Having trouble with IV's! Can't get them to thread...

FLArn · May 9, 2011

Sometimes if you flush gently as you try to advance the cannula it will help. I always attach an extender to my peripheral lines so I use a 10 cc syringe when starting a line. I get a flash then attach the extender and flush gently as I advance the cannula. I find that using the extender also helps my site last longer than having to access the heplock directly. The force needed to attach the needleless connectors to flush and/or give pushes seems to take a toll on the site. Especially on the fragile veins in the geriatric population.

tokmom, BSN, RN · May 9, 2011

I was going to advise to float the catheter too, but FLArn already did.

You might be hitting a valve too, so pull back a bit and see if that helps.

Slobgob · May 9, 2011

I'll lend my two cents here. I use to be terrible... now I'm known as the "IV Ninja".

Reasons you have trouble floating the catheter:

1) The gauge is too large. A hard stick usually means small or tortuous veins. A smaller gauge for MANY reasons is superior to large ones. I'm generally speaking of a 22. The last hard stick I placed, it lasted 9 days before he D/Ced. Less infiltration, less external leaking, less phlebitis, easier catheter floating, less pain.

2) You are entering at too steep an angle. You will surely get blood flash, but floating a catheter against a vein (as opposed to at the same angle) will be difficult or blow the vein. This is not obvious for easy sticks, but shows itself on hard ones. The angle, in some cases, is not much more than a PPD injection.

3) You aren't in far enough. If at least half your needle isn't in... go further before you advance the catheter.

Oh. And. Practice. You can call yourself the IV Ninja too. Volunteer to start EVERYONE'S IVs. Give it 5 years... then check back with us. =)

colleennurse, ASN, RN · May 9, 2011

practice, practice, practice and more practice. This is a learned skill. Even if you are trying and blowing them and having to ask someone else to place it, that is much better than not trying at all.

imanedrn · May 9, 2011

I'll lend my two cents here. I use to be terrible... now I'm known as the "IV Ninja".
Reasons you have trouble floating the catheter:
1) The gauge is too large. A hard stick usually means small or tortuous veins. A smaller gauge for MANY reasons is superior to large ones. I'm generally speaking of a 22. The last hard stick I placed, it lasted 9 days before he D/Ced. Less infiltration, less external leaking, less phlebitis, easier catheter floating, less pain.

Stuck on minutiae here... Isn't 9 days against CDC guidelines?

NurseNathalie · May 9, 2011

Stuck on minutiae here... Isn't 9 days against CDC guidelines?

As far as I´m concerned, this is OK for peds veins or fragile or very difficult to stick veins...

TheCommuter, BSN, RN · May 9, 2011

Stuck on minutiae here... Isn't 9 days against CDC guidelines?

While 9 days is against CDC guidelines, what if you cannot get another IV started on the patient who is a very difficult stick? You (and the patient) will be up the creek without a paddle, especially if you work in a small facility with no IV team and a limited number of staff who are good at IV sticks.

Even though this is not textbook practice, we leave the previous heplock in while starting the new IV. If no one can establish IV access, the old one stays in, and we notify the attending physician. If the patient is going to be on IV therapy for a long time, the doctor will often order a PICC line placement.

Our rule of thumb is to not remove IV access on a difficult stick until someone can re-establish it.

imanedrn · May 9, 2011

As far as I´m concerned, this is OK for peds veins or fragile or very difficult to stick veins...

When infection is in question, what "we" are concerned with should not be our primary concern.

True for children, I had no idea:

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm

"Replace peripheral venous catheters at least every 72--96 hours in adults to prevent phlebitis (128). Leave peripheral venous catheters in place in children until IV therapy is completed, unless complications (e.g., phlebitis and infiltration) occur."

While 9 days is against CDC guidelines, what if you cannot get another IV started on the patient who is a very difficult stick? You (and the patient) will be up the creek without a paddle, especially if you work in a small facility with no IV team and a limited number of staff who are good at IV sticks.
Even though this is not textbook practice, we leave the previous heplock in while starting the new IV. If no one can establish IV access, the old one stays in, and we notify the attending physician. If the patient is going to be on IV therapy for a long time, the doctor will often order a PICC line placement.
Our rule of thumb is to not remove IV access on a difficult stick until someone can re-establish it.

I have no problems telling a physician their patient will NOT have IV access unless they order a central line or PICC. If you want to extend those 72-96 hrs for "a few" until you can get another site, ok... but I have issue with bending rules indefinitely when my patient's safety is in question.

Those guidelines aren't in place to make our lives more difficult. How do we expect nursing to be elevated as a profession if we don't follow IBPG? :banghead:

ObtundedRN, BSN, RN · May 9, 2011

My hospital's policy is to rotate IV sites every 72-96 hours, EXCEPT for those of us in the ICUs. Our standing orders state NOT to rotate sites. To keep them in for as long as they are free of s/sx of complications. But generally patient's end up ripping them out before phlebitis or anything else develops. And many of our patient's end up with central or PICC lines.

Turd Ferguson · May 9, 2011

A little trick I learned that really helped me out a lot...

When you first get flashback, drop the IV almost flat with the skin and lift up before you advance- this keeps the bevel running against the vein wall instead of the tip of the needle, lessening your chances of blowing the vein

MissBrahmsRN · May 9, 2011

-my trick? release the tourniquet immediately after you get a good flash. i get alot of people with s*** for veins and they *always* blow if you advance with your tourniquet still on. a tip from a good friend & when i tried it my success rate went way up.

-some people insist on 18s for everything but if it looks iffy, start with a 22, or a 20. it's better to have a smaller line than no line at all. i had a lady with 2 22s in once she was end stage hepatic disease and had teeny hard veins from overuse, she started destabilizing & needing better access and the docs popped in a IJ in about 3 min but when she was stable the 2 small lines served her well for fluids, meds, etc. if they'd insisted on 18s when she was admitted she would have been stuck over & over instead of twice.

-you can also be hitting valves. some people are just valvey (is that a word?), they have so many & their veins are very convoluted & theres not enough straight line to get a catheter threaded! pull back a bit. try the inner arm above the elbow i have lots of luck there with super valvey people