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?

[Esme12, ASN, BSN, RN]

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.

I don't "float it in quickly. "Float" is a term to gently advance the IV catheter with a slow trickle of fluid to give it a cushion of fluid to slowly "float" onto the vein to minimize wall trauma by filling the vein with fluid to allow more "space" so to speak to gently insert the IV. In pedi as well as the elderly especially if dehydrated the veins are more fragile and fracture easily. When you get a flash and have trouble advancing a gentle flow of fluid can help "float" or guide the catheter into place. Doesn't work all the time but I have found it effective in certain circumstances.