Blind Stick

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.

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

with patients who have a lot of edema in their arms making it hard to find veins, try this. . .wrap the arm with an ace wrap from the wrist to the elbow (the direction going toward the heart) and elevate it on a pillow. you can also apply a warm towel over the ace as well. let the arm rest that way for at least 15 minutes, remove the ace and apply a tourniquet to see if you get better vein visualization. if not, put the ace wrap back on and do a little more waiting. when you are able to visualize a vein and insert an iv, leave some of the proximal cannula near the hub out of the insertion site and anchor the hub very securely. when the edema comes back, and it will, the patient's skin needs some room to expand with edema. if you don't allow for that, the edematous tissues are only going to engorge with fluid again and end up pushing the hub of the iv device out or cause the skin around the hub of the iv cannula to become irritated and/or break down.