How do you pick your vein for an IV?

Nurses General Nursing

Published

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!

Specializes in Infectious Disease, Neuro, Research.

http://www.amazon.com/Phlebotomy-Handbook-Blood-Collection-Essentials/dp/0131133349/ref=sr_1_2?ie=UTF8&qid=1319548101&sr=8-2

Garza-McBride have the bests texts on sticking, IME. It is a phlebotomy text, but the information translates directly.

Forearms are the best(any aspect- superior/inferior), for inpatients. These veins have long straightaways, are generally good sized, and the sites are easily protected.

Cephalic (bicep) is also good, just be sure to secure it well when bathing the pt, or assisting with dressing.

Hands are generally a poor(er) choice, because staying predominantly in bed, spatial orientation changes, as will muscle tone, even over fairly short periods. Pts are much inclined to dislodge hand-sites. what do you use to steady yourself, push up/off, wipe...? Yeah, not the most secure location.

AC. Yeah, I'm going to be an arrogant SOB. This is what one sticks when one can't stick. Outside of trauma, or an ED/OP rapid infusion, there is rarely ever a reason to use the AC. I have a 3 minute section of lecture on this.:D

Sticking is a perennial pet-peeve of mine. Nursing students would be far better off with 8 weeks less of Nursing History, or Leadership, Professional Issues, whatever, and 8 weeks with 120 hours of practicum in venipuncture.

After time spent waiting, difficulty with sticking is the second (sometimes the first) highest point of patient dissatisfaction. You can toss lack of information/education in the group as well. Obviously none of these plainly evident issues in care are perceived as important in education. Hmmmm...

Up Vote Up Vote ×
http://www.amazon.com/Phlebotomy-Handbook-Blood-Collection-Essentials/dp/0131133349/ref=sr_1_2?ie=UTF8&qid=1319548101&sr=8-2

Garza-McBride have the bests texts on sticking, IME. It is a phlebotomy text, but the information translates directly.

Forearms are the best(any aspect- superior/inferior), for inpatients. These veins have long straightaways, are generally good sized, and the sites are easily protected.

Cephalic (bicep) is also good, just be sure to secure it well when bathing the pt, or assisting with dressing.

Hands are generally a poor(er) choice, because staying predominantly in bed, spatial orientation changes, as will muscle tone, even over fairly short periods. Pts are much inclined to dislodge hand-sites. what do you use to steady yourself, push up/off, wipe...? Yeah, not the most secure location.

AC. Yeah, I'm going to be an arrogant SOB. This is what one sticks when one can't stick. Outside of trauma, or an ED/OP rapid infusion, there is rarely ever a reason to use the AC. I have a 3 minute section of lecture on this.:D

Sticking is a perennial pet-peeve of mine. Nursing students would be far better off with 8 weeks less of Nursing History, or Leadership, Professional Issues, whatever, and 8 weeks with 120 hours of practicum in venipuncture.

After time spent waiting, difficulty with sticking is the second (sometimes the first) highest point of patient dissatisfaction. You can toss lack of information/education in the group as well. Obviously none of these plainly evident issues in care are perceived as important in education. Hmmmm...

Where I work, we are getting patients off to a procedure; they will be in our facility for roughly an hour and a half after they are taken to the procedure room. There is tremendous pressure to hurry up the process to make room for the next one. We are asked to start IV's on the right if possible (patients are laying on their left side). Therefore we usually start with the hands or forearms (some really like that medial wrist vein) and go straight to the AC if we don't see anything. In a pinch, some of our best IV starters will go straight to the AC because transport is standing there waiting for them and the doc is impatiently tapping his feet in procedure room. The AC is used in this instance for expediency, not because the nurse is incompetent. In our facility the location is far less important than patency of the line since we are an outpatient facility (CRNA's say "I don't care where they are or what gauge as long as they run"). Inpatient, longer term IV's can totally change how the nurse approaches the issue.

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

That's interesting -- the comment I receive from my patients most often is, "Wow. That hardly hurt at all." Had only one lady cry and scream and pull away, and that was before I even stuck her.

Up Vote Up Vote ×

I recently had a patient literally begin wailing when I walked into her room with a basket of IV gear. She was, of course, covered with piercings and tattoos.

Up Vote Up Vote ×
That's interesting -- the comment I receive from my patients most often is, "Wow. That hardly hurt at all." Had only one lady cry and scream and pull away, and that was before I even stuck her.

Ditto.

Up Vote Up Vote ×
Specializes in HH, Peds, Rehab, Clinical.
That's interesting -- the comment I receive from my patients most often is, "Wow. That hardly hurt at all." Had only one lady cry and scream and pull away, and that was before I even stuck her.

Not going in, but if they bump it at all once it's placed it is tender! I try not to do to patients what I wouldn't want done to me, KWIM?

Up Vote Up Vote ×
Not going in, but if they bump it at all once it's placed it is tender! I try not to do to patients what I wouldn't want done to me, KWIM?

Could be a good point. For my practice specifically, it's not really an issue since the IV is placed just before the procedure and removed very soon afterward. For 3 days, might be a very valid concern.

Up Vote Up Vote ×

don't rely much on your eyes as looks can be deceiving....learn to palpate and appreciate veins...:smokin:

Up Vote Up Vote ×
don't rely much on your eyes as looks can be deceiving....learn to palpate and appreciate veins...:smokin:

I got one the other day that I felt and couldn't see. I surprised myself.:)

Up Vote Up Vote ×

I scope out my husbands' veins while pretending to caress his arms lovingly, lol!

I do have to say to those saying "don't listen if a patient tells you they're a hard stick"... I am one of those hard sticks. I have what look like pipes but VERY thin walled and I have a LOW HR/BP so especially when I'm laying down - valve city. Getting an IV in me is generally a long, very painful process. I had an outpatient procedure done a couple of years ago and started hemorrhaging after they had pulled my IV to discharge me. It took several nurses and IV therapists 4 hours and TWELVE sticks to restart me. You'd better believe by the time the last IV therapist came in my room, I was in tears before the stick.

Listen to your patients, don't be arrogant. There's no reason to cause someone pain because of your ego.

Up Vote Up Vote ×
Specializes in Infectious Disease, Neuro, Research.
The AC is used in this instance for expediency, not because the nurse is incompetent. ...

Inpatient, longer term IV's can totally change how the nurse approaches the issue.

Understood, as noted ED/OP has a different set of standards.

Physiologically, ACs are a poor choice for IV caths because of the inherent trauma. An easy demonstration is bending a drinking straw at a 90* angle- it produces 2 sharp corners. Solely from an anecdoatal perspective, I can say this is traumatic to the vessel, as I tend to be a long term employee, and have seen quite a few patients longitudinally- scarring and "devitalization" of the vessel are apparent in many instances. Unfortunately, there is no particular interest in collecting data on this, as it is "incidental" to practice.

There actually is quite a bit of theory behind site selction, gauge selection, maintenance, r/disease process and individual physiology etc., but it is considered a "monkey skill", so there is no particular interest in pursuing "best practices" in this particular arena.

Up Vote Up Vote ×
Specializes in Infectious Disease, Neuro, Research.
I scope out my husbands' veins while pretending to caress his arms lovingly, lol!

I do have to say to those saying "don't listen if a patient tells you they're a hard stick"... I am one of those hard sticks. I have what look like pipes but VERY thin walled and I have a LOW HR/BP so especially when I'm laying down - valve city. Getting an IV in me is generally a long, very painful process. I had an outpatient procedure done a couple of years ago and started hemorrhaging after they had pulled my IV to discharge me. It took several nurses and IV therapists 4 hours and TWELVE sticks to restart me. You'd better believe by the time the last IV therapist came in my room, I was in tears before the stick.

Listen to your patients, don't be arrogant. There's no reason to cause someone pain because of your ego.

You posted while I was typing.;) That is exactly my point, venipuncture is not(or should not be) simply driving a needle. It is a science, as much as "art".

Up Vote Up Vote ×
+ Add a Comment