difficult IV starts

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Any advice from anyone on strategies for starting an IV on those elderly and other difficult people with "no veins?"

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This topic has been addressed numerous times. If you do a search, you will find a plethora of useful information.

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Specializes in OB, M/S, HH, Medical Imaging RN.
Any advice from anyone on strategies for starting an IV on those elderly and other difficult people with "no veins?"

PRACTICE, PRACTICE, PRACTICE and then more PRACTICE, only experience helps in those situations and still sometimes you still can't get a vein. Then it's time to ask the doc for an order for a PICC or Central line.

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Any advice from anyone on strategies for starting an IV on those elderly and other difficult people with "no veins?"

Use hot packs to bring up the veins and then if you;re not happy, call IV Therapy!!

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You can also ask for an order to apply Nitropaste--just a very tiny amount on the very tip of a Q-tip--to the vein that you'd like to access. DON'T GET IT ON YOUR OWN SKIN---you risk getting a severe, pounding headache. The resultant vasodilation should make the vein easily accessible.

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Specializes in ER, PACU, OR.

Ya.........

Most places people don't consider, thumb veins (for the #24 when the small is better than none), snuffbox veins, and ulnar veins which I bet 90% of the people overlook. Most guys and some women have great ulnar veins. However, they roll easily and you have to be patient.

Last resort? Palpate the brachial artery, and go just medial enough that you don't hit it. All great veins run medially to the arteries in ANY part of the body. It works for meabout 70% of the time.

Very last resort in an emergency........the foot.

:-)

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Specializes in Inpatient Acute Rehab.
You can also ask for an order to apply Nitropaste--just a very tiny amount on the very tip of a Q-tip--to the vein that you'd like to access. DON'T GET IT ON YOUR OWN SKIN---you risk getting a severe, pounding headache. The resultant vasodilation should make the vein easily accessible.

Awesome idea!!!!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
You can also ask for an order to apply Nitropaste--just a very tiny amount on the very tip of a Q-tip--to the vein that you'd like to access. DON'T GET IT ON YOUR OWN SKIN---you risk getting a severe, pounding headache. The resultant vasodilation should make the vein easily accessible.
what about the patient getting a pounding headache???
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NTP is also not a good idea for someone with labile blood pressure or other cardiac issues. Sometimes with the kids we'll give them Emla or lidocaine before we stick, but that's for their comfort, not for our assistance. I find kids easier to stick than adults.

I agree, practice will make you more confident, and a confident stick is more likely to be a successful one.

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There's nothing wrong with going for the saphenous. It's always there.

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Specializes in Utilization Management.

There used to a very good thread about this somewhere in here, but I can't find it.

You might try here:

http://enw.org/IVStarts.htm

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