IV tips and tricks - page 16
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... Read More
Jul 16, '08Joined: Oct '06; Posts: 2,581; Likes: 3,841Quote from veetachthis happened when I was a new RN and worked med-surg. I totally freaked out, and put the pt in trendelenberg, opened up the saline line and in a panic called the doc. The pt immediately vomited profusely and went hypotensive. The doc told me to calm down and explained that the half life of dobutamine was very short, I monitored him closely (he was already on a tele unit) and soon his BP returned to normal and things settled down. I think I wrote volumes of paperwork on it though. LOL
Um, unless I am completely blanking out Dobutamine would not cause hypotension. Also I dont beleive most hositals would allow a patient to be on that unless they are in an ICU setting.
Jul 18, '08Joined: Jul '05; Posts: 3,100; Likes: 2,691Quote from Fergiesometimes that works, other times you go in right on top of it at a 45 degree angle - also if it's particularly hard to palpate, try a tourniquet above and below the site to pop it up - that works well.Do not be afraid of the needle. I was taught to go in slightly to one side of the vein.
Jul 18, '08Joined: Jul '05; Posts: 3,100; Likes: 2,691Quote from Sweetooth EMT-P, RNDobutamine S/E: tachydysrhythmias, VT, VF, HTN, N&V, H/A, AMI -Um, unless I am completely blanking out Dobutamine would not cause hypotension. Also I dont beleive most hositals would allow a patient to be on that unless they are in an ICU setting.
There are worse things to worry about with Dobutamine... hypotension is not oen of them..
Jul 18, '08Occupation: RN Specialty: Emergency Room ; Joined: Mar '05; Posts: 39; Likes: 14My #1 rule, ALWAYS asses both arm's when looking for a good vein. After 22 yrs I still forget this rule and after an unsuccessful attempt, go to other arm and find the gold mine.
I get a kick out these threads as you can find who the gun-ho I never miss types are. I don't trust anyone who says they never mis or never make an med error. Those are the type of people who will cover up mistakes and not take accountability for mistake because they have to preserve their fragile ego's.
I put in what I can get in. If it's a kid 24 or 22. Medical's get 2o's, traumas get 16. But if a trauma comes in and I blow a 16, my next try will be a 18 to gain access, then when I do get access, I'll do another 16.
I've been doing IV access since 1980. It's practice, gain confidence, but don't get cocky because your as good as your next stick!
Jul 19, '08Occupation: Night shift ER Charge nurse x 4 years. Specialty: 11 year(s) of experience in Medical, Pediatric and ER ; Joined: Jul '08; Posts: 12; Likes: 7Quote from TraumaInTheSlotI have to disagree. I think you can be a see'r or a feeler when it comes to IV's. I am definately a see'r. If I can see the vein, even if it is a shadow I do MUCH better when sticking. Infact, if I can see the vein, I don't have to feel it to get a good IV. I don't ever put anything less than a 20 g in an adult. I have even started many 20 g IV's in Peds. Now infants I always use a 24 g. The best sites I have found of coarse is the AC and the inner wrist behind the thumb. Also the dorsal aspect of the forearm has a great vein especially in males. You kind-of got to work upside down tho with this one. Here is some good information on IV's.the first thing i tell everyone is that selecting a vein is never ever something you do with your eyes. you have to do it by feel. one vein might look good, but it is too frail. get to know your veins.
Also, be sure to look at all your options before sticking. The first vein you come across might not be your best.
Remember, there will be good days and bad. Some days I can't hit the broad side of a barn, but then others come and I have a good IV day. Not to say I hit everyone, because no one hits every IV on the first stick.Last edit by nurse97mommy2000 on Jul 19, '08 : Reason: Wanted to add another comment. Sorry
Jul 19, '08Joined: Jul '05; Posts: 3,100; Likes: 2,691Quote from nurse97mommy2000I think it is all feel - even if you see it, you need to be able to feel it - think about those with dark skin... sometimes you can't see anything there, so it's all about palpation...I have to disagree. I think you can be a see'r or a feeler when it comes to IV's. I am definately a see'r. If I can see the vein, even if it is a shadow I do MUCH better when sticking. Infact, if I can see the vein, I don't have to feel it to get a good IV. I don't ever put anything less than a 20 g in an adult. I have even started many 20 g IV's in Peds. Now infants I always use a 24 g. The best sites I have found of coarse is the AC and the inner wrist behind the thumb. Also the dorsal aspect of the forearm has a great vein especially in males. You kind-of got to work upside down tho with this one. Here is some good information on IV's.
Also, be sure to look at all your options before sticking. The first vein you come across might not be your best.
Remember, there will be good days and bad. Some days I can't hit the broad side of a barn, but then others come and I have a good IV day. Not to say I hit everyone, because no one hits every IV on the first stick.
Sep 26, '08Occupation: Women's/Children's Joined: Feb '06; Posts: 130; Likes: 10I am a new pediatric nurse. I am almost totally dependant on seeing because I am not confident enough to know if I feel them or not. Any ideas on how to tell the difference especially on children and babies.
Sep 26, '08Joined: Jul '07; Posts: 2,251; Likes: 8,239Quote from ibmaryannThe only ones you generally will be able to feel in infants and young children will be the AC and the saphenous. The remainder will be either done by the visual or the "Hail Mary" approach. The ones you can palpate feel just like adult veins only smaller. I would see if your unit would invest in a "Wee-lite" which is a tool to find veins by use of transillumination and works very well. Don't be afraid of scalp veins in sick infants. They are easy to get and well-tolerated by the patient (although the parents usually freak if you don't prepare them well). Finding veins by palpation on infants takes a lot of practice and sometimes is impossible even for skilled practitioners.I am a new pediatric nurse. I am almost totally dependant on seeing because I am not confident enough to know if I feel them or not. Any ideas on how to tell the difference especially on children and babies.
Sep 28, '08Occupation: ER RN Specialty: 3 year(s) of experience in Emergency Room ; Joined: Jun '06; Posts: 34; Likes: 24For the record, I don't have peds experience, so I don't intend anything that I say to be taken in reference to peds.
I have to agree with the many who have stated that it's all about feel. IT IS!! I started working in the ER as a nurse tech during my last semester of nursing school (3.5 yrs ago) and while starting an IV once, one of the paramedics I work with proceeded to tell me that I was doing it all wrong since I was relying on sight. Although she hurt my feelings a little bit, I feel I owe much of my IV skills to what she taught me that day. Sure, it is possible to stick a vein that you can't feel. But, if you can train yourself to be able to stick veins that you can feel and perhaps not see whatsoever, you'll find that it's actually much easier to find a vein. Many people have great veins that can only be felt, not seen.
And to the poster who suggested that there will always be a vein near where you feel the brachial pulse, great tip...it's true, and often forgotten.
Sep 28, '08Occupation: RN, Charge Nurse, Emergency Department, Nights Specialty: ICU, CRU, ER, Med/Surg ; From: US ; Joined: Oct '06; Posts: 14; Likes: 32Just my 2 cents worth...
Make sure you and the patient are both comfortable. You can't do your best if you are in an awkward position or uncomfortable. A stool or chair works wonders.
Also, set up all your supplies somewhere other than the patients bed or stretcher. I don't know how many times I've seen co-workers pile all their supplies up on the patient only to see them land on the floor when the patient makes an unexpected move. Get a bedside table or Mayo Stand.
If you have the time...look, look and look some more. Especially if you think the stick will be difficult. I think many posters have mentioned listening to the patient. But, make sure the site the patient recommends will be appropriate for whatever treatment or test...CT, blood, fluid resus. Get the picture.
Know your limits. Don't stick just so you can say "I tried" to the "expert" when you have to call on them. Somethings are beyond our abilities.
If you ever become the "Expert," let everyone know to call you first if it looks like a very difficult stick. There's nothing I hate worse than coming behind someone or several someones who have ruined every possible site I could have attempted and now I'm supposed to perform a miracle.
If at all possible, avoid the AC. Not always an option. I've had patients go for contrasted CTs with access in the AC only to discover that they cannot put their arms above their head...for whatever reason. (think McCain)
It has already been mentioned but well worth repeating...your patient is not going to tolerate some IV infusions in the small veins of the hand or even other sites. Go for the largest vein you can find, preferably not in the hand or AC but do what you have to do for the sake of the patient.
Trauma patients need the largest IV you can get as quick as you can get it. Just because they look "OK" now has nothing to do with 15 minutes later when they start to crash. Be safe...not sorry.
Infants under say 60 days old will be easier sticks than say the chunky 10 mo old. Not as much baby fat.
Parents make poor and unpredictable assistants. Never trust them to be your holder.
Proper restraint and holding are essential in starting a pediatric IV. Find a team mate that can hold properly and always call on them if possible. Does not have to be a nurse. I've known several Phlebotomist who were excellent.
The flat veins of the anterior forearm, the ones you can see but cannot feel, are easily accessed by sticking almost parallel with the skin. Too much angle and you'll go right through the other side.
Some patients have a very large vein running on top of the bicep. Don't over look it. We have a tendency to look at AC and below. I've even had success at the shoulder. Depends on time and situation.
Let your doctor know quick when a central line is needed. Sure, I might get an "IV" but is it going to be appropriate and how long is it going to last...fingers...spider veins...???
If the patient wears a watch, there's probably going to be a rather large vein under the band. Don't forget to look there.
Secure the site properly. We use T-Ports at my facility. Some nurse let them dangle and they get caught on everything. I make a loop and tape in down. If fluids are connected I make a loop in the tubing and tape it down. If I think the patient might try to pull the IV out or is a "picker," I wrap it, especially if it was hard to start.
Practice makes for good IV skills. Stick...Stick...Stick and Stick some more.
Find out who is good. Watch them and ask questions. Everyone has little secrets. The nurses that are good usually love to share with others so they will not be called on so much.
Hope someone finds something they can use out this. I've learned a little from reading this thread and was reminded of a few things I had forgotten.
Thanks for posting it.
Sep 28, '08Occupation: Family Nurse Practitioner Specialty: Pain Management, RN experience was in ER ; From: US ; Joined: Nov '06; Posts: 264; Likes: 131Someone mentioned earlier (and about 4 years ago! This is a great thread, I'm glad it's revived) that their friend had a hard time remembering where the vein was after she cleaned it. If you're using an Insyte catheter, look at the back of the chamber. You'll notice there is a hole in it. If you press this against the point of the vein you want to stick, it leaves a small red dot that stays there long enough for you to clean and start the IV.
Oct 1, '08Joined: May '08; Posts: 15; Likes: 6thanks for all these great tips nurses!! I started my first IV in clincal today!! whoo-hoo! I got it on try number two. How exhilarating.. i had to keep myself from doing the jig all the way down the hallway!!
Oct 20, '08Joined: Feb '05; Posts: 31; Likes: 8Prior to starting an IV get all your equipment and open it all. Set up your flush, extension tubing and window dressing. Have it all conveniently placed within arms reach so that the risk of unneccessary bleeding is reduced. Fiddling around in front of your pt may make them lose confidence in you, so you might want to set up your trolly somewhere private. When in front of the patient if you're not sure of something, take a bottle of hand cleansing gel and wash your hands. This shows the patient you are busy and also gives you time to think. There are many pts who know what veins are better so don't hesisate to ask. Act confident, think positive and expect success.