IV starts - page 2
I've been on a bad streak with starting IV's for the past couple weeks... I swear EVERY TIME I blow the vein. :uhoh3: Let me tell you how I normally start them... I obviously follow Policy and... Read More
Dec 6, '06Specialty: med/surg, telemetry, IV therapy, mgmt ; Joined: May '05; Posts: 15,027; Likes: 8,983It doesn't matter if you go in from the top or the side of the vein. The important thing is that you anchor the vein securely, otherwise it's going to roll around like a little worm and your chances of "blowing" it are greatly increased.
You all might want to waltz over to the Emergency Nursing Forum and check out this thread on IV tips and tricks. There is a lot of very, very good information and advice that has been posted on that thread:
Dec 6, '06Joined: Oct '06; Posts: 230; Likes: 14Quote from NurseWi_JennJennI've been on a bad streak with starting IV's for the past couple weeks... I swear EVERY TIME I blow the vein. Let me tell you how I normally start them... I obviously follow Policy and procedure so let's just go straight to inserting the needle... (btw policy is to use a saline wheel first), so after I put the wheel in, I come in from the side of the vein (normally the right side). I get it in the vein, start advancing it, and than the veing blows... I'm getting so frustrated. I know I can do it, but don't know what the heck the problem has been lately...
So my question is:
A. Do you go in over top the vein or from the side...
I go over top of the vein, but it seems most nurses come from the side. But I have to say, I work in a busy ER and start many during my shifr. I miss very few. I usually wet the site well with alcohol first, I then feel the vein (most times I don't look at it I just feel it , I'm feeling for the veins integrity as opposed to the look of it ). Many times those big fire hose veins are easy blowers. I insert the cath from the top of the vein just until I get a flash back , then I place my saline lock on and flush the cath up the vein. (after removing the tournique) For some reason I found If I have the cath at a point where I have a good flash then the cath advances eaisier , without blowing. But , any way I think the thing is , to find a vien with good integrity first. (which is impossible some times)
B. Do you have any advice/tricks/tips for me to get these in without blowing the vein all the time?
Thanks so much in advance!!!
Put my message in the wrong spot , see above. sorry
Dec 6, '06Occupation: Employee Health Nurse Specialty: 5 year(s) of experience in ER/Occupational/Infection Control ; Joined: Jul '06; Posts: 7I was a paramedic both ground and flight before nursing and still work as a medic prn so I am used having unique challenges starting IVs both on the ground and in the air. Thus far I have been very successful. As far as technique I have always tried to anchor the vein with a side to side grip as well as make sure to loosen the cannula on the needle. I have noticed most problems seen during precepting others come from too acute of an angle and passing through the vein or in many cases not getting the catheter into the vein, by that I mean you will notice an appx 2 - 3mm space between the end of the needle and the end of the catheter so just because you have flashback does not mean the catheter has passed into the lumen of the vein. Once I get flash I ususally advance a little more. Lastly I have infiltrated with lido prior to starting but I have a hard time reconciling sticking someone to stick someone, usually I just get it done quickly. I don't know if this has been any help but it was fun.
God Bless and Merry Christmas
Dec 6, '06Occupation: RN, Cardiac Step Down/Tele Unit Specialty: Cardiac ; Joined: Jul '06; Posts: 281; Likes: 18I am a student and have never heard of using a wheal before and IV start. Do you end up sticking them twice, or do you use the same needle/catheter? How do you inject the NS or lido? Sorry if this sounds stupid, I just cannot picture this to save my life!
Dec 6, '06Specialty: med/surg, telemetry, IV therapy, mgmt ; Joined: May '05; Posts: 15,027; Likes: 8,983fleur-de-lis. . .When I worked on an IV team we had the option of "numbing" someone's IV site before inserting the actual IV. Sometimes patients who knew we did this would ask that we "numb" them first. It involves doing an intradermal injection of 1/10 of a cc of 1% Lidocaine with a tuberculin syringe at the spot where you will be inserting the IV device and bringing up a wheal. You then insert the IV device through the same puncture hole. Usually, it results in the insertion of the IV device being painless. Some advocate the use of saline rather than the 1% Lidocaine. Sometimes the saline works to prevent pain; sometimes it doesn't. I have my theory as to why it doesn't work, but it's only a theory and I have no evidence to back it up. You need a doctor's order to inject the Lidocaine or a facility policy to cover you doing this.
Dec 8, '06Joined: Oct '06; Posts: 2,602; Likes: 3,890LOL thank god we do not have to put a "wheel" over the site before the stick, that would be challenging...
Dec 8, '06Occupation: RN Specialty: 30 year(s) of experience in vascular, med surg, home health , rehab, ; Joined: May '04; Posts: 298; Likes: 488with elderly fragile veins, try not using a tournequet, but a bp cuff inflated to about 60. That seem to help.
Dec 8, '06Joined: Oct '06; Posts: 1,256; Likes: 66OKay, I use forearm veins, they are my favs, but they don't pop out, so I rarely use a tourniquit. I rarely miss, sometimes I need to try twice. These veines are stable. I use the forearm veins, palm side up.
They are more stable than palm down veins that stick out much better, but roll. Not too many people use these because they don't pop out, but I have real success with them. I use a warm blanket to relax the veins. I agree, forget the tourniquit on the old folks. Don't forget that diabetics have a smaller lumen even if their veins pop out and look great.
Dec 8, '06Occupation: med/surg/ortho RN Joined: Oct '01; Posts: 2,617; Likes: 161I go in over the top of the vein using somewhat of a scooping motion. That way if you have one that is rolling you can secure it and keep it from moving much. Also if you try to stick at a bifurcation it is easier too. You might try that and see how it works for you.
Dec 9, '06Occupation: RN Specialty: Medical Progressive Care Unit ; Joined: Mar '04; Posts: 60; Likes: 11once you get the flash, hook a 3cc (no bigger) syringe to the catheter and push a small amount of saling into the vein to *open* it up while you advance it. bigger syringes create too much pressure and blow the vein. Works like a charm!!!!!!!
Dec 9, '06Joined: Oct '06; Posts: 1,256; Likes: 66Quote from dbihlIst of all, where I work we have safety equipment that prevents one from hooking up a syringe to an IV until the needle is removed. Secondly, I think you have that reverse. A 3cc syringe creates higher pressure on the vein, which is why you must never use smaller than a 10cc syringe to flush any central line. A 3cc syringe, however, creates less negative pressure when aspirating blood from a line, which makes it less likely to collapse the vein and makes blood draws easier.once you get the flash, hook a 3cc (no bigger) syringe to the catheter and push a small amount of saling into the vein to *open* it up while you advance it. bigger syringes create too much pressure and blow the vein. Works like a charm!!!!!!!
Large syringes create LESS pressure when flushing lines. Never use a small syringe when flushing central lines!
Dec 9, '06Occupation: Medical Device co. Specialty: 10 year(s) of experience in Critical care, cardiothoracics, VADs ; Joined: Nov '05; Posts: 1,470; Likes: 48Given that this thread is about IV sticks, I highly doubt they were referring to central lines.
Dec 9, '06Occupation: RN Specialty: Neuro ICU, Neuro/Trauma stepdown ; Joined: Oct '05; Posts: 525; Likes: 54Quote from Alabama_Medici think both of these were my problem last night. my "hold" is not working for me, but i see how a side to side would...also, i've notice that gap, but hadn't made the connection as to what that means to my stick...thanks!As far as technique I have always tried to anchor the vein with a side to side grip as well as make sure to loosen the cannula on the needle. I have noticed most problems seen during precepting others come from too acute of an angle and passing through the vein or in many cases not getting the catheter into the vein, by that I mean you will notice an appx 2 - 3mm space between the end of the needle and the end of the catheter so just because you have flashback does not mean the catheter has passed into the lumen of the vein. Once I get flash I ususally advance a little more.