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?

[OCNRN63, 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

I start a ton of IVs, but for the life of me, I have never been able to "float" one in, ever.

[Fribblet]

"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.

Wow. I totally misread that. My bad!

[Esme12, ASN, BSN, RN]

I start a ton of IVs, but for the life of me, I have never been able to "float" one in, ever.

IV catheters are flow directive.........hook up the saline and begin to slowly open the IV and gently guide it in........the fluid expands the vein causing less trauma to the vien hence lessening the chance of blowing the vein. It is also helpful sometimes opening the valve in the vein if patircularly stubborn. This is particularlly helpful in dehydrated patients, pedi patients, and the elderly. Try it.....it may work! Having my IV certification and PICC certification and 31 years.......everyone has their own tricks of their trades

[Phase2Pro]

I don't understand "floating it in" either, and I've been doing IVs for almost 20 years. Are you saying once you get a flash to withdraw the needle, hook it up to the saline and then continue to advance it? Since moving into periop I do a lot of IV, but find I have a hard time with 18s. They always blow in my no matter what. My coworker have mentioned floating it in, but I don't really understand the concept. I hate to be dense, but...

[roser13, ASN, 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!

In a surgical situation, there is often no "choice" allowed. Depending upon the procedure, the patient's positioning during the procedure and the anesthesiologist's preference, the IV site may be pre-determined. Prone patients will likely always require an IV in the hand. In my facility, overnight patients cannot have an IV in the antecube because their IV pump's beeping at flow restriction will keep them awake all night.

[OCNRN63, RN]

IV catheters are flow directive.........hook up the saline and begin to slowly open the IV and gently guide it in........the fluid expands the vein causing less trauma to the vien hence lessening the chance of blowing the vein. It is also helpful sometimes opening the valve in the vein if patircularly stubborn. This is particularlly helpful in dehydrated patients, pedi patients, and the elderly. Try it.....it may work! Having my IV certification and PICC certification and 31 years.......everyone has their own tricks of their trades

Thanks.

I read another post about threading it quickly; I never do that. When I get a flash I let the chamber fill a little first, then I gently thread it. IDK if the difference is that I'm starting IVs on people who are getting chemo, so they have bad veins to begin with, but it works for me. The times I blow them are usually if I try to thread too fast.

For the OP, I don't understand why your docs insist on hand veins. I used to work in day surgery, and while we tried to avoid antecub. sites because of anesthesia needing to monitor BP, they were OK with us using the forearm.

[sunnycalifRN]

I don't understand "floating it in" either, and I've been doing IVs for almost 20 years. Are you saying once you get a flash to withdraw the needle, hook it up to the saline and then continue to advance it? Since moving into periop I do a lot of IV, but find I have a hard time with 18s. They always blow in my no matter what. My coworker have mentioned floating it in, but I don't really understand the concept. I hate to be dense, but...

I "float" 'em in sometimes. The way that I do it is to withdraw the needle, connect the flush syringe, check for flash back, then very gently flush and advance. It usually works!! (and obviously, if you get no flash back or cannot flush, then you're not in the vein . . . time to re-stick)

[OttawaRPN]

In my facility, overnight patients cannot have an IV in the antecube because their IV pump's beeping at flow restriction will keep them awake all night.

Many a times, I've improvised a splint using cardboard and cling to prevent those annoying occlusion problems for those poor confused patients who insist on flexing the elbow.

Side note: We try to avoid the ACF only because the lab techs have deemed it their territory for blood draws, but if we have no choice, they just suck it up.

[OCNRN63, RN]

Many a times, I've improvised a splint using cardboard and cling to prevent those annoying occlusion problems for those poor confused patients who insist on flexing the elbow.

Side note: We try to avoid the ACF only because the lab techs have deemed it their territory for blood draws, but if we have no choice, they just suck it up.

With a vacutainer?

[OttawaRPN]

With a vacutainer?

With a vacutainer... or with their vampire fangs... ha!

[sunnycalifRN]

Many a times, I've improvised a splint using cardboard and cling to prevent those annoying occlusion problems for those poor confused patients who insist on flexing the elbow.

*clip*

I just use a 2 foot length of 2x4 with zip ties!!:lol2::lol2:

[iluvivt, BSN, RN]

The most common mistake I see with the use of the hands,elderly or not IS to use too sharp of an angle. Look at peoples hand..there is hardly any tissue there..so the veins are literally right under the thin skin in this area. Some catheter designs make it very difficult (not impossible) to get the correct low angle needed. The one I have had the most trouble with and had to make a few adjustments is the insyte autogard. I prefer to use an intima or introcan in these veins. Realizing you may not have a choice you can make anything work once you identify the problem. So insert flush with the skin and get on top of the vein...I suspect you may be going through it (through and through puncture). The other thing that will help is traction . Hold pts hand.... fold their fingers down with your non dominant hand and pull any loose skin down at the same time so you have a nice flat smooth surface...this may make the vein look smaller..but trust that it is still there...you are just pulling down the loose skin