IV starts

Nurses General Nursing

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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 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...

and

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!!!

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Specializes in med/surg.

Hi

I usually go in on top of the vein. Then when I feel the pop, I lower the cath and start advancing. Going in on the right seems like it would be hard. By the way, what is the "wheel" you are talking about?

Also, pretty soon you will start getting a lot of good IV advice. I'll look for it myself. You can always learn new things. Good luck.

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Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

I usually go in from the top or side depeding on the vein. Remember when you first get the flash you need to flatten the catheter almost against the skin, but not touching it obviously so that you do not just go through the other side of the vein. Also remember you need to adjust the angle that you insert based on the vein itself, if it is a large superficial vein obviously you should be at less than a 45 degree angle and vise versa... Hope this helps

Swtooth

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Specializes in Day Surgery/Infusion/ED.

I think she means "wheal," the small bubble that is formed if you use saline/buffered lido intradermally at the site prior to starting the IV. It helps reduce the pain of the IV insertion.

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We use a saline wheel as a numbing agent. It's exactly like doing a PPD test, but instead, we use saline. We insert it on top of the vein or next to it, depending on where you insert the actual needle. When starting the IV than, we go through the 'wheel' so the patient doesn't have any pain. If you ask me, I hate having to use it. It's like trying to start an IV blind sometimes because the wheel makes it hard to see the vein than. I know it really does help with the pain issue for the patient, but just makes it difficult to start it.

Thanks for responding!! I appreciate your support/advice!

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Specializes in Emergency & Trauma/Adult ICU.
We use a saline wheel as a numbing agent. It's exactly like doing a PPD test, but instead, we use saline. We insert it on top of the vein or next to it, depending on where you insert the actual needle. When starting the IV than, we go through the 'wheel' so the patient doesn't have any pain. If you ask me, I hate having to use it. It's like trying to start an IV blind sometimes because the wheel makes it hard to see the vein than. I know it really does help with the pain issue for the patient, but just makes it difficult to start it.

Thanks for responding!! I appreciate your support/advice!

OP is referring to a wheal (not wheel - that's the thing w/the tire attached to it on your car ;) ) -- think intradermal injections.

Wheal or no wheal, it's probably best to go in right on top of the vein - isn't going at it from the side greatly increasing the chances that the vein will roll? Sounds like it's making it harder than it has to be.

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Yeah, "wheal" that's what I meant...sorry don't know how to spell.

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I go in the top of the vein after injecting a wheal of lidocaine which is what we use, but I agree with other posters who say that once you get the flash to lower the angle of the cath. and thread it in. I find going in on top of the vein is much easier than trying to "fish" for it in the side of the vein

hope that helps. but with anything...keep at it and you'll get better at it.

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They require using a saline wheal? We are allowed to use lidocaine where I work, but I find it interferes and causes more trouble than it's worth.

On older pts I often don't use a tourniquit, that helps with not blowing the vein. I can go either from the top or side, depends on the vein. I almost always use a warm blanket ahead of time, that relaxes the veins.

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Specializes in med/surg.

MLOS: Silly me, why didn't I realize that they don't use "heavy equipment" to start an IV? I had to laugh about that one! That would have been easy enough for me to figure it out. Oh well.

Also, I have found for myself, using the wheal hurts about the same.

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I use lido with sensitive people because they are more likely to squirm and move while trying to thread the cath, and with kids if I don't have time to wait for EMLA to work. I buffer it with bicarb so the lido doesn't burn.

As for the technique, I've been thinking about this and I can't really say I have one technique. It depends on the location, size, and pathway of the vessel for me. I do not believe in rolling veins, I anchor the vein above and below my puncture site with my opposite thumb and index finger. As for angles, once you get a flash, decrease the angle before threading the cath in.

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I would be careful anchoring the vein above the site, you might wind up sticking yourself if you do this. I anchor, but only below the vein and if the pt is able to follow directions, I ask them to hold their hand in a fist position if it is going in the hand, this helps keep the vein nice and taught. If I am placing it in the inner arm, I sometimes place a pillow underneath to keep the arm nice and straight. However, we do not us lidocaine or ns wheals with our iv insertions. Lightning Bug RN ;)

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