Hand IV trouble

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I have been doing IV's for 3 years but continue to have trouble putting IV's in the back of the hand. Especially thin or elderly women, I get a flash but then it stops. Sometimes the vein blows.I tend to avoid the hand sites at all costs, but sometimes that is the best spot.Today I had 3 patients with good hand veins with no success. Any suggestions to help me improve my IV skills?

yes it does. Tomorrow I will look carefully at the needle tip and see where the cannula starts. I could be advancing it more than the difference of the two. Thanks so much for the help.

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I had a great IV day today! Even got some really tough ones. I used several of your tips, lowering my angle and really looking at the IV catheter , and seeing the length of the bevel and where the cannula starts. I lessened the amount I advance the needle after getting a flash. That also seems to help. Thank you all for your helpful tips!! It really did help!!

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Awesome!!! :)

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Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
I had a great IV day today! Even got some really tough ones. I used several of your tips, lowering my angle and really looking at the IV catheter , and seeing the length of the bevel and where the cannula starts. I lessened the amount I advance the needle after getting a flash. That also seems to help. Thank you all for your helpful tips!! It really did help!!

I knew it would happen!

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I had two difficult IV patients today that I used AC sites on. Both c/o a lot of discomfort when I was putting the IV in? I wondered if anyone had any suggestions? Could it be I wasn't using enough traction which I find hard to do in patients using their AC? Any tips for me? Thanks.

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Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
I had two difficult IV patients today that I used AC sites on. Both c/o a lot of discomfort when I was putting the IV in? I wondered if anyone had any suggestions? Could it be I wasn't using enough traction which I find hard to do in patients using their AC? Any tips for me? Thanks.

A disclaimer here b/c I was (obviously) not present and available to "critique" during these insertions. I'm going to go out on a limb here and say, with confidence, that you are doing just fine. Patients are stressed and fearful of the healthcare experience, and I have empathy for that. (I've had a few surgeries and having two in July so understand.) Some discomfort is to be expected by the patient during IV insertion. I've inserted IVs myself that were hardly noticed by patients and been poked myself with with minimal discomfort. Perhaps warning the patient ahead of time may help; you may already be doing this. Keep up the good work and please believe me you are on the right path. Like most life experiences, it just takes time.

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Specializes in Emergency Department.
I had a great IV day today! Even got some really tough ones. I used several of your tips, lowering my angle and really looking at the IV catheter , and seeing the length of the bevel and where the cannula starts. I lessened the amount I advance the needle after getting a flash. That also seems to help. Thank you all for your helpful tips!! It really did help!!

That's awesome! Keep at it, pick 2 sites, try the more difficult one first (experience when you miss, confidence booster when you nail it!) and eventually you'll be someone that can somehow manage to get IV lines in just about everyone that isn't as dry as a prune.

I had two difficult IV patients today that I used AC sites on. Both c/o a lot of discomfort when I was putting the IV in? I wondered if anyone had any suggestions? Could it be I wasn't using enough traction which I find hard to do in patients using their AC? Any tips for me? Thanks.

Some people notice the discomfort of IV insertion more than others. Remember that pain is both a signal from nociceptors to the brain and an emotional response to those signals. Some people just are more "emotional" about their discomfort and therefore they actually likely experience more pain. Most of the nociceptors are in the skin and there are fewer present in deeper tissue. If you get through the skin relatively quickly, you can actually limit the size of the signal sent. Distraction also works well as does coaching the patient's breathing or use guided imagery. With injections I actually heavily vibrate the skin in the area of puncture as this overdrives deep pressure and vibration sensitive neurons and this basically shuts down the pain signals at the spinal cord (gate control theory of pain control). Not easy to do with IV starts unfortunately. If you know your patient is very sensitive, you might be able to treat them like a pediatric patient and get them some topical anesthetic cream or (if allowed) perhaps a small wheal of lidocaine right at the insertion site can also help reduce the discomfort. Probably getting the patient to just mentally and physically relax would be just as effective as anything as long as the patient doesn't move during the insertion.

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Specializes in Infusion Nursing, Home Health Infusion.

After you have started many IVS you will learn that not only are some patients more tolerant of pain you will also learn that certain areas are more painful. The volar wrist,hand, anterior surfaces and ACF can be sensitive.You must know there is an H and M pattern of the veins on the ACF and you must know where the nerves are. If you are attempting venipuncture in the Acf and your patient complains of pain you need to ask them what kind of pain or ask them if it is a shooting electrical type of pain. If they say it is then you touched a nerve and must know what to do. I have a diagram that will help... I will find it on Sunday on my work computer and send it.

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What do you do if you hit a nerve? I just took out the needle, the patient seemed to be in a lot of pain.

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