Best Advice for Successful IV Sticks

augigi, CNS · Nov 18, 2006

1. Knowing the anatomy of the area I was sticking and where the veins are.

2. Confidence.

TazziRN, RN · Nov 18, 2006

Practice, practice, practice. And don't be too hard on yourself if you miss.

Does your hospital have an IV team? If yes, see if you can follow them around sometimes. If not, when you have to start one ask the best sticker working with you to accompany you, then later critique you (in private, of course!).

Nursonegreat · Nov 18, 2006

I remember when i was first in nursing i couldnt stick someone unless it was an 18g with veins the size of tunnels. we had this really great IV starter on my floor. i went to her if i couldnt see the vein from the door. one day, she was really busy and i needed access. she said just TRY it. i did but didnt get it. she said u will never learn unless u try the hard ones...even once. so i tried again the next time and got it....a 22 in the forearm. after that i could get an iv in almost anyone. i became known as the IV queen. knowing where a vein "should" be when u dont see it helps too.

if a patient ever asks or requests that u dont "practice" on them, i always assure them there is no "practicing" (altho we are hehehe)....we ATTEMPT. my advise is when u need an IV try once then get someone else. but build up some "attempts"

PANurseRN1 · Nov 18, 2006

Take. Your. Time.

Have all of your equipment (tape, 2x2, prep pads, etc.) ready ahead of time. Once you put the tourniquet on, take the time to really look at the veins. Don't stick the first thing you see...stop and look around. Ask the pt. if he/she has had an IV before; if so, where was the best place for the IV start. Pick the right size cannula for the vein (i.e. don't try to put an 18 in a small vein).

Make sure you are in a comfortable position. Pull up a chair, elevate the bed...it's hard to be successful at sticking if you are in an awkward position.

Once you stick, if you don't get a return don't automatically assume you've missed. Try repositioning (without actually "digging"); sometimes that's all it takes.

And I know there will be conflict on this, but if your hospital allows for buffered lido, offer it to pts., esp. the ones who are really apprehensive. I was very "anti" using this, but since we've started using it I have noticed a difference in success with difficult sticks. I've had so many pts. tell me they didn't feel a thing, and from experience I can say it's a pretty painless IV start.

P_RN, ADN, RN · Nov 18, 2006

You may cringe, but look at veins on folks in the elevator, in the grocery line, at a football game. Feel your own for that familiar bounce. Think about which way they twist and turn. Take your index finger and obstruct the flow slightly and then feel the difference.

Ok then go with someone who is good at it. Ask to watch quietly.

Then ask that they go with you and watch quietly. Have your equipment, needle, tape, flush, cap etc. Look at the vein and remember how yours felt. See if theirs feel like that. That bouncy, soft rubbery feel. Put on the tourniquet if it is a younger person. Only tie it tight enough to stop venous blood. If you have tostretch it so much it turns into a rubber rope it's too tight.

If it's an oldie you may not need the tourniquet, obstructing with a finger may be sufficient.

Now in your dominant hand look at the length of the jelco/angiocath etc. Imagine how it will feel next to the vein. Then on a less than 45 deg angle touch the tip and commit to the stick. If it's a good stick you will get a visual confirmation.

Follow whatever directions the mfg. says. Never withdraw and restick. Use a new cath each time, and never pull the sharp out and resheath it, you might cut the cath.

SO, research, feel, look, get advice, try, get feedback and you will soon become the one others ask for help with IVs.

mocaj · Nov 18, 2006

Hi everyone -
I know this question has been posted before and I've looked at some of the websites mentioned on advice for IV's but I'm still having trouble with getting successful sticks.
SOOOO..
I thought I'd ask everyone what was the one thing you would say you believed HELP you become successful with IV sticks???
thanks in advance for any tips... :wink2:

I have been a nurse for 5 months and I still have problems myself and have had very few successful sticks. I try, but i always end up getting one of the more experienced nurses to conplete the procedure. I volunteer to do other nurses iv sticks and it seems that I have learned, once i see blood in my needle chamber, I should hold the skin taunt at the entrance point and advance the catheter into the vein. I have attempted 3 iv sticks, since learning this new tid bit of information, and 2 were successful.

You should always try first, and if you have a chance to volunteer to do someone elses stick, it would be good practice. Practice makes perfect! Don't give up.

fusster · Nov 18, 2006

1) Stabilize the vein by putting a finger from your non-dominant hand on the vein just above where you are going to stick. This helps to keep the vein from rolling.

2) Look for veins that you can see/feel where they go so you know that when you advance the needle it won't just pop through the end of the vein. It's scary the first time you pop through the vein because a HUGE bubble of blood starts forming under the skin. They never told me this in nursing school, so it freaked me out the first time it happened. If it does happen, undo the tourniquet, apply pressure, and bandage it. Let the patient know they will have a big bruise at the site.

3) If someone has veins that are difficult to find, wrap them up in a warm blanket and put the site down as far as possible.

4) Warn the patient before you stick them so they don't jerk and make you have to start over, plus it's curtious.

That's all I can think of for now.

tgb3rn · Nov 18, 2006

SET THE HEAD OF THE BED UP!!!! I know this is as basic as it gets but it drives me nuts to see a nurse start an IV with the bed flat. The lower the hand/arm is from the heart the bigger the vien swells up.

Tom

SouthernLPN2RN, MSN, RN, APRN, NP · Nov 18, 2006

Sometimes I rub a "barely there" vein with my thumb from distal to proximal a few times to make it show more clearly. I wouldn't do it with fragile skin and always do it before you clean the site. I also pray. Every time. As soon as I get blood return, I stop, decrease the angle of the needle and advance the catheter. I have seen some nurses use the flush to "float" the catheter farther in, but I don't do that. I've never tried. Above all, practice!! And always have the mindset that you can do it.

nursingisworkRN · Nov 18, 2006

As said previously, PRACTICE PRACTICE PRACTICE. I do best on the veins I can feel, and when I anchor it with my thumb of my left hand it helps with the rolling. There is no way to be good without poking around. You will have good days and bad days. Don't volunteer that you are new. Simply state "I am going to be starting your iv." And then do it. Maybe you can observe the techniques of others on your floor. I know who started an iv on my unit based on how it is taped (totally useless fact but amusing to me). And know that you will only get better and that some people are impossible to start peripherals on. Nothing you can do about that (except call the md and get a central line). Keep trying..I missed 15 in a row and was starting to dread it. Now I haven't missed one in awhile. You will get better at it.:)

Indy, LPN, LVN · Nov 18, 2006

What they said. Just keep poking. My "IV mentor" and actually, she's taught me a lot more than just IV's, has her method which, if there's a vein, will help you find it.

She gets the IV tray, makes sure it's stocked. Gets a couple of towels and several washrags and plops that on the tray, sets all this in a good rolling chair from the nurse station. Rolls that in the room. Then she runs hot water in the sink and makes the washrags into a hot compress. One towel goes under the arm with the tourniquet already on it, the other goes on top of the hot compress which is over most of the arm below the tourniquet.

Then she'll adjust the head of the bed, get her supplies out, situate the chair and bedside table, etc. and chat with the patient. She takes the towel and washrags off the arm and usually there's something there begging to be stuck.

I don't use a chair, I bring the bed up to my level (which isn't that far from ground anyhow). But I have duplicated most of her other steps including the compress. It works to bring me veins. Her methods of taping the dressing on and such are really creative and I can't explain them, but I can do them. Now if I could just get a vein not to blow when I stick it, we'd be in good hands with allstate.