"blown" IV's

  1. I had a pt on a shift last week who was poked 8x. The nurses would try to start the IV and every time the vien would just instantly bruise and the nurse would say "The vien just blew" Pt came back in on my last shift with the same complaints. MD ordered an IV But I went into it thinking that I would just try once and see what happened. I put the tourny on-found lots of great "looking" viens and felt a nice fat one on the underside of her arm. I poke...get nice flash...start to advance and the vien up close to the catheter hub gets a nice little bruising around it...But the dang thing draws like a champ and flushes easily. I had my charge look at it before we put anything besides N/S in it and he said it looked great.

    Any ideas on why this happened? I get the feeling that the nurses on the previous shift may have had patent IV's-but saw the bruising and d/c'd them.
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  3. by   gr8greens
    We actually have an "IV team", a few RN's whose job is to just start IV's! They will sometimes bruise upon insertion too......but the line is still patent. They just add "bruised on insertion" to their charting. Seems as though your co-workers had patent lines too. That poor patient!
  4. by   AnnieOaklyRN
    some patient's especially the elderly who are on anticoagulants and even steroids have very fragile veins and capilaries. Do not worry about bleeding/bruising around the insertion site in the skin, usually alittle direct pressure will stop it. Worry when it is at the insertion site into the vein (distal from the hub), then the IV should be removed. A trick for these patients is to use a blood pressure cuff instead of a regular turniquet as they do not bleed nearly as much and the vein doesnt form an explosive hematoma when the needle is inserted into it.

  5. by   TazziRN
    If the veins "just blew" 8 different times then someone should have thought about trying it without a tourniquet. With the elderly it's not uncommon for there to be too much back pressure, so that when the vein is pierced it explodes.

    In this case I agree that they didn't blow, or at least not all of them, but that the first pokers were too quick to quit.
  6. by   MS._Jen_RN
    I don't count it as "blown" unless I get no blood return or puffing up (infiltration) when I flush. (Flush slowly if you think that it's blown.) The others were right on about the BP cuff and/or no tourniquet at all.
  7. by   Nurseboy1
    While I don't work ER, I work in MICU and get frequent bad veins from steroids etc. I have found that putting the tourniquet up higher than the vein. In other words I try not to put the tourniquet directly above the site that I'm going to stick.
  8. by   Victoriakem
    for elderly patients with fragile skin, sometimes I don't put a tourniquet on at all, but look for the tiny flash to make sure the IV is in place. If I draw blood from the site, then I put on the tourniquet but I usually prefer to draw their blood separately to keep the IV patent.
  9. by   nurse2b2004
    Another trick I learned is to use a bp cuff inflated to about 100. Sometimes it is just enough to let some blood return but not too much to "blow" the vein.
  10. by   southern_rn_brat
    I just got out of the hospital last night with a PE. When I was in the ER on Saturday they stuck me over 10 times to get my IV. I'm fat and have horrible veins

    Im not angry, it is what it is and I HAD to have a line.

    this thread just made me think about it lol