Blind Stick

[Nursebarebari]

My dear fellow nurses, recently I have become confident and very good at IV insertion and I'm even helping co-workers with their pt. But I don't understand how to do the blind stick method, I thought you just have to visualize the anatomy of the veins and stick, but a wo-worker said I was wrong. She could not explain to me how to do it. So could any of you experience nurses educate me on how to do it. Your input will be really appreciated.

Thanks so much in advance for your answers and for all your help. :bow:

[jessiern, BSN, RN]

Never did much "blind-sticking". If I can't see, I don't stick. I think blindstick IV = Nurse that got lucky. But, I may be wrong about that.

They only exception was a dehydrated dialysis patient I had, notrious for being a bad stick. She had some knotty veins on her forearm, then nothing, and the some knotty veins. I just kinda figured in between all the bad veins may lie some good ones. And I got luckyU.

[Daytonite, BSN, RN]

well, having been an iv therapist, i have to say that my definition of a "blind stick" is someone who just goes poking around hoping they hit a vein!

what your co-worker was talking about was finding a vein by palpation rather than visual sight. to do this you have to (1) know the places where veins are likely to be, and (2) train the tips of your fingers to recognize what an engorged vein feels like apart from the plain old other tissue in the arm. when we were training people in iv insertion we told them to always feel the veins when they are engorged (after you have applied the tourniquet to the arm) to learn this feeling, even the veins that they could see. do it all the time. then, when you get a patient where no veins can be seen after you apply the tourniquet, and it will happen (the obese, edema, burly muscular guys), you use your finger to feel for a vein in a likely place. when you press on an engorged vein under pressure and lift up, you can feel a bounciness to it that tells you "this is a vein". the vein will also have a firmness to it so that you will be able to literally trace the line of the vein, which you want to be able to do, since you need to know what direction to aim the point of your iv needle in, don't you? the other element here is depth to push the iv needle to because you don't want to go in and straight through the backside of the vein wall. go slow because my experience has been that just because you can't see the vein doesn't necessarily mean that it is buried deeply. a lot of times it isn't.

my suggestion. . .take a tourniquet home with you. put it on everyone's arm and inspect their arms (both of them). start noticing the anatomy of the veins and where the major and minor veins are located. there is a lot of variation from person to person. start palpating the veins once the tourniquet is on. press down and release your finger pressure slowly. pay attention to what your finger is sensing. close your eyes and concentrate on what you are feeling and sensing. this is more highly advanced and skilled than what you have been doing to locate veins up to now.

as far as inserting the needles, keep this in mind. . .you are, in essence, inserting a rigid piece of steel into a flexible tube, or pipe. get the tube (vein) as stabilized as you can. usually, downward traction or pulling on the tissues of the forearm below the targeted vein will do that. in your mind's eye (you know where that is, right? ha! ha!) make sure you line up the iv needle and the vein so if you put a straight edge of some sort up against them they would be in a perfectly straight line--otherwise, you'll blow the stick. insert the steel and slide it into the tube. the main reason i saw people blow these veins was because they inserted the needle tip so tat it ended up veering a little to the left or right once it was being slid up into the vein and, bam, it blew. you gotta get that rigid steel iv device 100% perfectly seated into the direction that pipe (vein) is going and there isn't much room for error. this is probably where people like to say that it is a blind procedure because you can't really see what's going on under the skin. but if you know what you are doing, your chance of success is a lot better than someone who just grabs an iv needle and decides to "try here". now, you know the secret.

practice makes perfect. as an iv team nurse, guess why we got called? not to insert ivs into the veins that everyone could see! it was when they ran out of veins that they could see that we got called. ha! ha!

good luck! practice, practice, practice.

[seanpdent, ADN, BSN, MSN, APRN, NP]

IMHO.. a 'blind' stick is simply not being able to actually see the vein, but 'feel' the vein.

I can happen a lot with edematous pt's and dark-skinned pt's. (although it does happen with dehydrated pt's as well)

You feel the vein... feel for the sponginess 'feeling' of your vein and visualize the track of the vein.

I guess it simply comes with practice. I couldn't do it at first... I had to actually 'see' the darn vein. Now I go by 'feel' everytime, seeing it is simply a bonus!

Best of luck.

[TazziRN, RN]

A blind stick is done when you cannot see or feel it....you are "blind". My blind sticks usually happened when I could feel the vein distal and proximal, but neither of those sites were desirable for some reason, so I tried to visualize the track in between.

I happened to be very good at IVs and blood draws and rarely missed, and while blind sticks were not my first choice, I rarely missed. At my last job they called me the IV Queen. It wasn't just luck, I have known other nurses who were good at IVs who were also able to do blind sticks. Not everyone can do it

[Altra, BSN, RN]

Agree w/Tazzi.

When we refer to a blind stick we are talking about the patient on whom veins can neither be visualized nor palpated.

After all, if I can palpate a vein, I know exactly where I'm going -- I'm not sticking "blind." If I can palpate a vein I have no need to actually see it.

This is where anatomy knowledge comes in.

[Medic2RN, BSN, RN, EMT-P]

I follow the rule: if I can't see it or I can't feel it, I don't stick it.

[mcknis]

Do you all choose to use a side approach method to IV sticks or an above the vein method? Is there a benefit to one or the other?

[TazziRN, RN]

Depends on how deep it is. If it's one of those that pop up without a tournie then I go from the side usually.

[Wendy_RN]

It would be great if everyone had beautiful bulging veins and we never had to rely on visualization. The reality of it is that not everyone is that fortunate and sometimes we have to do the best we can to access a vein. I would much rather be able to see the vein, but I don't feel stupid or incompetent when I have to visualize and insert an IV into an 82 year old lady who has had numerous chemo treatments and horrible veins as a result.

[aeauooo]

to do this you have to... train the tips of your fingers to recognize what an engorged vein feels like apart from the plain old other tissue in the arm.

a friend of mine taught me a technique he learned from working on the brake lines of his old vw van - it's probably the best "trick" i've ever learned in nursing, and i had a high rate of success after learning it.

veins (line the brake lines on a car) are filled with fluid, and we all know that fluid does not compress. so, when you tap on a column of fluid, the vibration will be carried the lenght of the column (the same thing allows us to use transducers to monitor pressures and waveforms inside of our patients in the icu)

when you think you've found a vein, lightly place one finger at one end of it, and with another finger, tap the other end of the structure. if it is a vein you will feel the compression wave your tapping caused with the other finger. if you don't feel it, don't stick it.

make sense?

[Otessa, BSN, RN]

I either need to SEE or FEEL it. I did 'blind stick' a couple times but that was mostly because of severe edema and a bit of luck and the necessity for an IV so I 'went for it'.

Otessa