IV starts help!

loricatus · Jan 6, 2009

Once you get return do you level out and advance a bit more before you advance the catheter, without the needle? Sounds like you may just be piercing the vein but not have fully entered it-that would account for the bend (not being in the vein, but being pushed against it). If you cannot easily advance the catheter without the needle, just try to advance more with the needle. The catheter should easily advance when in a vein, to the point it can float in when the needle is pulled back.

If you are in the vein and have this problem, you could be hitting a valve. Sometimes you can push through it and other times you cannot.

Have a peek at this site:

http://enw.org/IVStarts.htm

DIVA_NURSE405 · Jan 6, 2009

Yea once i see blood return i drop it slightly then advance my needle a little more then the cath. Thanks for that website it sounds very informative

suanna · Jan 6, 2009

Start with confidence-don't sneek up on the vein. A tenative stick will rarely get good result. Try inverting the needle I know this sounds wrong but you can get a "false flash" when the tip of the angiocath introducer needle enters the vein but the actual catheter tip isn't in the lumen of the vein. When you try to advance the catheter it just bunches up trying to push through a tiny prick caused by the tip of the needle. If you insert with the needle inverted the needle enters more flush with the vein and the cateter enters the vein the same time the needle does. Try to insert at points of bifercation of the vein-spear the "Y". That way vein motion is not an issue. Use a BP cuff instead of a tourniquet. If you hold the BP cuff pressure 20-30 mm/Hg below systole the vein will engourge more. For very fragile veins hold the BP cuff pressure 10-20 points above diastole so the pressure in the vein is less and you don't pop the vein like an old innertube. Coach the patient- If they are anxious (most are) tell them to keep the arm you are using relaxed. Tense up the other one if they need to but you will never start an IV in a clenched arm. Before you stick, tap the area you are going to stick with two fingers like you are doing percussion assessment. If the vein is a good site it will become more engourged and obvious- I've seen nurses slap the site but haven't seen any benifit to starting the IV from this. It just makes the patient more aggitated. Practice does make perfect. I've been starting IVs for 25 years and if I haven't started one for a few weeks I still don't get it first try every time.

Boston-RN, RN · Jan 6, 2009

thanks for this thread....one problem I have (hopefully this isn't going to hijack) is identifing where the valves are....I have pretty decent success with my starts but more often than I would like I find a valve....any tips

leslie :-D · Jan 6, 2009

definitely start below bifurcation sites, and drop/level needle before advancing.

if you still meet resistance, pull back a bit and repo.

i too, use bp cuff vs tourniquet.

elderly's veins blow very easily.

better off starting higher up w/these folks.

and pt relaxing arm, means everything.

leslie

RedhairedNurse, BSN, RN · Jan 6, 2009

I've also noticed that if I don't pop the tourniquet right after I get my flashback, the vein will blow. So take off that tourniquet right after you know your in the vein.

BlueBug · Jan 6, 2009

Hey there, practicing, often, really does make a difference. No matter how good you get, you won't get all of them, and then the ones you miss are not always the hardest looking all the time. What looks like a sure thing can turn into mission impossible. Some days you are the one who finally gets lucky on that hard to start patient.

I always wiggle/spin the cath loose before inserting because sometimes they seem stubborn once inserted.

I pull up a chair and position my self so I am as comfortable as possible.

I avoid using a tourniquet if possible, especially in older patients. If I have to use one, I remove it as soon as possible, always before flushing.

Be gentle when you flush the vein, some nurses bury the plunger and blow an otherwise good IV start.

If the vein suddenly disappears on you, make sure you haven't accidently blocked the vein with your fingers and cut off the blood supply. Seems obvious but it can happen by accident and is one of my personal stupid tricks to pull when starting an IV. Just move your offending hand and the vein should reappear.

If you are easing the cath in and it stops, sometimes gently twisting it while trying to advance it will help. This will sometimes help if you are running into a valve.

Sometimes you can find large veins close to the surface on a person's upper arm.

Good luck, and remember that no one is successful all the time.

~BlueBug

* OH yeah, Sometimes you see little "bumps" or slightly enlarged spots on a vein, those are valves. Sometimes you can see them, sometimes you can't. Try to avoid placing an IV where you can see that the cath would pass through a valve. Sometimes you can't see them to avoid them.

loricatus · Jan 6, 2009

thanks for this thread....one problem I have (hopefully this isn't going to hijack) is identifing where the valves are....I have pretty decent success with my starts but more often than I would like I find a valve....any tips

Close your eyes when palpating the vein and you will feel less of a 'bounce' where valves are. Of course, this is only good for the superficial veins. Pick one of those who do some form of exercise or body building because they seem to have more pronounced valves that you can even visualize by a 'bump'

You do have some options to get past the valve: Pushing through with the needle (greatest chance of blowing the vein with this one) or floating it through by either using the flush or a wide open line. I sometimes have success just trying to twist the cannula through. And, as another poster mentioned, be sure to remove the tourniquet

mscsrjhm · Jan 6, 2009

Plenty of light, and raise the bed to a level comfortable for you.

I ask the patient to drop their extremity lower than their heart for a few minutes prior to the attempt- I prefer this to tourniquets or bp cuffs.

redfoxLPN · Jan 6, 2009

This is great I just took my IV certifacion class at the hospital where I work (that is how it is done in NY). This is so helpfull. The more I read the more confondent I get. :up:

I'm still a little nurvis, but that's OK. I just say to my self "I can do this" or "so-in-so does this I can to". :chuckle

FireStarterRN, BSN, RN · Jan 6, 2009

I often don't use a tourniquet at all, it really helps on the old folks. All the other above advise is great! Also, take your time finding a site. Plus warming up the vein ahead of time helps relax and dialate the vein. I like a heated blanket, it'll catch any blood too.