Having trouble starting IVs on the hand

[CaliLVN3583]

I work for a surgery center that requires all patients to have IVs started and 90% of these patients are elderly. I had never started IVs before on patients since I am still considered a new grad (8 months working). I worked in private duty for 6 months and I have been working for the surgery center for a month now and I can start the IVs on the forearm just fine, but its the back of the hands where Im having trouble. The Dr usually prefers the back of the hand so I keep trying to but for some reason, whenever I try to advance the catheter, the veins end up blowing.

In the forearm, I advance the cather just fine but I dont know what Im doing wrong! Is it the angle of the hand? What tips can you guys give?

[Caffeine_IV]

A general tip for starting IVs in the elderly is to NOT use the tourniquet...that works for me 90% of the time.

If you are already doing that, I don't have any other advice other than starting the IV a little further back or to the side of the vein.

I find that when I start IV in the hand people tend to flex and "fight" against it which can mess me up/slow down the process.

[JoblessNewGradRN]

Nice tips from lil'mama. Another thing I learned is floating it in with a steady and slow NS flush while you insert the catheter further into the vein. It takes a bit of practice, but I find it keeps the vein open enough for the catheter to insert nicely without so much pushing or force that you end up blowing the vein.

[nurse2033, MSN, RN]

Don't go too slow. Because their SQ tissue is either lacking or has poor tone, once the bevel hits the vein it is easy for blood to flow outside the vein. In healthy people this isn't usually a problem as their tissues are firm enough to keep a hematoma from forming. Once you pierce the vein get the whole cather into the vein before that happens. Hands especially seem to lose SQ tissue over time. One of the first times I ever drew blood the patient developed an instant hematoma the size of a golf ball, because I was going too slowly and carefully. Good luck.

[TheCommuter, BSN, RN]

Moved to the General Nursing Discussion forum for more responses.

[AznMattRN]

If its an elderly person, try starting the IV w/o a turnoquet if you can already see it... the veins are usually more frail and too much backpressure may be building up causing the vein to blow.

Also, be sure to a good job stabilizing the vein before you poke.

[licha]

I work daily with the elderly and what has helped me alot is the fact that nurses in our hospital became responsible in drawing labs (phlebotomy) in other words our RN 's carry out the orders to the max we draw the blood and start iv's. So being fresh out of school I was hit with this. Thanks to this my IV skills maximized:smokin: So my advise to you is to learn what a vein feels like and when you find a vein be gentle hold the vein (with your free hand) and proceed the secret is to take your time sit down next to patient and relax as you feel. Learn to feel the vein. The elderly are very fragile so you need patience and of course the technique of mastering the way a vein feels will help you a whole lot. (Also it helps alot to say a little prayer and be thankful when you finally are successful;))

[Fribblet]

Experience has taught me that sticks in the hand hurt worse, so people are more apt to jerk and move. The veins are also more superficial so be aware of your angle of attack.

In addition, make sure you're using an appropriate sized catheter. You may be able to squeeze an 18 g in granny's hand, but just because it fits doesn't always mean it's the appropriate size. If the catheter is too large, you increase the likelihood that the vein will blow.

I also find it disturbing that they're not letting you start IVs because you're "still considered a new grad." I'd question that orientation policy, personally.

[roser13, ASN, RN]

"I also find it disturbing that they're not letting you start IVs because you're "still considered a new grad." I'd question that orientation policy, personally."

Not at all what OP said. She's starting IV's every day. Just struggling with the hand placement IV's.

OP, I agree with the poster who suggested no tourniquet - that is the key in the elderly with fragile veins. Securely anchoring the vein with your opposite hand is also vital.

Personally, I think that the hand veins have an inordinate number of valves:D. Maybe because the hands are the farthest from the heart, but it is incredibly easy to run into a valve and end up blowing the vein. I have actually been able at times to feel a valve and move above it.

Don't worry - as in all things, practice will help.

[Asystole RN]

Try using a manual BP cuff for all your IVs. It allows you to crank up the pressure or decrease it to nearly nothing depending upon your assessment needs. It is much more comfortable for the patient..doesn't leave the nasty tourniquet marks nor does it get caught it hair.

Also look for bifurcations in the veins, they tend to be anchored much better around them.

[Esme12, ASN, BSN, RN]

I usually use a BP cuff and gently inflate. I try to use the smallest sized needle that is appropriate for the Rx. i am a righty when I start IV's so switch it if you are lefty.

Explain the procedure, explain they need to hold still and it will hurt a little bit as there are a lot of nerve endings in the hand. I prep the skin, palpate the vein, now with my free hand I hold the patients hand and with my thumb I pull the skin taut and the base of the vein therefore immobilizing the vein and straightening it while I insert the needle bevel up! until I get a blood return, deflate the cuff,and then as someone previously said I gently "float" it in with saline. Bevel up is a big key! good luck

[RedhairedNurse, BSN, RN]

It's also good to ask the patient where they prefer. My mom is close to 80 and when she went to day surgery, the nurse had a hard time finding a vein. My mom then pointed to a vein on her anterior forearm that was good to use. It didn't look like a good vein to me, but low and behold it was and my mom knew it. I am liking the advice you're getting here, lots of good answers!