often it is worth it to warm up the patient's arm rather than having to stick the patients several times. I mean, the body's cooling mechanism involves dilating the veins and pushing them closer to the skin's surface, which is just what we need for an easier IV insertion.

Your post helped me remember something I got into a little trouble for as an IV therapist. I used to routinely grab clean towels from the linen carts, wet them down and then throw them in the closest microwave to warm them up before wrapping them in a chux and using them on a patient to help dilate veins. Then, I got asked to stop doing that. Apparently, the microwave was causing pinpoint little burn holes in the white towels deep within the folds which I never really saw (dog gone those microwaves!) which, of course, were permanent burns. Guess you have to time the microwave warming very precisely.

I, too, am very good at putting IV's in the very obese. It's because I have great feeling in the tips of my fingers and I can track those veins by feel. However, my trick was to go to the anesthesiologists every once in awhile and get my own private stash of 2-inch IV cannulas. Some of these veins are deep and you need the extra inch to make sure the cannula is nicely seated in their veins and there is no stress on the cannula to bend at the surface of the skin. I also used the 2-inchers on the people with anasarca and edematous arms. Used an ACE wrap on the arm for 15 minutes to get the edema out in order to find a vein and then used the 2-inch cannulas with about ¼ inch or more of the cannula left out on the skin to allow for the edema which was inevitably going to come back. Otherwise, the returning edema would cause the hub of the cannula to dig into the person's skin or, if the cannula wasn't taped down securely, literally pull the IV out of the vein as the arm resumed it's swelling.

I also just wanted to make mention that many times what makes or breaks a stick is a person's finger dexterity and knowing and making each of your fingers perform the way you want it to at the time you need it to. I guess I was a little lucky in that regard since I had been playing the piano since age 5 and doing a lot of sewing, knitting and crocheting as a teenager. I think that those, or similar, kinds of activities help you have better control over the actions of your digits.

leerner · Oct 9, 2006

if you're looking for an AC vein, have the pt make a fist and then bend their elbow slightly then feel for a vein. Some people just have lousy veins (genetics, current or past meds/treatments, frequent I.V. meds-frequent flyers, has been my experience). With these people, you can keep their elbow bent and stick them and get flashback but can't advance, but have them straighten their elbow and you then may be able to advance. Older pt's- don't tighten the tourniquet as much. Larger people- try using two tourniquets together. Hope that helps. Oh, I work in an E.R. and any I.V. that you can get in and works is all you need in most cases unless you have a pt in critical condition, in those cases use your E.J.'s or have doc place central line, whatever is needed.

Jokerhill · Oct 9, 2006

Just a quick note, the position of the hand palm up or down can make a differance. Try it on your self rotate your hand whill palpating with the other, your find the whole area changes in feel. Jokerhill