IV tips and tricks

Emergency RN · Dec 1, 2009

Does anyone use NTG cream for really hard to stick patients? I heard a rumor that's what the ER nurses are doing in my hospital.

Between the various modern techniques (LED lights, sono, infrared) that are available, if one cannot get something peripherally, then it may be more clinically reliable to just go for central access instead. I would hesitate to use NTP (an old first year "intern's trick") as it requires a medical order, could have systemic vasoactive consequences, and may trigger an allergic response. If one can get the vein to locally dilate by chemical means, then it would be just as easy to do so with better tourniquet technique, transient heat, and lowering the arm.

KungFuFtr · Dec 1, 2009

when i start ivs, i'm careful about the power of suggestion. pain is very subjective. i don't tell them it will hurt.

"will this hurt nurse...?"

"yes, it will hurt and you will feel pain. if you can imagine...it will be a very sharp, piercing pain. this pain is very hot. you know, like getting stung by a hornet; however the stinger is much longer and thicker."

when i set my supplies up i'll ask "so what are your thoughts on iv's?" if they tell me they are terrified of needles i'll ask... "so, how many tattoos do you have?" it seems that people who hate needles always have multiple tattoos. this usually breaks the ice and people laugh; an instant state change. i try to distract others by asking them to describe their ideal vacation (something pleasant). i'll have them close their eyes and get them into a more positive, relaxed state.

Editorial Team / Moderator · Dec 1, 2009

It seems that people who hate needles always have multiple tattoos. This usually breaks the ice and people laugh; an instant state change.

To be fair, as a heavily tattooed nurse, I can tell you that an IV needle/catheter and tattoo needles are nothing alike. But yes, it's a good icebreaker. Now, a piercing needle and an IV? Very similar. Piercing needles are generally 14g, so often bigger than the IVs we use -- generally. I will often point out to the pierced folks that what I'm using is actually smaller than what they're used to getting. They like to hear that!

goodneighbor · Jan 2, 2010

Saline lock tape trick: When preparing your anchoring tape at the beginning, take a strip of tape, sticky side up, turn the two ends inward and stick it to a clean surface. So now you have a semicircle of tape, secured, at the ends underneath. When you need it, spread your index and middle fingers and place them on the tape, like one-and-a- half inches apart, palm down. Now you can slide your fingers with the tape right under the catheter and then do that little cross thing with one across and one up. Then apply the transparent dressing.

JessicRN · Jan 10, 2010

Please remember Infusion Nurses Society standards... "Always choose the SMALLEST guage and length IV catheter for the prescribed therapy."
The key is NOT to go bigger. A 22 guage is most appropriate for that elderly patient, and for that 90 lb soaking wet 90y/o female, a 24 g may be appropriate. You want the smallest guage to allow for adequate blood flow around the IV catheter and decrease the damage to the smotth tunica intima. A 22 guage IV catheter can withstand infusion rates of up to 35ml/min or 2100cc/hr. If in doubt, look at the back of the package that your IV catheter came in. The flow rate is listed on it.

:yeah: Many patients have chronic conditions and lousy veins many have lots of valves all of which will take a smal gauge but not a large gauge. needle. if you keep blowing veins trying to get a large gauge IV in it you ruin the vein for others to try . The only time I use anything bigger then a 20 is for Chest CT and real trauma that will need multiple blood tranfusions and surgery Too many nurses think you need the largest IV gauge,. also 22 gauge does not kill hand veins can get around a valve and go through crooked veins easier with the more pliable 22 and not blow a vein.

Also if the patient is like ours who come daily and sometimes several tiimes in a day the best thing to do is start low and move up. Remeber if you are lousy at veins my suggestion is to start with the easy ones, that will then give you the confidence to move on to the more difficult ones and will allow you to become more accurate. Nothing funner then trying to start an IV in the underside of a pt who has overdosed and is violent. Or that extremly anxious pt in respiratory distress who is flailing around.

allthesmallthings · Apr 3, 2010

Do not be afraid of the needle. I was taught to go in slightly to one side of the vein.

Why is that?

inteRN · Apr 5, 2010

Many patients have chronic conditions and lousy veins many have lots of valves all of which will take a smal gauge but not a large gauge. needle. if you keep blowing veins trying to get a large gauge IV in it you ruin the vein for others to try . The only time I use anything bigger then a 20 is for Chest CT and real trauma that will need multiple blood tranfusions and surgery Too many nurses think you need the largest IV gauge,. also 22 gauge does not kill hand veins can get around a valve and go through crooked veins easier with the more pliable 22 and not blow a vein.
Also if the patient is like ours who come daily and sometimes several tiimes in a day the best thing to do is start low and move up. Remeber if you are lousy at veins my suggestion is to start with the easy ones, that will then give you the confidence to move on to the more difficult ones and will allow you to become more accurate. Nothing funner then trying to start an IV in the underside of a pt who has overdosed and is violent. Or that extremly anxious pt in respiratory distress who is flailing around.

Thank you for the message!! I use a 20 on most healthy people, BUT I use a 22 on alot of my harder sticks and elderly patients and I seem to have more luck and the IV's last.

But there is one RN whom I work with and she is one of those "ive been a RN for 30 years and I know everything about everything,etc" so she ALWAYS will start everyone (especially the hard sticks) with an 18 gauge. Almost to prove something. The same thing went through my mind--"isnt that too big and could impede flow?" I dont say anything but oh well....

MissIt · Apr 5, 2010

even if you dont know what you are doing, try and make it seem like you do. be professional, dont let your hands shake, and read your patient. their eyes can tell you alot.

Is there any way to keep your hands from shaking? Tricks people use to get this under control?

LMPhilbric · Apr 5, 2010

Lay off on the caffeine??? No, then I'd be in a coma. Seriously, if the shaking is from nerves, then you just have to be confident in your own skills that 1) Yes, I WILL (not try) get this IV started 2) Let the family watch - now they'll see my mad skills. If the shaking is a physical problem like an essential tremor, you might talk to your doc and see if there is some medication that might help you. Some people take low dose propranolol for stage fright. Maybe something like that might work for you. I used to shake when I was starting IVs on kids, but now I'm very confident in my IV skills so I don't worry. One of the best Paramedics turned RN that I know shakes like a leaf every time he starts an IV and he has mad skills so I think that's just him. If I had that problem, I would probably tell the patient ahead of time so that they knew that I was a shaker and it in no way affected your ability to start the IV.

Good luck!

Linda

shinneh · Apr 6, 2010

what if you are not sure whether that is really the vein because you can't see it clearly? how will you know that what you palpate is the vein?

Editorial Team / Moderator · Apr 6, 2010

Sometime you can go by anatomy -- i.e., it's in a place typical of having a vein. With some practice and experience, you'll be able to tell if what you're feeling is a vein -- in most patients. And there are some patients where you'll be able to see it, but not palpate it at all.

LMPhilbric · Apr 7, 2010

Bounce your finger up and down on the spot. Veins bounce. Other structures don't. Once you think you feel the vein, take the tourniquet off. If it goes away, that is the vein. Tendons, ligaments, etc will feel the same without the tourniquet.