blowing veins during IV starts - page 4

I've been a nurse for seven months, and I'm doing well, except that I suck at starting IVs. In school I was almost completely unable to do them, and I've improved to the point that now I virtually... Read More

  1. by   sherbearccrn
    My Technique:
    [COLOR=#9b00d3]Anchoring/keeping the skin taut;
    Insertion to the forearm
    Say, I have a client with very loose, tissue-like skin. I choose the anterior forearm(where I might do a TB test) Although, this would probably NOT be my first choice, as it is extremely sensitive. I place my tourniquet ABOVE theelbow, prep the site (betadine, alcohol) per your hosp. policy. I always slightly twist the needle/cath to make sure the catheter will advance smoothly. Then I grasp the client's arm(on the opposite side I intend to insert the IV) posteriorly, and gently pull the skin toward the palm of my hand (this is the only way I can think to describe it, for you to get a visual). Obviously, I don't fill my hand with skin...but enough to smooth out the skin on the anterior side. As I smooth out the skin gently/firmly, I'm hopefully immobilizing and straightening out the vein underneath.
    Insertion to hand (posterior);
    [COLOR=#9b00d3]I hold the hand (as though I am going to kiss it ) and using my thumb gently/firmly pull downward to smooth the skin and straighten the vein.
    Other methods
    Depending on the site I choose. I will firmly "push" the skin up, above the area I'm intending to insert the IV so I can straighten/anchor the vein and smooth out the skin. Or, using your forefinger and thumb (as though your zooming in on an iphone) above and below the insertion site will help to smooth skin and straighten/immobilize the vein).
    [COLOR=#9b00d3]**If veins are really torturous you WILL have to keep it anchored until the catheter is completely advanced.
    Thick, rolling veins
    ...[COLOR=#9b00d3]**[COLOR=#9b00d3]Imagine cruising[COLOR=#9b00d3] next to another car and suddenly turning the wheel 45 degrees to hit it. (it's kind of a quick jab) you see a flash of blood then advance the needle a mm to insure your catheter is also in the vein before you move the shringe to a more parallel position, then continue to advance the catheter (otherwise, the catheter may bend)
    or push the mechanism that causes it to retract) before advancing catheter ....if you do, you may have alot of difficulty advancing the catheter esp.on clients with weathered, tough skin [COLOR=#9b00d3]**I have had the catheter tip wrinkle up as I'm trying to advance it over the needle.
    REMEMBER, YOU CAN NEVER RE-INSERT A NEEDLE THROUGH THE INSIDE OF AN IV CATHETER ONCE IT HAS BEEN REMOVED. (shearing of the tip may occur and cause an emboli to the patient)
    If a lot of blood is escaping I will place my ring finger from my non-dominant hand above the insertion site and over the underlying IV catheter [COLOR=#9b00d3]...**[COLOR=#9b00d3]never on the insertion site (remember, aseptic technique) to decrease the flow, and attach the "pigtail" (AKA; Lock, PRN adapter)
  2. by   eatmysoxRN
    I'm not sure if it's been mentioned, but an inflated blood pressure cuff is a fantastic tool in IV starts to replace tourniquets. They provide more even pressure and are much more comfortable to the patient and I doubt you'd miss a big bp cuff while you may overlook a tourniquet.

    The tightness of a tourniquet or cuff should depend on your veins. If they are already sticking up then you don't need to apply it tightly. I find veins blow more easily in those situations.

    Don't spend 10 minutes searching. Usually I look for 20 seconds and give it a shot. The procedure isn't pleasant for the patient.

    Make sure all of your supplies are ready. Tape pretorn (although our start kits have the little white cushioned adhesive holders). I also prefer to leave the loop tubing off and just use the lock cap. Have your saline lock primed and ready.

    Clean per policy and do not touch that site again. Anchor the skin: hold firmly a few inches down and be sure to go in bevel up. I go as parallel as possible and once I feel the pop into the vein and see flashback, advance slightly more and push the cathelon in. Release the anchoring. Pop the tourniquet. Apply pressure above the site with my pinky to prevent a crime scene. Hold the cathelon with the same hand you're applying pressure with. Remove the needle and screw on your lock. I pull back gently to see if I get some blood. Either way after that I'll flush gently. If it's resistant I pull the cathelon back slightly while pulling back to get blood return. Once I do I flush gently while advancing the cathelon further. Securely dress your site and clean up.

    It's okay if you don't get it. Be confident. Accept that you can't hit them all. Keep practicing.

    ~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~
  3. by   caleeah80
    I worry about iVs as well. I always make a mess--once removing the tourniquet and the needle, there's so much bleeding! Is that normal? I get flashback and it flushes without a problem, no swelling at the site either....
  4. by   SquishyRN
    Quote from caleeah80
    I worry about iVs as well. I always make a mess--once removing the tourniquet and the needle, there's so much bleeding! Is that normal? I get flashback and it flushes without a problem, no swelling at the site either....
    Apply pressure above the site as you withdraw the needle.
  5. by   rubato
    This is all great advice guys. I'm a student still, but I LOVE starting IVs. We have started them on our fellow students a lot, but I've now had success 3 times in clinicals. I have had pretty easy veins though, so far. I'm happy to read all the advice for that day when I've got a puzzle in front of me.