I have a IV insertion question :-)

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You find a vein on a patients arm; the vein can see and felt. The vein curves/angles, a lot.

is it OK to insert the needle at the same angle that the vein is angled at, while inserting the IV?

Yesterday, I had a 25 year old patient with a vein the size of a earthworm, but it seemed to practically spiral up his arm instead of a linear line towards the heart. I inserted the IV at a slight angle, because I felt that had I went "straight", I would have infiltrated it. It was still aimed towards the heart, just at a slight angle. Is this appropriate? A nurse that I worked with said, no...IV's should always be inserted linear.

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Specializes in ICU.

It is ok to put a PIV in on an angle. Sometimes that is your only option. As long as the catheter is in the vein in the direction of blood flow back to the heart, you are good.

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Specializes in Med/Surg.

It stands to reason that you'd follow the path of the vein. If you put it in straight and the vein goes to the left, obvously, you're going to go through it. Am I understanding your question right?

We had one RN (how she EVER got through school is a mystery to me, she didn't last long and thank goodness!) who put an IV in pointing towards the patient's hand. Obviously, NOT related to your question, but I thought it was stunningly dumb, so I mention it. :)

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Specializes in ER/Trauma.
We had one RN (how she EVER got through school is a mystery to me, she didn't last long and thank goodness!) who put an IV in pointing towards the patient's hand. Obviously, NOT related to your question, but I thought it was stunningly dumb, so I mention it. :)
There's nothing "dumb" about it. :)

Access is access. What difference does it make if the cannula is pointing toward the heart or away from it? Venous blood flows in one direction - regardless of the way the IV cannula is facing.

I've inserted plenty of IVs "facing away from the heart" - especially in crashing nursing home pts. with severe contractures.

cheers,

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Specializes in Med/Surg.
There's nothing "dumb" about it. :)

Access is access. What difference does it make if the cannula is pointing toward the heart or away from it? Venous blood flows in one direction - regardless of the way the IV cannula is facing.

I've inserted plenty of IVs "facing away from the heart" - especially in crashing nursing home pts. with severe contractures.

cheers,

Yes, access is access, but I disagree on putting one in facing away from the heart (and this was not the case of a crashing pt by far). On a fairly brisk infusion, you're going to be at a much higher risk of compromising that site just by plain mechanics. I stand by my statement.

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Specializes in Public Health, Med Surg, HIV Care.
Yes, access is access, but I disagree on putting one in facing away from the heart (and this was not the case of a crashing pt by far). On a fairly brisk infusion, you're going to be at a much higher risk of compromising that site just by plain mechanics. I stand by my statement.

It also seems like this would decrease the time to the catheter clotting-off from having the blood flow into, rather than around, the catheter. In an emergency situation with no other option at the moment it seems like it would be fine, as long as a better solution (alternate site, central line if appropriate) could be employed.

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Specializes in Med/Surg.

Hummm-don't think I've ever seen that. How do you do it , stand on your head to access a vein backwards? Just asking

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Specializes in ED, ICU, PACU.
Hummm-don't think I've ever seen that. How do you do it , stand on your head to access a vein backwards? Just asking

Think about those that are put in the back of a bent arm. Easy to enter backwards, have to stand on your head to get it in the correct way.

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Specializes in ER/Trauma.
Yes, access is access, but I disagree on putting one in facing away from the heart (and this was not the case of a crashing pt by far).
I used the crashing patient just as an example. And in any case, how does it 'negate' placing a 'reverse facing IV catheter' in a patient... just because 'they were in a code' ??

On a fairly brisk infusion, you're going to be at a much higher risk of compromising that site just by plain mechanics.
But how? :confused: Especially when you mention that the risk is higher for a "fairly brisk infusion" ... shouldn't 'briskly flowing fluid' reduce the chance of the IV clotting???

You claim "mechanics" - I request proof/validity.

I'm not mocking you here, I'm genuinely interested. :)

It also seems like this would decrease the time to the catheter clotting-off from having the blood flow into, rather than around, the catheter. In an emergency situation with no other option at the moment it seems like it would be fine, as long as a better solution (alternate site, central line if appropriate) could be employed.
Again, this doesn't seem to make sense. Blood clots when blood clots - it makes no difference if blood is flowing in the direction of the catheter or otherwise. Rather, blood "clots" when it stands still - it matters little if the catheter is facing blood flow or against .... to provide an example - how many of you have had IV catheters placed "towards the heart" clot off??? Now if "blood was flowing towards the heart as the same direction as the catheter", this shouldn't happen as often as it does; right?

Or to provide another example; why do 'central lines' clot? After all, their tips are present at the RA... greatest blood flow prior to entering cardiac circulation.... and still, sometimes they clot. Why? They're facing in 'the direction of blood flow', right?

But it happens. Plenty of times. Doesn't it?

cheers,

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