"Floating" an IV and other IV tips needed

Altra, BSN, RN · Mar 14, 2007

I'm on my 3rd semester and have yet to start a successful IV. Granted, I've only had 2 attempts and my pts were an elderly person and a dehydrated person....But still I feel rather disappointed in myself. I was looking for tips on starting a successful IV.....
I had never heard of this until I went for a CT scan and it was tried on me. I am wondering if this is standard practice at some places. It is not something they are teaching us in nursing school, so it makes me question whether it is something I should be doing. Anyway, this nurse told me I was a hard stick....I told her I was a student so she proceeded to show me this "floating" technique on myself. I was taught to get blood return before you flush. In this instance she put the catheter in and proceeded to try to float the IV into my arm. Well, it didn't work and infiltrated under my skin and it bruised into the size of a fist, something awful! She tried on my other arm and successfully "floated" the IV into that vein instead.
I am also confused by the contradiction in doing a stick, then pulling back on the needle and trying to go deeper or shallower.....etc to get return. We've been taught not to go "vein searching" but yet everybody I've seen does it, and I was being guided to do it by a preceptor when I was attempting to start an IV! I don't know what is wrong and what is right, but now I'm starting to have anxiety about it. Can anyone please offer their thoughts on this please??? Thank you!!!!

1. Don't worry that your first 2 attempts were unsuccessful ... after you've successfully done it 100 times it will be irrelevant. Take your time - position yourself comfortably, take your time looking & feeling to choose your best target. Have all your supplies handy, along w/extras if it makes you more comfortable.

2. Floating can sometimes help thread a catheter that otherwise doesn't want to thread. Push the saline slowly while advancing the catheter slowly.

3. Sometimes veins will blow despite your best efforts. Good technique greatly increases the chances for success but does not mean that you'll never be unsuccessful. We all have days where it is literally like trying to get blood from a stone.

4. No one advocates gouging the patient in hopes of hitting something, but a little repositioning is probably less traumatic for the patient than starting all over again.

HTH. Good luck to you. :)

CRNI-ICU20 · Mar 14, 2007

There are some really great websites out there for people just as yourself...one of the things I did early in my practice, when I was still wet behind the ears, was to take the time to observe someone who was considered an 'expert' in IV THerapy....someone who had done alot of IV starts...ie, and anesthesiologist....ER Trauma nurse...ICU nurse....and I learned alot from these people....I would go in on my days off....and watch someone start IV's all day long...so I could learn from observation...

Then when it came time for me to 'try', I would implement what I had observed...and most of the time I was successful...

What made me 'get it' was that I had to educate myself on alot of things....

Most IV therapists will tell you that floating an IV catheter into the vein isn't really good practice.....the Infusion Nurse Society doesn't recommend this approach...there is too much of a risk of catheter migration...or a false belief that you have captured the vein, and then you end up with a fist sized infiltration...just like you experienced....lucky for you it wasn't a caustic agent...like Dopamine...or some other agent that could cause loss of a limb...(no kidding)

Here a website that you may not only find very practical....but kinda fun as well...

Many people will try to go by sight...not by feel....they will pick the gnarliest vein in the arm...and ignore the obvious straight one...

because the gnarly one sticks up more...so go by FEEEEL!....check out the website....and good luck...you will get the hang of it...

here is their website:http://enw.org/IVStarts.htm

Daytonite, BSN, RN · Mar 14, 2007

i was an iv therapist for a number of years as well as a crni (certified rn, intravenous through the intravenous nursing society). floating an iv into place is a stupid thing to do. as you found out, the likelihood of infiltration is very high. also, by doing that, the nurse is literally forcing the iv cannula into the vein, usually pushing it through a valve that doesn't want to "give" in the first place, is crooked, or pushing the cannula into a vein that is too small to accommodate the iv cannula. iv cannulas that get pushed into veins like this eventually end up causing a phlebitis. it's a bad practice and i don't recommend that it be done. the potential of injuring the patient is too high. if there is difficulty threading an iv cannula into a vein there is a problem and the cannula should be removed and the iv put in a different place. the patient may not be happy, but i'd rather have an unhappy patient than an injured patient.

here is a thread on the er nursing forum that has lots of good practical iv information on it.

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

NurseguyFL · Mar 18, 2007

floating an iv into place is a stupid thing to do. as you found out, the likelihood of infiltration is very high. also, by doing that, the nurse is literally forcing the iv cannula into the vein, usually pushing it through a valve that doesn't want to "give" in the first place, is crooked, or pushing the cannula into a vein that is too small to accommodate the iv cannula. iv cannulas that get pushed into veins like this eventually end up causing a phlebitis. it's a bad practice and i don't recommend that it be done.

i agree. i'm not an advocate of 'floating' or 'fishing' either.