IV insertion issues - page 2

Hi all, I've been working in NICU for about 8 months now and I'm having issues with starting IVs. It usually goes like this: Insert, see flashback right away, remove needle, no more flashback, try to adjust catheter to get... Read More

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    Quote from iluvivt
    What brand of catheter are you using? We switched to introcans so now I can take the flashplug entirely off and can get the flashback faster. Many products (cannulas) have a special feature as part of their structure that speeds up the flashback. What angle are you generally attempting your start? Are you dropping your angle to parallel to the skin and advancing your catheter a bit more after you do get a good flashback? If you can describe each step in detail I can tell you what step you need to improve, If I could watch you I could tell you right away so be as detailed as possible. The 2 most common mistakes are going in at an angle that is too high and the 2nd is failing to lower the angle after the flashback is seen and then advancing it a bit more before sliding the cannula off the needle and into the vein.
    The brand is BD. I start pretty much parallel to the skin and angle down a little. I almost always get a flash right away, then I withdraw the needle a little bit while advancing the catheter and then I don't get any more blood. I usually pull the needle out and try to adjust the catheter to see if I can get more flashback, but it doesn't work.

    You're saying I should lower the angle AFTER the flashback is seen?

    Thanks for all the responses everyone!

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  2. 1
    I don't work neonatal (yet) so it may be different on teeny veins. But it sounds like you might try dropping the angle (ever so slightly) after the flash, advance the whole thing about another 1cm or so and then thread the cath. Then withdraw the needle.
    champagnesupeRNova likes this.
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    I would try advancing just a bit further after you get the flash in case the needle is in the vein but the catheter is not yet. I am talking maybe 2-3mm more of an advance. And then advance the catheter off the needle and try flushing.
    rnkaytee, TeenyTinyBabyRN, and prmenrs like this.
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    Wow it's been almost a year since I started this thread and I'm happy to say that I've been kicking some rear-end on IVs for the past 6 months now. I was going too deep before.

    Tips for people who are having the same problems that I was: I pretty much stay very superficial and straight with the catheter and it works. I also was paying too much attention to the catheter going in and not watching the vein at the same time. You have to watch both the catheter and the vein. Holding the skin above taut also helps. Make your environment comfortable (as in, remove the rolls around the baby so that you have a better grip on their extremity, etc.). I also don't turn out all the lights like some other nurses do - I want to see the blood return right away.
    Now, taping by myself is another story
    prmenrs and Bortaz, RN like this.
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    Yes! that is the one of the most common mistakes I see is that the angle of approach is too steep. In you patient population you need to be going in flush and then if needed adjust your angle. It sounds like you are getting better at keeping track at bothe the flashback chamber and an eye on the target vein as well. As you get better you will have a sense of when you are just about at the outside wall of he vein and about to enter. The feeling is one of slight tension and resistance and this part is generally uncomfortable for the patient. One ED nurse that would panic at the point the patient complained of increased pain and would just take the catheter out told me this was the best advice I gave him for his problem: Do not pull out the cannula unless the patient demands it and do not tell the patient that that is an option prior to the stick but be aware as you are at that point in the procedure and feel a change in the tension as you are just about to pop int the vein..stay in control and proceed with advancing the catheter as you are just about to get a flashback. That taught me that I can help others learn if I can find out what exactly the problem they are having so I can exaplin why that happens and steps to have increase success.

    Congrats on hanging in there as it truly is an art and takes a lot of practice,patience and skill. A few months I got called to ED to start a PIV and get some blood on a 6 mo old. I took a very experienced IV nurse with me. This baby boy had many birth defects and no one could get any access. We both looked and could not find a thing. My partner decided to try US and actually hit a vein but it blew with the flush as we had not selected a long enough catheter and we had no 22 Gauge longer than one inch. Our long 20 gauge may have been too large. I finally got it after my second attempt but we were down there and at least an hour and half and the place was loud and a zoo that day. So even IV nurses with a combined 65 years of experience have challenges.
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    Think about it this way: Look at the end of your angiocath. The tip/bevel of the needle juts out past the end of the actual plastic cannula. When you see a flash, just the metal part is in the vein, not the actual part that needs to be in for it to slide the rest of the way in. When you see that flash, stop, advance the entire unit a hair more, and then start to slide the plastic cannula in. Blowing the vein usually happens when you only have the needle part in, and try to shove in a plastic cannula that isn't in the vein.
    Jenbean87 and champagnesupeRNova like this.

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