Difficult IV Starts

[Epidural, BSN, RN]

Just some things that work for me:

• Warm Compresses ( skin warmers-warm towel-leave on for about 10 minutes)
• Double tourniquet ( don't leave on for more than 1 minute)
• Accuvein vein locator ( easy to learn how to use-works when you can't even feel a vein)
•  Using an ultrasound for access - this is more difficult to learn how to do, and a qualified provider is not always available
• Take your time and pick the best vein you can find (bouncy on palpation-no roughness from internal scaring-not too hard-preferably anchored well in the tissue)
• Don't be afraid to try at least once-your skills will improve  with practice

[dianah, ASN]

Thanks for those! 

I have never had the opportunity to try US or Accuvein location assists, good they work for you!

May I add a few tips:

Get comfortable.  Yes, the nurse needs to be comfortable, not leaning over, when the back will start hurting or spasming RIGHT at the WRONG time!  Seat yourself on a stool and have the arm dependent, so gravity assists with filling up the vein.

I once asked an anesthetist how they cannulate the little ones' veins??  Can you feel them, as you do (most) adult veins?  He said, 'no.  You just have to aim for and go for the blue streak.'  Well, that works with some veins that you can't feel, that don't 'bounce.'  If there is a streak of blue, go for it.

Some ppl are SO squeamish about needles/being stuck.  I have had a couple of moving targets!  If I identified someone who would have a hard time with an IV start (and, barring any allergies to it), I would pull a little 1% lidocaine into an insulin or TB syringe, and (with a lot of 'vocal anesthesia'!) inject a leeeeeeeeeetle wheal, right where I planned to put the IV needle.  Then allow it about a minute to work, and then when I would place the IV, it was a lot more tolerable for the patient.

And, there is no shame to asking someone else to try, if you are unable to hit a vein.  Sometimes it is our "off" day, and someone else can get it.  Another day, you will be the one to place the IV for a colleague!