Hand IV trouble

Cvepo · Jun 22, 2017

Hand veins are tricky because depending on the anatomy, sometimes they turn, curve, or go deeper and you can't see where they go to properly thread it. Honestly, some people just struggle with certain areas. I suck at ACs. I cannot get one to save my life. However, I rock at upper arm PIVs and hand IVs; I've even gotten a 22# in a thumb once that lasted (and had a slight blood return!) for 3 days! Keep practicing!

But don't beat yourself up over failing on old ladies; they are probably the hardest IVs/sticks in the business! Those and chronic kidney failure patients haha

LovingLife123 · Jun 22, 2017

I'm terrible at older people. Their veins often look good but blow right away. I'm best at the ac but hate putting them there because they always bend their elbows and they beep. I'm better at hands though than forearms. I need to be able to feel and see something.

Racer15, BSN, RN · Jun 23, 2017

In elderly folks, if the vein is popping up pretty well just hanging it off the side of the bed, I don't use a tourniquet. Reduces the number of veins I have blow.

missmollie, ADN, BSN, RN · Jun 23, 2017

Agree with Racer on the tourniquet advice. The other thing is once you get flashback, stop pushing the needle in. I like to hook up the flush and float the catheter in. That way it can travel the path of the vein without puncturing it.

If other nurses are able to get hand veins, ask to come in the next time they do it. You may see differences in what they do vs what you do, and that can help!

iluvivt, BSN, RN · Jun 23, 2017

Hand veins are very visible on most patients and therefore are NOT deep so the first thing you need to do is check your angle of entry. You usually can just go flush with the skin and if you need an angle to get through thick skin make sure once you use it to get through the skin drop it down before entry into the vein. This is a very common mistake... Angle of entry too deep. Next in the hand you need good traction and my favorite way to do this with a hand vein is to use my nondominant hand to cup their hand and at the same time pull a bit of downward traction. It's best if you can do a one handed IV start so you never let go of your traction until the cannula is threaded. An introcan or insyte is easy to do one handed. You can also pull up skin and then apply your tourniquet and use it to pull up loose skin and get upward traction. It's tricky to to do at first but it really works. Next you need to select where you are going to perform the venipuncture exactly. Start with the easier veins on the top of the hand and look for a fairly straight section. Estimate where the tip will end so it does terminate at the bend of the wrist and cause your pump to beep constantly. Avoid below the thumb and the short curvy veins until you master the easier ones. Once you access the vein make sure you advance it slightly before you pull the needle back just a bit. You just want the sharp tip pulled back ever so slightly while still having the nice stiff needle in the cannula so it can be advanced and not buckle. I can help you more if you can describe where exactly you are going wrong in detail..my phone keeps deleting my paragraphs sorry

mariaconcetta · Jun 24, 2017

Thank you for your advice. I do think my angle of entry in the vein might be part of my problem. What usually happens is I get a flash but not a lot , then it stops. I try to pull back and see if I went to far in. Not always successful. I also sometimes go to advance the catheter after getting in the vein and it doesn't go in. I can see the catheter curling and not going in the vein. I hate sticking the patient more than once, because I know the IV is their biggest concern. I work in a one day surgery center and I learn a lot from the nurses I work with. I some times get really tough sticks, but then miss veins that look easy. I appreciate all the tips and comments posted. IV's have not been easy for me and I have to work on improving my skills.

akulahawkRN, ADN, RN, EMT-P · Jun 25, 2017

Thank you for your advice. I do think my angle of entry in the vein might be part of my problem. What usually happens is I get a flash but not a lot , then it stops. I try to pull back and see if I went to far in. Not always successful. I also sometimes go to advance the catheter after getting in the vein and it doesn't go in. I can see the catheter curling and not going in the vein. I hate sticking the patient more than once, because I know the IV is their biggest concern. I work in a one day surgery center and I learn a lot from the nurses I work with. I some times get really tough sticks, but then miss veins that look easy. I appreciate all the tips and comments posted. IV's have not been easy for me and I have to work on improving my skills.

If you see a flash and then you see the cath curling, it's probably because you've inadvertently gone too deep and through the back of the vein. The biggest tip I can give is that you should have a very good sense for how much needle sticks out past the catheter. Once you get a flash, advance maybe 1/2 of what you think that distance is and then try threading the catheter. Chances are it'll thread. Why? When you get the flash, it's because you're already in the vein and the time it took for the blood to show (the flash) probably got the cath into the vein without perforating the other side.

One of the tips of having a nearly flat angle is also very helpful. Get into the skin and then once there, stay nearly flat and aim for the middle of the lumen, if you have to increase the angle, do it ever so slightly and you should find success. This technique can also work when having to cannulate shallow veins elsewhere. The other day I was able to plant two 18g caths in an elderly patient with very thin/fragile skin using basically the technique described here. I was quite amazed that one of them didn't blow...

iluvivt, BSN, RN · Jun 25, 2017

Ok now I know what you are doing. Your aim and angle is not good. If you are just getting a little flash and then it stops...... you have only nicked the vein and/or done a through and through puncture of the back wall or side wall of the vein. So you must take some extra time before actually performing the venipuncture and carefully select where you will make the entry into the skin. Leave yourself enough room to get through the skin (especially if thick) then drop your angle to almost flush to the skin.. then aim for the vein and try to enter from the top and not the side (side entry is a bit tricky for a novice) once you get a flash drop your angle if you still have any and advance as a until about 1/8 an inch or so then pull back the needle just a bit.... (Your blood should still be filling up the flashback chamber) then slide the remainder of the cannula in. I still want you to hold traction and get your target vein as full as you can before you poke. Please take a catheter and play with it... Look at a few gauges that you use... Look at needle tip and see how much you need to advance after you get your flash... Do you get why you must advance after you hit the vein? Try this things and disect every part of your steps to see where you are making your mistakes so you can improve and good for you for trying and I am happy to help. It always upsets me that RNs are expected to have all of that's skills when the reality is that it is very difficult. On Friday every call I had was difficult.... I got them all but it took me a long time just looking for something to even try. Almost all my calls were for African Americans. I find that nurses really struggle with venipuncture in this population. Of course almost every call I get is on a patient that has already been tried. Once in awhile I get a new grad and I am so happy I get an easy one. :yes:

mariaconcetta · Jun 25, 2017

Thank you for your advice, I will keep it in mind as I start all my IV's. I learn so much from people like you that are very experienced . It's my goal to improve on my IV skills, and not feeling guilty about sticking patients twice.

mariaconcetta · Jun 25, 2017

Thanks for the tips. I will use them tomorrow and hope for better success. It's good to hear from other nurses with expertise in starting IV's. It is so much help to me!!!

Editorial Team / Moderator · Jun 25, 2017

Picture what is happening: IV cath goes in bevel-up, so when you get a flash, only advance it further the length of the bevel to avoid going out the back of the vein. If you only advance that little bit, the cannula will be in the vein and should advance. Hope that makes sense.