Any nurses really good at getting IV's please help

On hard sticks, I always, always, ALWAYS start with warm packs on both arms/hands. I also ask the patient to let his arms hang down for a few minutes to let gravity do its job. Of course, adequate lighting is essential (I've always wondered why people forget this step and try to start an IV with only the over-bed light on).

If I'm using a tourniquet, I place it about 5-6 inches above my chosen site, then encourage the patient to "pump" up his veins by clenching and unclenching his fist several times in rapid succession. Sometimes I'll lightly flick the vein with my thumb and middle finger, which is often all I need to visualize it, then position my needle directly over the vein and dive in. Once I've got good flashback, I withdraw the needle at the same time as I advance the catheter (this helps prevent going through the vein), attach the tubing with the flush solution, and gently attempt to flush the line.

This simple technique works for me approximately 90% of the time, even on patients who are notorious at my hospital for being hard sticks. I got one in yesterday on an anxious, frail little lady who weighs probably 70# wringing wet, with spindly little veins, and who had been stuck six or seven times by three other nurses. I missed on my first attempt, but got it in easily on the second, and she even complimented me to a friend on the telephone by saying "There's a girl here who just started another IV on me and she did a really nice job.....she hardly even hurt me".:)

I'm not perfect, of course........sometimes I miss, even with the garden-hose-type veins Stevie Wonder could cannulate! But the only patients I consistently have trouble with are the severely obese whose veins I can neither visualize nor palpate.......with these, locating a vein is a guessing game at best, and sometimes one just has to estimate where it MIGHT be and go for it!

Angelbear......I'm talking about massively obese people, 300-400# and up, not garden-variety overweight folks. I'm in the morbidly obese category myself, and this is what I have to do whenever someone starts an IV on me. I'm a notoriously hard start, and worse yet, I don't tolerate IVs for long......they usually infiltrate within 24 hours regardless of the type of fluid. Thank goodness I rarely have to have them---the only times I've needed IVs in recent years was for short periods during a short-stay surgery, and once when I went to the ER in an ambulance for what turned out to be a vasovagal response to a bout of diarrhea. (I passed out in the loo, and decided I'd best have it checked out.)

But yes, make sure they do the warm packs for you before they attempt a stick. My sister is average weight, and she has a TERRIBLE time with venipuncture.......she has veins that run and hide, and I've told her never to let anyone stick her without having first warm-packed her. So far, so good......since she's been insisting on this, she's had several blood tests and they've gotten her every single time.:)

"I'm having a thought here, Barbossa. . . ."

--- Johnny Depp as Capt. Jack Sparrow, Pirates of the Caribbean

Weight-lifters always seem to have veins that won't quit. You know, the garden hoses that angelbear mentions. Might it help if you use hand weights routinely? I don't mean 50-pounders, just enough to tone muscles and develop the veins that drain 'em.

Again, just a thought for the future. Any comments from others (possibly trainers, etc)? -- D