IV starts - page 2
Seems somewhat elementary but I would say that my IV skills are average. Now that I am working in an outpatient surgery center part time, I have many more opportunities to practice my skills. Other... Read More
Sep 16, '02Occupation: Hospice clinical director Joined: May '02; Posts: 2,873; Likes: 26Jen911: LOL..."vampires like to work in the dark." I almost snorted the Coke I was drinking out of my nose when I read that!
Sep 16, '02Joined: Mar '01; Posts: 1,898; Likes: 37I find that if you are over 40 and having trouble finding veins, buying a pair of nonprescription glasses really helps.
It did wonders for me, now if I can just remember where I put them half the time.
Sep 16, '02Occupation: travel nurse - ob Specialty: OB ; Joined: Jul '01; Posts: 3,170; Likes: 4,503I tend to work more by the "feel" of a vein than visual. For difficulty advancing an i.v. cath, try attaching the tubing and "float" the catheter in - works well if up against a valve.
I get the biggest laugh out of pts. who profess to be scared of i.v.'s, raise a fuss, and when you look they have a hoop in their eyebrow and a stud in their tongue!
Sep 17, '02Joined: Mar '02; Posts: 1,888; Likes: 117Use local if your facility allows it. Can be as dilute as 0.5% Xylocaine (Plain) approx. 0.25 cc to make a wheal, with a 30 G needle.
If you are going to use 1% Plain, buffer it with injectable NaHCO3--1cc NaHCO3 to every 10 cc Xylocaine. That way, the intradermal injection won't sting.
DON"T use Xylocaine with Epinephrine, and don't use Marcaine (Bupivicaine.)
Stick to the basics--don't invite trouble.
I often see people slapping a vein, or getting down on their knees to insert the catheter. Such unnecessary drama!
I agree with those who said the vein seems to pop up the best when you hang the arm down and lightly "stroke" the vein. I usually sit for my IV starts.
Some nurses have good luck, if they are doing a hand vein, by immersing the hand in a graduate or bowl of warm water for a little while.
Antecubital vein is usually the easiest, but try to start lower, and work up. Save that as your last resort.
Most of the newer IVs (i.e., InSyte AutoGuard, Introcan) are very sharp; therefore, you will not feel a "pop" when you enter the vein. That "pop" is trauma to the vein wall from a dull stylet. Learn to depend more on the "flash."
Take your time, and go in at the angle recommended by the manufacturer. InSyte AutoGuard, by BD, works best with a "low and slow" approach (10 to 15 degree angle of insertion.) Introcan, on the other hand, by B Braun, is 30 to 45 degrees.
Learn to discern veins more by palpation, then by having to depend on good lighting. Somewhere, sometime, you might not have the luxury of good lighting.
One more thing: if you have an IV drug abuser, let him start his own. Trust me--he is adept, and will not miss.Last edit by stevierae on Sep 17, '02
Sep 17, '02Occupation: travel nurse - ob Specialty: OB ; Joined: Jul '01; Posts: 3,170; Likes: 4,503I tend to kneel at the bedside at times - not drama - just easier on my poor, tired, middle aged back! Even sitting in a chair makes me bend.
Sep 17, '02Occupation: CCU Joined: Aug '02; Posts: 572; Likes: 6There are some great ideas here!
I have also found it helpful on certain patients to use a small marker when having to feel for the vein and making a small line on each side parallel to the vein to help define the borders.
Sep 17, '02Occupation: ER RN Specialty: ER,ICU,L&D,OR,ETC ; Joined: May '01; Posts: 5,588; Likes: 566Howdy yall
from deep in the heat of texas
Use good lighting.
use local anesthesia
take your time
make yourself comfortable, I like a stool, saves my old back.
Also good IV starting is like good putting, Line up your site and take a nice easy stroke. Never hurts to pray a little, too.
doo wah ditty
Sep 17, '02Occupation: rn supervisor Joined: Jul '02; Posts: 472; Likes: 10I love the challenge of a hard stick so here's my 2 cents;
- I never look, but feel for the vein, must be at least 1 inch long when stabalized at the base without the lumps and bumps
-I first put the turniquete just below the shoulder, going above the antecubital gives you rare, larger finds, not disturbed by bending.
-The vein above the radial artery when you hold the hand sideways is good, plus the thumb.... everyone avoids it yet a 22 fits perfectly if you stabalize below and float the catheter in once you get a flash back.
-The underside of the forearm is a great place too, especially in men, never interfers with movement... but positioning yourself and the arm takes practice.
-Again, forget what it looks like... go for spongy feel even if you can't see.
Thanks for letting me share some tips.... good luck