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Blowing IV's - what am I doing wrong?

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I've been and RN now for about 10 months and I've been working mother/baby now for about 8 months. We don't get many chances to start IV's as they are usually already done in L&D and the only reason we would need one is if one accidentally came out on a pt needing IV abx or meds. In the past few months I've had the oppurtunity to start about 5 IV's. Every time I blow the view! I am good at finding viens and can flashback no problem. But when I advance the needle and cath sligtly and then go to advance the cath the vein is blown. I suspect that I may have an angle that is too high. Anything else that I could be doing to cause viens to blow? Like should I pop the tourniquet when I see flashback or wait until I have the cath in the vein completely?

When I was in school I was great at starting IV's. I don't know what happened :down:

RochesterRN-BSN, BSN, RN

Specializes in Psych, ER, Resp/Med, LTC, Education. Has 6 years experience.

Wow as students we are not allowed t do IVs here in NY. I would also suspect that either you are too high up of an angle or going in too far with the needle still in or the other thing that can happen is if you are trying to use a real small cath--trying to be nice--and the small size can't handle the pressure. If you are tring to put in like 22G caths trying moving to a larger-- you should really use at least a 20G. this way too if you get a woman who needs blood you can use it--

Good luck

NursingAgainstdaOdds

Specializes in Med-Surg/Tele, ER. Has 2 years experience.

If you are blowing them when you are advancing the catheter, you might try popping the tourniquet first, then advancing. Because you don't do IVs very often, it may be taking you a little longer, and a lot of pressure is building-up in the vein prior to attempting to advance the catheter.

Also, is there a way you could go play in another department for a day just working on IV skills?

I second going somewhere to get more experience. Maybe you can spend a day in the same-day surgery center or something- that's what I did.

As for advancing the needle/cath if I am picturing it correctly, I think once you have flashback you do not want to advance the needle at all, only the cath. I am trying to see my hands doing it because I don't really think about it, but you may be going through the vein by advancing the needle too far.

hmm i think i was taught, that as soon as you get a flash, you undue the tourniquet.....

have you tried without a tourniquet?

nyforlove

Specializes in ICU, Cardiac Cath/EPS Labs.

Thanks; I'm going to release the tourniquet after getting the flashback and BEFORE trying to advance the catheter...AND I will advance ONLY the catheter and NOT the needle. Thanks allnurse.som :)

hmm i think i was taught, that as soon as you get a flash, you undue the tourniquet.....

have you tried without a tourniquet?

FlyingScot, RN

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc. Has 28 years experience.

Thanks; I'm going to release the tourniquet after getting the flashback and BEFORE trying to advance the catheter...AND I will advance ONLY the catheter and NOT the needle. Thanks allnurse.som :)

If you do that you won't get the catheter in. Take a look at the end of new catheter. You will see that the stylet protrudes beyond the end of the plastic catheter. You get the flash as soon as the stylet has entered the vein but the plastic catheter is usually still outside. If you try to advance just the plastic catheter it won't go through the vessel wall and you will see the vein actually move away. You must advance a little further once you have gotten a flash. Those of us who have been doing it for awhile are usually so quick about it that you can hardly tell it's happening but it is. Newer people are usually quite a bit slower so the part where you advance a little is more obvious. I believe you were on the right track when you mentioned your angle. You are likely using too much of an angle when inserting and going out the back of the vessel. Trying going in a little more parallel to the skin but not absolutely flat. Also, tourniquettes are not always necessary.

truern

Specializes in Telemetry & Obs.

If you do that you won't get the catheter in. Take a look at the end of new catheter. You will see that the stylet protrudes beyond the end of the plastic catheter. You get the flash as soon as the stylet has entered the vein but the plastic catheter is usually still outside. If you try to advance just the plastic catheter it won't go through the vessel wall and you will see the vein actually move away. You must advance a little further once you have gotten a flash. Those of us who have been doing it for awhile are usually so quick about it that you can hardly tell it's happening but it is. Newer people are usually quite a bit slower so the part where you advance a little is more obvious. I believe you were on the right track when you mentioned your angle. You are likely using too much of an angle when inserting and going out the back of the vessel. Trying going in a little more parallel to the skin but not absolutely flat. Also, tourniquettes are not always necessary.

I agree!

Also, sometimes I have MORE luck without a tourniquet.

flightnurse2b, LPN

Specializes in EMS, ER, GI, PCU/Telemetry.

I agree!

Also, sometimes I have MORE luck without a tourniquet.

i agree! i usually don't ever use a tourniquet for elderly patients with paper thin skin. it causes more damage than good, imho, and you always end up blowing the vein because their skin is so fragile and the vessels are so superficial. a BP cuff works well sometimes, too.

Use a 18 or a 20. I know it is daughnting to use a bigger needle but i think the smaller needles have some give to them when trying to get them in. may just be my imagination but i always do better with a bigger needle. Also as soon as you get a flash let the tourneqet go. that way the vein won't have all the pressure in it. Maybe spend a day in the outpt part so you can get furhter practice

Ask some of your more seasoned co-workers if there is something you need to know about the catheter you are using. All are not created equal. Chances are they know something you don't.

I have a question...during several different attempts at IV insertion, I have gotten good flashback, but when I go to advance the catheter, I meet resistance and it ends up unsuccessful. When I pull the catheter out after the failed attempt, the catheter is bent/kinked. WHY is this happening and how can I avoid it? It is so frustrating to know I am right there in the vein and then I'm obviously doing something to lose it. Someone earlier in this post mentioned to try advancing the need just a tad farther once you get flashback..do you think this is it? I have been trying to do that but maybe I'm not going far enough? I'm always worried about going through the other side of the vessel. Seriosly any advice is welcome, I need to get much better at IV starts, and quick!

truern

Specializes in Telemetry & Obs.

I have a question...during several different attempts at IV insertion, I have gotten good flashback, but when I go to advance the catheter, I meet resistance and it ends up unsuccessful. When I pull the catheter out after the failed attempt, the catheter is bent/kinked. WHY is this happening and how can I avoid it? It is so frustrating to know I am right there in the vein and then I'm obviously doing something to lose it. Someone earlier in this post mentioned to try advancing the need just a tad farther once you get flashback..do you think this is it? I have been trying to do that but maybe I'm not going far enough? I'm always worried about going through the other side of the vessel. Seriosly any advice is welcome, I need to get much better at IV starts, and quick!

You're not advancing the needle far enough....the catheter is getting bent when it meets resistance at the vein wall.

SmilingBluEyes

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 24 years experience.

THIS set of great tips and tricks, by an ED nurse (face it they are the best at this) ROCKS:

http://enw.org/IVStarts.htm

Emergency Nursing World: Improving Your Odds!

I tell you, talk about amazing success tips. I learned a lot even being a nurse with 11 years' experience!

good luck.

SmilingBluEyes

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 24 years experience.

PS: when you "hit the vein" always advance the needle JUST A TOUCH MORE and THEN advance the catheter slowly. This will help you immensely. Also "floating them in" is a trick that works, whereby you advance and push just a tiny bit of fluid from the saline lock or IV at the same time as you advance. It really works!

SmilingBluEyes

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 24 years experience.

I agree with those who say a tourniquet is not always helpful. More so, if you "see" a tough stick (and we know who they are) before you even touch her or look for veins, get some warm compresses and place them on the extremeties and dangle them low. Have her pump her fists on and off. This alone will show you veins that previously you had no idea were there, esp in dehyrated people. If you do use a tourniquet, don't have to use much pressure and release it now and again to let blood flow if you are taking more than a minute or so to get going.

Hope this helps.

deege58

Specializes in Labor and Delivery. Has 26 years experience.

I've been and RN now for about 10 months and I've been working mother/baby now for about 8 months. We don't get many chances to start IV's as they are usually already done in L&D and the only reason we would need one is if one accidentally came out on a pt needing IV abx or meds. In the past few months I've had the oppurtunity to start about 5 IV's. Every time I blow the view! I am good at finding viens and can flashback no problem. But when I advance the needle and cath sligtly and then go to advance the cath the vein is blown. I suspect that I may have an angle that is too high. Anything else that I could be doing to cause viens to blow? Like should I pop the tourniquet when I see flashback or wait until I have the cath in the vein completely?

When I was in school I was great at starting IV's. I don't know what happened :down:

What you might find helpful is to spend the day in same day surgery department..no body starts more iv's than them!! Or the iv team..you get the idea. Starting iv's is a real skill and kind of an art, just takes time and practice...

I have a question...during several different attempts at IV insertion, I have gotten good flashback, but when I go to advance the catheter, I meet resistance and it ends up unsuccessful. When I pull the catheter out after the failed attempt, the catheter is bent/kinked. WHY is this happening and how can I avoid it? It is so frustrating to know I am right there in the vein and then I'm obviously doing something to lose it. Someone earlier in this post mentioned to try advancing the need just a tad farther once you get flashback..do you think this is it? I have been trying to do that but maybe I'm not going far enough? I'm always worried about going through the other side of the vessel. Seriosly any advice is welcome, I need to get much better at IV starts, and quick!

Watch out for valves. They feel like tiny knots. Try and go either above them or at least inch and half below. Those can be tricky. Sometimes if you time it right, the catheter can go through the valve, but I won't recommend it.:bow:

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