IV tips and tricks

ERNURSEOH · Jun 5, 2005

I read through the replies and one simple but patient appreciated solution to discontinuing IVs is to loosen the tape with alcohol swabs before removing, and in most cases you can insert the IV without a tourniqet.

Hi all,
I am starting to compile a list of tips and tricks concerning starting venipuncture. The goal is to share experiences and tricks of the trade.
Tips e.g. on how to find that elusive "best vein", would be greatly appreciated. (and if you have a few that are not to be taken entirely serious those would be welcome as well).
Please answer me directly - no need to clutter up the board with this. I will post the text once it is finished.
Thanks in advance!
------------------
Katharina Loock, RN, BSN
Department of Education
Wadley Regional Medical Center
1000 Pine Street
Texarkana,TX 75501

bunny722 · Jun 6, 2005

I started my career on a med-surg floor in a community hospital and 22g were the norm. We would hang everything through them including blood. On the frail elderly we would use 24g if we had too (though not for blood). Larger catheters only lead to infiltrates and phelbitis. If someone was a post-op or from the ICU they would probably have a 20g.

One thing that always ticked me off was when we would get a confused geriatric patient with an 18 or 20g in their anticubital put in by the paramedics and the IV pump would alarm all the time for occlusion from them bending their arm! Although I can imagine it is hard to put an IV into an confused geriatric patient in the back of a moving ambulance, a tip for paramedics: although this is usually a good vein, the nurses usually need to change the site upon hospital admission or use a wrist restraint to prevent the line from occluding. Please, paramedics.. if the patient is not serious or critical, try to avoid the a/c. Thanks.

Now I work in OB and 18g are the norm for all patients whether they deliver vag or c/s.

Kidrn911 · Jun 12, 2005

Daytonite

You have some very good information, however it is for adult patients, not pediatrics.

You normally don't get too many 18g or 20g in an infant. Plus you don't change sites every 72 hours in a child. You only change the site if it is no good. After working in 3 different children's hospitals, I dare say that you never pull a line on a chronic kid without good reason, and a 72 hour time limit is not a good reason.

Daytonite, BSN, RN · Jun 12, 2005

Daytonite
You have some very good information, however it is for adult patients, not pediatrics.
You normally don't get too many 18g or 20g in an infant. Plus you don't change sites every 72 hours in a child. You only change the site if it is no good. After working in 3 different children's hospitals, I dare say that you never pull a line on a chronic kid without good reason, and a 72 hour time limit is not a good reason.

I strongly disagree with your opinion. You are basing it on what you have seen in practice and not on IV standards of care. For infants we almost always used 24g Insyte catheters and sometimes 22g. And, yes, our IV team did change IV sites every 72 hours on infants and children. They get phlebitis just like adults do except that it is sometimes more difficult to spot. A kid's vein can get sclerotic and be of no use for the future just like an adult vein if an IV is allowed to remain in them until it goes bad.

If a child or an adult is having a lot of IVs and their veins are getting used up, it's time to approach the doctors about some kind of central line placement. We had many sickle cell and leukemia kids who had Port-A-Caths or Hickman lines.

With infants we almost always had another adult restrain the child's arm or hand and we also drew any blood work before connecting the IV fluids. We were not to use scalp veins without a physicians order. Arms, hands, and feet were fair game. We placed them on Styrofoam splints designed for infants and children. We wrapped them with Kerlix and tried very hard to leave the IV site visible for inspection and tape the IV tubing so that it could be easily changed without having to unwrap and remove the dressing from the IV site to accomplish this. We did the same for children. If a toddler or younger child was seen picking at the IV dressing he was restrained. If we had a diabetic child who was going to be having a lot of blood draws we would ask the doctor for an order for a saline lock for blood drawing. You have to develop a kind of claw hold on kids hands and arms when you are sticking them with a needle because they will always try to pull away. We had to be good at inserting the IV cannula with one hand and holding their hand or arm with the other. They are very challenging to do and not for beginners.

Of course, there are always exceptions, but we followed the same standards with infants and children that we did with adults. This is the difference in having an IV team following INS standards as opposed to letting staff nurses decide how to manage their IVs because everyone has their own opinions on this. I'm not trying to be mean, but what IV standards are you following? Please think about that. While you may be leaving IVs in a child until they need changing, is it for your convenience as a nurse, or for the best care of the patient? Unfortunately, you may not see the results of long indwelling peripheral IV catheters because it may not be known until subsequent encounters in the healthcare system. Some of your chronic disease kids most likely have had a lot of venous abuse from previous IVs just as what occurs in adults with chronic disease too. I urge you to re-think your ideas about pediatric IV therapy and check out INS (Infusion Nurses Society) standards.

Daytonite, BSN, RN · Jun 12, 2005

One thing that always ticked me off was when we would get a confused geriatric patient with an 18 or 20g in their anticubital put in by the paramedics and the IV pump would alarm all the time for occlusion from them bending their arm! . . .a tip for paramedics: although this is usually a good vein, the nurses usually need to change the site upon hospital admission or use a wrist restraint to prevent the line from occluding. Please, paramedics.. if the patient is not serious or critical, try to avoid the a/c.

The paramedics use the antecube and large bore catheters for good reason. If that patient goes sour in the ambulance or in the ER it is a lifeline to save the patient's life. If an IV in the antecube is positional and the IV pump is alarming all the time then change the IV site to a more accomodating place for you and the patient. Paramedics and ER personnel place IVs where they do for very different reasons than nurses on a hospital unit.

Our IV team always checked the IV sites of new admits, reviewed their charts and changed the IV site to a more convenient spot if warranted.

Kidrn911 · Jun 13, 2005

Just because your IV team has a standard of policy doesn't mean it is beneficial to all.

Have you ever worked at a dedicated pediatric hospital as an IV nurse?

I dare you tell a parent (with a chronic kid) that you would be willing to inflict more pain to their child by d/c a perfectly good IV to avoid phelbitis.

How many sticks this time?

I have worked at 3 different facilities that are dedicated peds hospitals in various parts of the country and numerous community hospitals and none practice what you say your facility does.

I know how to hold and start lines with children of all ages, I also know how to do it with no help at all (someone holding the extremity) and let me say what you are suggesting is not the standard of care for pediatric patients. Maybe what IV nurses want, but not what they get.

And as a mother and a peds nurse I will say that any one that tried to d/c a perfectly good IV and restart another on my child I would knock them into next week. There is no need for unnecessary pain. especially after a child has been stuck 6-7x to get the IV they have. IMHO

BTW scalp veins are excellant in cardiac babies that have nothing. Did many scalps in my days, and really no need for a doctors order.

Daytonite, BSN, RN · Jun 13, 2005

Just because your IV team has a standard of policy doesn't mean it is beneficial to all.
Have you ever worked at a dedicated pediatric hospital as an IV nurse?
I dare you tell a parent (with a chronic kid) that you would be willing to inflict more pain to their child by d/c a perfectly good IV to avoid phelbitis.
How many sticks this time?
I have worked at 3 different facilities that are dedicated peds hospitals in various parts of the country and numerous community hospitals and none practice what you say your facility does.
I know how to hold and start lines with children of all ages, I also know how to do it with no help at all (someone holding the extremity) and let me say what you are suggesting is not the standard of care for pediatric patients. Maybe what IV nurses want, but not what they get.
And as a mother and a peds nurse I will say that any one that tried to d/c a perfectly good IV and restart another on my child I would knock them into next week. There is no need for unnecessary pain. especially after a child has been stuck 6-7x to get the IV they have. IMHO
BTW scalp veins are excellant in cardiac babies that have nothing. Did many scalps in my days, and really no need for a doctors order.

You are basing what you say on what you have seen in your practice, not on scientific testing and knowledge. I still stand by what I say. How can you believe that the anatomy and physiology of a human infant or child is all that different from an adult human? If anything, the immune system of a child is much less developed than an adult and requires special monitoring in order to prevent damage from an IV. I would urge you to read the Infusion Nurses Society Standards of Care. Perhaps there are pediatric nurse practioners that can offer some insight into this. Infusion Nurses Society offers national certification in IV therapy and have conducted nursing research in the area of IV therapy for many years. The standards that they have developed are based on this research. I don't know that you were exposed to much nursing research during your training, but it is what many nursing standards are based on. Old standards are questioned and tested through research methods. It is through this process that nursing care is updated and changed.

I also take issue with your caving in to the desires of parents. I understand that there may be exceptions and you just cannot go in to a parent and say "we're going to change this IV whether you like it or not", but we have the knowledge to teach parents what is good accepted practice and why. I have seen children and adults alike who had terrible phlebitis that developed from long dwelling peripheral IVs. We're not supposed to cause harm to our patients.

UM Review RN, ASN, RN · Jun 13, 2005

Oh Good Lord, this is turning from an informational thread into a pi**ing contest.

In any event, no matter what information is given here on a website, the OP should always consult her hospital policy and follow that first.

rachellesgram · Jun 22, 2005

For those older patients with the "rope" veins, I often find they blow when you use a tourniquet. We've taken to using a BP cuff slightly inflated (60-80) on these patients and haven't had a problem since. It's an excellent technique taught to us by one of our paramedics.
also works well on infants/toddlers too.

as an old iv therapist+ ccu nurse--now geriatrics, have found that there are even times that I can start iv without a tourniquet or cuff. Esp. the old folks with the big, blue,ropy veins. They are usually very fragile and blow as soon as you puncture if ther is ANY pressure.

:uhoh3:

Rnannie94 · Jun 28, 2005

You are basing what you say on what you have seen in your practice, not on scientific testing and knowledge. I still stand by what I say. How can you believe that the anatomy and physiology of a human infant or child is all that different from an adult human? If anything, the immune system of a child is much less developed than an adult and requires special monitoring in order to prevent damage from an IV. I would urge you to read the Infusion Nurses Society Standards of Care. Perhaps there are pediatric nurse practioners that can offer some insight into this. Infusion Nurses Society offers national certification in IV therapy and have conducted nursing research in the area of IV therapy for many years. The standards that they have developed are based on this research. I don't know that you were exposed to much nursing research during your training, but it is what many nursing standards are based on. Old standards are questioned and tested through research methods. It is through this process that nursing care is updated and changed.
I also take issue with your caving in to the desires of parents. I understand that there may be exceptions and you just cannot go in to a parent and say "we're going to change this IV whether you like it or not", but we have the knowledge to teach parents what is good accepted practice and why. I have seen children and adults alike who had terrible phlebitis that developed from long dwelling peripheral IVs. We're not supposed to cause harm to our patients.

I hate to keep this one going, but......

With IVs in kids, I'm sorry, but it is a whole new game. Some kids are incredibly difficult to start a line on and although, yes, it is ideal to change IVs every 72 hours and it IS best practice, it is sometimes just not possible. And in some cases, you do have to accept the preference of the parent. You do have to remember it is their child and they have the right to say no (except in special circumstances.) In most cases, the parents will accept the side of right, but not always. Some times you have to work with what ya got, not what ya want.

Hairstylingnurse · Jun 28, 2005

i started my career on a med-surg floor in a community hospital and 22g were the norm. we would hang everything through them including blood. on the frail elderly we would use 24g if we had too (though not for blood). larger catheters only lead to infiltrates and phelbitis. if someone was a post-op or from the icu they would probably have a 20g.
one thing that always ticked me off was when we would get a confused geriatric patient with an 18 or 20g in their anticubital put in by the paramedics and the iv pump would alarm all the time for occlusion from them bending their arm! although i can imagine it is hard to put an iv into an confused geriatric patient in the back of a moving ambulance, a tip for paramedics: although this is usually a good vein, the nurses usually need to change the site upon hospital admission or use a wrist restraint to prevent the line from occluding. please, paramedics.. if the patient is not serious or critical, try to avoid the a/c. thanks.
now i work in ob and 18g are the norm for all patients whether they deliver vag or c/s.

so your saying size does matter:rotfl: :chuckle :rotfl: :chuckle :rotfl: :chuckle i'm so srry but it had to be said. :chuckle :rotfl: i'm delerious, it's like 2:30am. but seriously, there are as usual some great tips:smiley_ab in here.

have a great morning.:roll

AFnurse3 · Jun 28, 2005

Wow!!! That is an awesome site with lots of great info! Thanks so much!

Looooove the background sounds on this one!!
http://www.enw.org/IVStarts.htm