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!