IV tips and tricks - page 6

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

  1. by   Danelle

    How quick you heal up and the pain subsides naturally varies from person to person, but this was my experience..... When in hospital (Sun night to Sat morning, ORIF on Monday morning) after the surgery I got a IM injection of something every 4 hours, right in the hip. Started with a D, wasn't Darvocet, Demerol or Dilaudid. No idea what it was, but it was VERY effective - 10 minutes after the shot and I wouldn't feel a thing. They had to alternate sides for whatever reason (bruising?).

    Thanks So Much! I think the problem is that I have never had an injury this bad before, and I just want it to be better RIGHT NOW, and of course, that's not going to happen. thanks again, the information has been very helpful
  2. by   cadillac05
    Quote from obliviousRN
    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.
    Not only 'rope' veins, but for patients using steroids. Those blow in a heartbeat.
  3. by   cadillac05
    I've found that approaching the task with confidence, talking with the patient while setting up (tape, dressing, etc.) and smiling all the while helps to put the patient at ease. While placing the tourniquet, I say " You know, there's a very important trick to this....You've gotta slowly open & close your hand 3 times. Now, it's gotta be just 3." By this time, they've usually done it 5 or 6, so it becomes a little joke. I also utilize light touch and the warmth of my hand resting lightly over the site to promote dilation. (My hands are always warm. Cold heart?:chuckle ) Always tell them every step and never say it's a "little stick".

    This has been an information thread for me. Thanks, everyone, who has contributed tips.
  4. by   JBudd
    Don't usually have time for this in the ER (or the wax bath either ), but an oncology unit uses the hot wax bath intended for arthritis treatments to raise veins on the chemo pts who have "no veins" left at all. Dip the hand into the wax (it feels really good), wrap plastic, then a towel, and in 5-10 minutes MAMBO veins come up. Really impressive.

    (Using the bath was my student teaching project in the late 70's, now you can buy them at Walmart for softening your skin).
  5. by   LMPhilbric
    1. Be confident! Do not go in to the pt and say I'm going to "try" to start your IV. Would you like the nurse who's going to try or the one who's going to get it?

    2. Bacteriostatic saline is the greatest thing since sliced bread. Use 10 units in an insulin syringe and inject intradermally alongside the vein. The benzyl alcohol works as a local anesthetic but it doesn't burn like lido and it works instantly. It only works for about 45 secs though so don't inject until you have everything ready. (I started a 16 g on someone using this technique and they THANKED me for starting the IV. When was the last time that happened to you?)

    3. On elderly people with huge veins, tie the tourniquet very loosely. The reason those veins are so big is because they have a lot of back pressure. With the sudden release of the tourniquet, the pressure is released and the vein blows. You can use a BP cuff but make sure it's not one of the leaky ones.

    4. When you palpate the vein always use the same fingers. This trains them to feel the vein. If you keep switching fingers, they never learn. Also when you palpate the vein, "bounce" your finger. Veins bounce, other things don't (like tendons).

    5. Finally, in the ER, all adult pts get an 18 in the AC period end of discussion (as long as I can get it). In order to do a CT PE protocol, this is where it has to be. I can give blood, run a code, fluid bolus, send them for an emergency angioplasty etc. I have been messed up too many times but someone who comes in with a stubbed great toe or some other stupid complaint, put in a 20, and the doc says "Let's do a PE protocol." Now I have to stick them again. The only exceptions are traumas, big bleeds or tearing back pain (possible dissecting AAA), they get something bigger.

    6. If you are on the floor, then you can use a smaller bore catheter, but this the ER and you just never know.

    I was on the IV Team for 3 years and we each started about 3000 IVs a year. There is no substitute for practice. IV therapy is 10% talent and 90% practice. Good luck!

    PS I was also the only IV nurse on nights, so I had no backup. It's amazing how good you get when you don't have a choice.
  6. by   fyrelight74
    I'm not a nurse. I just want to say I've had about 4 IVs (3 pre-op, 1 ER), and I have no complaints. They've always put them in the elbow (antecubital?) vein, as most of my other veins are rather deep, even though they are very visible. (I'm extremely fairskinned). I've had no pain with any of them... a few I never even felt. Are IVs in other areas (say, the hand) more painful, perhaps, or am I just lucky not to feel anything?

    I've also donated blood and plasma back in my college days... even most of those were painless. Some were a tad scary, but painless! (In donating plasma, I had the blood end up clotting and I didn't notice, neither did anyone else until it was running all over the place, was one instance.) I don't donate plasma anymore, but it's not because of that. My last couple of donations, I started vomiting mid-donation. Not sure if because of the anti-coagulant or if my electrolytes got imbalanced, but I decided after 2 times of vomiting in public (You know how donation centers are, with like 20 people in there with you), that was enough. Sorry, I guess I just chased a rabbit!

    Anyhow, thanks for the good job you guys do and the gentleness you do it with and often get no credit for!
  7. by   TraumaInTheSlot
    thats just it, its not done by sight, its done by feel. some veins are better than others.

    i think IVs hurt no matter where u out them. of course, those docs that put them on the inside of the wrist should be shot.
  8. by   kmrmom42
    In L&D we always try to use 18 g. We need to have a large bore for fluid resucitation fetus, for hypotension r/t epidurals, for stat c-sections or for blood. I will only use a 20 if I have no other choice.
  9. by   fergus51
    Quote from SmilingBluEyes
    I have NEVER been able to develop the skill of FEELING for good veins. Am I just stupid??? ugh.
    I'm terrible at palpating too. I need to see it, and I admit, I can seldom feel that "pop" in my babies. I also don't like using that wierdo light thingy, but a good 80% of the nurses here seem to.
  10. by   avahsmiles
    Quote from TraumaInTheSlot
    ... those docs that put them on the inside of the wrist should be shot.
    Ain't that the truth!! I had a nurse that put an IV in my wrist when i was admitted to deliver my 2nd child. I still remember the IV pain was worst in comparison to the actual natural birth pain!
  11. by   elnski
    Quote from TraumaInTheSlot
    thats just it, its not done by sight, its done by feel. some veins are better than others.

    i think IVs hurt no matter where u out them. of course, those docs that put them on the inside of the wrist should be shot.
    Oh yeah..shoot em all:angryfire ....when i was admitted for ?AGN, this doc cant get through my visible, bouncing veins on my hands and forearms..twas d 6th cannulla on the inside of my wrist she got.... i asked is ther sumthing wrong w/ my veins?..well, she politely sed, "no, ur veins r perfect..twas me..cuz i know ur a nurse"....:uhoh21:
  12. by   CRNAsoon
    Quote from stevierae
    ... IVs are standardized everywhere in the world--18G is green, 20 is pink, 22 is blue, 24 is yellow--regardless of brand.
    I've seen grey catheters before. Anyone know what size they are?
  13. by   thanatos
    Quote from CRNAsoon
    I've seen grey catheters before. Anyone know what size they are?
    grey = 16g

    orange = 14g

    at least at my hospital and with our local ambulance/fire services