How do you pick your vein for an IV?

Nurses General Nursing

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As a nursing student, I try to take every chance I get to practice IV's on patients, I still suck at it. Every time I start one, I get kind of nervous that I won't find the right vein, or that it will blow on me. My last clinical I got 3 out of 5 in, but this is not the usual for me. Any suggestions on getting it in the first try? And what veins to avoid? Any help is appreciated!

I work ED and will often opt for the AC. I know that the back of the hand is more convenient for the patient who's being admitted, but I often need a bigger gauge than a hand vein can comfortably support, particularly if contrast is going to be forced through the catheter. (My hospital requires an 18-gauge for chest angios, for example.) Obviously you want the bigger gauge if you're doing fluid resuscitation or anticipate giving blood products. I also shy away from the back of the hand if the patient is on seizure meds -- shouldn't give dilantin there -- or likely to receive phenergan.

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I work ED and will often opt for the AC. I know that the back of the hand is more convenient for the patient who's being admitted, but I often need a bigger gauge than a hand vein can comfortably support, particularly if contrast is going to be forced through the catheter. (My hospital requires an 18-gauge for chest angios, for example.) Obviously you want the bigger gauge if you're doing fluid resuscitation or anticipate giving blood products. I also shy away from the back of the hand if the patient is on seizure meds -- shouldn't give dilantin there -- or likely to receive phenergan.

Not in the dominant hand :o

In the ED, you guys need to get the hoses in wherever they go :)

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I am not understanding where the "tooth brush" vein is, sorry I should probably understand what you are saying but don't quite. Thank you all very much for the input! I do need more practice and often feel people's veins just to try to get a feel for it. My boyfriend is my guinea pig for feeling good veins ;)

It's the vein you can see on your arm in the mirror when yhou brush your teeth....;)

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Specializes in Med Surg.
When talking to coworkers or strangers... do you ever catch yourself admiring the veins on the hands and arms. LOL

Not so much that but I have had coworkers actually run a finger up and down the ropes I have in my forearms and hands and say "OOOH." A couple of time nurses who were starting IVs on my wife, who is a notoriously hard stick, look at my arms and say "why couldn't it be you?"

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Not in the dominant hand :o

In the ED, you guys need to get the hoses in wherever they go :)

Not sure what you mean. Not in the hand, period.

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I am not understanding where the "tooth brush" vein is, sorry I should probably understand what you are saying but don't quite. Thank you all very much for the input! I do need more practice and often feel people's veins just to try to get a feel for it. My boyfriend is my guinea pig for feeling good veins ;)

LOL, my husband has big rope veins. From time to time he will notice me gazing at them with starry eyes and will say "STOP IT! I see you ogling me! I have a mind, too!":D

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Specializes in ER, progressive care.
LOL, my husband has big rope veins. From time to time he will notice me gazing at them with starry eyes and will say "STOP IT! I see you ogling me! I have a mind, too!":D

:D My husband is the same way (then again, so am I, I have garden hoses for veins!). I am constantly admiring his veins and will sometimes just run my fingers along them :lol2: Call me crazy, but I always admire his large veins! I wish all patients had perfect veins. I wish I could "loan" my veins to patients with crappy ones...for a nominal fee :lol2::D

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Specializes in CICU.

We need an 18 in the R AC if the patient is getting a CT (if possible).

I try for the forearm first. Will go AC if no other option, or if I am in a hurry. Or, if the patient has no fluids running, I don't mind the AC. I like the bigger veins anyway - we give a ton of IV ABX...

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Specializes in HH, Peds, Rehab, Clinical.
The vein along the medial side of the wrist, just below the thumb, is awesome for me usually -- sorry, the name of it escapes me. It's often very palpable even without a tourniquet. I've heard it is called "the dummy vein," because any dummy can hit it. :bugeyes:

I will first look to place a 20g, but that's just not always possible. On my floor at least, we use a 24g as a last resort. I hate using the AC personally, especially if the patient maintains a running IV, simply because every little bend of the arm means endless beeping.

Another tip I have found useful: on those fragile, elderly veins that blow if you even look at them funny -- instead of using that tight tourniquet, use a BP cuff inflated to about 20 mmHg above the patient's normal systolic. I have found that the veins will seldom blow that way. And when you see that first flash, hold steady and don't move to advance the catheter until the flash moves down the tubing about halfway.

Works for me! Hope that makes some sense. And practice, practice, practice!

Ack! I never use that medial vein---too tender! And I NEVER let anyone even look at that one on me, LOL!!!

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Interesting. Why right AC?

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Specializes in HH, Peds, Rehab, Clinical.
Interesting. Why right AC?

Probably b/c of the way the cath lab is set up...

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Specializes in CICU.
Interesting. Why right AC?

THats a good question, and I don't know... Maybe I'll ask tonight when I go in:). For awhile, they wanted a 20 with no specific site.

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