1 more question about starting IV's

[rileygrl11, BSN, RN]

I received some helpful tips about starting IV's but I have one question left for those that are good at doing them. I usually find the vein ok. But the problem I notice that I am having is that it's hard for me to figure out how deep (or not) to insert the needle. People say you can feel "a pop" when you hit the vein but I can't pick up on it. To me, it feels like a pop when I first break the skin with the needle. Is the trick just to angle it in until you get a flashback of blood and then level the needle out? I am bound determined that some day I will be good at this.

[c.wicks]

This web site has some excellent advice and helpful hints utilized by the IV PRO'S.

http://www.enw.org/TOC.htm

[ShandyLynnRN, BSN, RN]

I have never felt the "pop" when I enter a vein either, so you are not alone.

I find that going in at about a 15-30 degree angle usually works to hit the vein.

[kdhrn72]

Yeah, you don't always feel the 'pop' on everyone. The 30 degree angle and then thread after getting flashback. You just have to get the feel on how far you go in b/c everyone is different of course. I like the ones that are big and simple. I can tell ya that when starting an IV the springloaded IV caths are awesome. Soon as you get flashback aftter puncturing the vein you just click the button and it basically threads it for ya. They are really great

[dianah, ASN]

You'll get used to feeling the vein "bounce" when you palpate it. Practice on GOOD veins first; close your eyes briefly, and gently push down, then let up; push down, then let up. Do this a few times on the good vein, then move your finger(s) to the skin beside it. Compare the two areas. You'll feel a difference in the response under your fingers (the bounce). Soon, even if you don't see a vein, except for a faint blue streak on the skin, you'll be able to feel one, and somewhat gauge how deep it is.

Regarding the "pop" you're supposed to feel: since we changed to the retractable needles, I no longer feel a pop when I pierce the vein. Go figure. You have to rely on your flashback. Remember too, as soon as you get a flashback, advance the needle a millimeter or two more, just to be sure the bevel is totally inside the vein, before sliding the catheter into the vein.

Too, always apply traction on the skin distal to where you're going to start the IV. It stabilizes the vein and minimizes trauma to the vein. Makes it easier to start the IV! :)

Good luck, keep trying!

[zacarias, ASN, RN]

Originally posted by dianah

Too, always apply traction on the skin distal to where you're going to start the IV. It stabilizes the vein and minimizes trauma to the vein. Makes it easier to start the IV! :)

Good tips. Here's my problem. When I apply traction, the vein becomes flat because I'm stretching it I guess. Do I still go as deep as I would if the vein was plump with no traction or do I have to adjust because I flattened it..does that make sense?

I had a good time with phlebotomy for a while but lately I've been missing...of course I seem to practice on IVDA dehydrated folks.

Zach

[dianah, ASN]

Apply enuf traction to stabilize the skin but not enuf to flatten the vein, if possible. It's a fine line, and the more you start IVs, the more "feel" you'll get for how deep the vein is.

[ESRD]

I encourage new nurses to go for the anticub.. I know many will yell at me for that...It's a crappy place ..Need an arm board etc..'

But for newbies it gives them confidence and helps them get the feel of it.. Especially if it's the only vein there is...

Also, I don't always go for "rope" veins they can be tough to go through and then you go right through the back wall..

A vein I like is on the thumb side of the wrist... Usually pretty big and not to sclerosed or crooked..

I usually only use a 18 ( old former Pre Op nurse) and a 22 for chemo...

Remember it's not so much what you can see as what you can feel... When searching and when sticking.

Good Luck..

ESRD