IV tips and tricks - page 4
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 22, '04Occupation: R.N. Specialty: 27 year(s) of experience in cardiac, diabetes, OB/GYN ; Joined: Feb '02; Posts: 1,947; Likes: 418Thanks for the info but I have to say I disagree for the most part. Appreciate the info, however...
Jul 22, '04Joined: Mar '02; Posts: 1,888; Likes: 117Quote from mother/babyRNWhat is it you disagree with? Just curious.Thanks for the info but I have to say I disagree for the most part. Appreciate the info, however...
Jul 24, '04Occupation: rn Joined: May '03; Posts: 235; Likes: 2I was taught to practice on a straw...a drinking straw.....it gives you the "pop"......good tip for 1st timers......lots of good info.....
Jul 26, '04Joined: Jul '04; Posts: 631; Likes: 99Giving blood through a 22 guage catheter is one of the most assinine things I have ever heard.
that, and using a knuckle vein, or the veins on the inner wrists! if that's all you have, you need to be discussing a jugular line or central line with the er doc.
you do NOT win a prize for getting a 22 in a knuckle!
i'll add that each pt and their problem is different. a copd-er will be fine with a 20 to get his solumedrol.
cp will need at least 1- 20. if the ecg is positive, you're going to need at least 2 more lines that are 18s. if you can get a 16 in the a/c get it. why? bc once they get their tpa...that's it. all labs come from your lines. think ahead.
abd pain should also get an 18 if possible. they could be anything like a gi bleed.
just last week i had a man hit by a car. i put a 16 in him right away. another nurse was like...' 16?' yes, a 16. his veins were huge, it wasn't a problem, and he sustained trauma. think about it.... it's a no brainer.
in the er, it's not all about comfort. sure, you don't want to torture someone with a 16 if there's no good reason for it, but if it's logical to go with an 18 or larger, don't hold back either.
Jul 26, '04Joined: Mar '02; Posts: 1,888; Likes: 117Quote from tridil2000And it only tales a second to put in local--if you don't want to take the time to make an intradermal wheal with buffered (with NaHCO3) 1% Lidocaine, then use 0.5 % Lidocaine (plain)--makes access a bit les traumatic for them.in the er, it's not all about comfort. sure, you don't want to torture someone with a 16 if there's no good reason for it, but if it's logical to go with an 18 or larger, don't hold back either.
Of course, as stated by tridil, in the ER, with people coming at them from all angles poking and prodding them (trauma patients, I mean) IV access, with or without local, is just a transient minor pain that is over in a flash, and then it's on to other things--like a trip to the operating room, where their pain will be gone soon enough--
Jul 26, '04Occupation: Surgical RN Specialty: 40 year(s) of experience in surgical, emergency ; Joined: Jan '04; Posts: 428; Likes: 95As a 25 plus year vet of nursing, I really like reading this thread.
I'm sure some will be repeats, but here is a few of mine.
Where I work, we can numb the site, using bacteriostatic normal saline. Less than 1/2 ml is plenty.
The skin of lifeguards, farmers, etc are tough. We also sometimes use a metal 18 ga needle to open a small nick where the IV needle goes in.
A BP cuff works great when a tourniquet does not.
I was taught to start distal and go from there.
A bifurcation is a good solid place to start. Go right up the "Y".
As far as what guage...in OR, we hate to see anything less than a 20. Bigger for the bigger procedures of course.
I had an anesth. doc tell me one time he would rather have a good 20 in the arm, than a 16 or 18 in the trash can. :chuckle
Jul 26, '04Occupation: RN Specialty: ER, PACU, OR ; Joined: Dec '98; Posts: 2,120; Likes: 281st - All great veins run medial to the arteries. Personally, I don't think you should ever have to rely on sight, but rather go with a what you feel.
2nd - If all else fails (other than a central line or EJ), palpate the brachial artery, then insert the catherter just medial to where you feel the pulse.............
it will be there I promise! :-)
Jul 27, '04Occupation: Emergency Room RN Joined: Jun '02; Posts: 75; Likes: 9In our ER, we tend to go for the 20's all the time...unless it is known that the pt is a potential GI bleeder, TnKaser, etc then we go for the 16's/18's. Pretty much every nurse grabs an 18 and a 20 when going to start an IV...but we accept22's all the time...if all they need are pain meds, or solumedrol, or antibiotics...why torture them with something bigger? I agree large bores are needed in SOME patients in the ER, but not all...and from experience, an 18 hurts A LOT more than a 20...We give blood through 20's all the time...it flows plenty fast, gave a guy a unit of blood in less than a hour via a 20 the other night...I've heard about using 22's for blood, but our hospital policy is no less than a 20 for blood. We get a lot of drug users, and its true if they say to go for a specific vein go for it...and sometimes you will be unable to get anything bigger than a 22 or 24 in these guys (yes I said 24g)...but unless they are in a potentially life threatening situation (and come on ER nurses, your instinct usually knows), then an EJ or central line may not be necessary...while we don't make it a habit, if all they need is a little fluid and pain/nausea meds, and a 24 is all we are able to get (normally the 24g wouldn't have been the 1st attempt), then by all means make the patient feel a little better, and then reassess the need for something bigger! I found people's veins are getting worse and worse, and sometimes the large bores aren't feesible or just aren't necessary, and if its really not indicated than all your doing is causing extra pain.
Jul 27, '04Joined: Apr '03; Posts: 518; Likes: 47I'm a new nurse so this is a super thread for me! I saw a new one several weeks ago.... Many nurses took a stick at a guy with *nothin* for veins. Nothing could be seen or felt - even with all the usual tricks - even the "IV queen" of the unit couldn't find anything to stick. So she tells the doc 'hey, i need an order for nitro paste'. Sure enough, a pea-sized dab and the vein popped right up. She nailed it on the first stick.
Jul 27, '04Joined: Mar '02; Posts: 1,888; Likes: 117Quote from PJMommyYeah, we used to do that a LOT in the '80s and '90s, in various ORs where I worked. It's a great trick. Just be careful--it works, of course, because it is a vasodilator, so DO NOT put it on with a fingertip--use a q-tip. It only takes what you can put on the very tip of the q-tip--actually "a pea sized dab" is too much. If you get it on a finger, you will end up with a horrendous headache.So she tells the doc 'hey, i need an order for nitro paste'. Sure enough, a pea-sized dab and the vein popped right up. She nailed it on the first stick.
This is NOT a good technique for patients who are wide awake--THEY can experience the blinding headache. But for OR, when you need a second IV in a rush after your patient is already asleep, especially due to sudden and excessive bleeding or in ER where immediate access may save a life, it's a real time and sometimes lifesaver.Last edit by stevierae on Jul 27, '04
Aug 29, '04Occupation: RN Joined: May '03; Posts: 213; Likes: 78Quote from rn4boobooNurses eat their young is ad nauseam- seems like you have it down pat though?
I agree...if the thread bores you, DON'T READ IT :angryfire
Aug 29, '04Occupation: ER, ICU, HOME HEALTH Joined: Jan '04; Posts: 282; Likes: 34mother/babyRN]We had to learn how to put in an iv with the lights out in the room so you could feel the vein only...
Aug 29, '04Joined: Aug '04; Posts: 73; Likes: 12No tourniquet on little old fragile veins.
Be creative, we have veins everywhere, and I mean everywhere.
Lidocaine is our friend, use it.
Warm compresses, how simple..but it makes a lot of difference in a lot of ppl.
Vasopressors cramp my style.
Please don't try 6 times then call me...
Quote from kloockHi 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