Ideas needed

[honeybee888]

I have been a nurse over 2 years and just lately have been experiencing some difficulties in starting IVs. It almost seems as if the needle is "dull". One man asked me if I were using a stick to start the IV. When trying to start an IV on a darker skinned individual, the skin just seemed to roll up where I was trying to insert the needle. Are there such things as dull needles, straight from the package? My reoccuring problem is after getting flashback, the cannula will not seem to advance. I can sometimes pull back on the cannula until the blood flows more easily and then advance, but sometimes that doesn't work. Many of my patients are in their 80's and I can understand that difficulty. However, here lately it seems that i can't get a IV going on anyone. Before the last 2 weeks, I felt good about my ability to start an IV, but here lately I just can't seem to get one successfully started. I know this issue has probably been discussed numerous times and I have watched countless videos and read countless sites trying to correct what I am doing wrong, but any help you can supply will be appreciated.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

Did your organization recently change brands of IV catheters? I had a similar problem when mine changed. Turned out the new brand catheters were less pliable, and where the old ones would give a little to follow a vein, the new ones just went straight through the opposite side.

[AirforceRN, RN]

That's funny...in the past two weeks I've been having the same "are these things dull?" feeling. Interesting.

My thoughts...if you are getting flash and not being able to advance 1 of three things are happening:

1) You are hitting a valve, although I think that this is unlikely. I think people blame valves more often than they should.

2) You are just glancing the top of the vein, getting flash but not actually entering the vessel, and then trying to advance through tissue, although I think this is unlikely also.

3)You are entering the vein, going right through and then trying to advance through tissue. I think this is most likely and would explain why you are able to withdraw the catheter a bit (re-entering the vessel) and then thread successfully. These IVs usually leave a pretty substantial bruise as blood continues to enter the tissue from the hole in the bottom of the vein. Try dropping the angle of your cathlon a little more after getting flash and before advancing and see what happens.

[canoehead, BSN, RN]

Sounds like you might have forgotten to go in with the bevel up?

[HappyBunnyNurse]

Even if your organization hasn't changed manufacturers, the manufacturer may have changed their product.

[nurse2033, MSN, RN]

Stretching the skin taut will thin it out a little and prevent bunching up that can occur. Don't forget that the needle tip has a curved shape, if you rotate it the tiniest bit around its axis you can use it to cut like a scalpel without causing tissue damage or missing your vein.

[classicdame, MSN, EdD]

have your supervisor contact materiels management to see if other depts are complaining about the product

have infection control nurse or educator research that particular product. Sometimes products change, even with same vendor, and do not work like we want. There are ways to compare products and the vendor ought to provide inservices and documentation on the product. Good catch!

[mcknis]

I am in the same boat as yourself, except I am in just an IV slump and know it. Seems like no matter who I stick, I am just not successful. Being in the ER, I see IVs daily and more so I feel like I can hit the sickest old person, but then I can't get a kiddo or very small adult. I'd like to blame it on faulty IVs, and sometimes it has been the valves I am hitting, or a hidden bifurcation ...