Tips

**canoehead, BSN, RN** · Aug 11, 2001

Use a BP cuff instead of a tourniquet, inflated to 30mmHg above the diastolic pressure, tighter IS NOT better.

Some elderly and most infants'veins will collapse with a tourniquet, just hold a finger above the vein you intend to puncture, if the limb turns blue stop and wait a minute for circulation. Then ease up on the finger pressure and start fresh.

The more difficult the cannulation the slower you go. Small veins flashback a couple instants after you would expect them to, they may not draw for you because the vein is so fragile it collapses with suction or the IV cannula is so large it is partially blocking venous flow.

If you get a flash and then lose it, perhaps you have pushed the cannula in too far, or at too steep an angle, Remove the needle and pull back SLOWLY on the plastic cannula watching for flashback, then when you get it lower your angle to almost parallel with the limb and thread it in. About 70% of the time when I do this I can salvage a site I thought was ruined.

Never, never, never say anything cocky to the patient or fellow nurses. It will curse you into a bad luck run. Besides, you will get more practise if your coworkers keep you in mind when there is an IV to be started. Also, always make it your policy not to stick someone unless you have a vein you sincerely think you can get, and ask for assistance to hold kids and confused folk still.

That's it, good luck to all.

ohbet · Aug 11, 2001

Thank you very much.

IVRN94 · Aug 17, 2001

In addition to the previous advice; I also will try to improve venous distention in elderly or other pts with small veins by use of gravity, massage, warmth etc. I always take as much time as I need to look and feel every possible site to find the best one. Also use as small a guage as possible for the ordered therapy (or anticipated therapy). And I find a lower insertion angle works better, and when you get your flash, wait to make sure the chamber continues to fill before attempting to thread.

The previous advice for having co-workers alert you to IV needs is also important, the more practice you get the better, have them let you know when a pt presents as a possibly "easy" stick.

Watch out for valves and crunchy or scleroced veins. If your facility has an IV team ask if you can spend some time with them for practice and directon. They may also have practice dummy arms. If you don't have an IV team, maybe same day surgery would let you hang out to do IV's, everyone gets one in there.

hope this helps.

H.

RNforLongTime · Aug 21, 2001

There was an excellent article in the April 2000 issue of Nursing Magazine! You can find it on-line! It is an excellent article and has improved my skills a great deal!

RNforLongTime · Aug 21, 2001

Alos, I just found a pretty good article called "I.V. Starts......improving your odds!" Its located at http://enw.org/IVStarts.htm. It offers some good tips as well.

Researchnurse · Nov 7, 2001

Another tip that is very important: make sure YOU are comfortable. Raise the bed if standing, or sit in a chair with the bed at a comfortable height. I was an IV therapist for 8 years, and couldn't hit a garden hose when I started in that department. One of the pro's taught me that it was important that I am comfortable, especially for the hard sticks that will take awhile to get. When your back is hurting from stooping over,or you are at an uncomfortable position, you stand less of a chance of getting that tiny vein!

radnurse2001 · Nov 13, 2001

IF YOU GET A GOOD FLASH BUT CANNOT THREAD, WITHDRAW THE NEEDLE KEEPING THE PLASTIC CANNULA IN AND FLUSH WITH SALINE AS YOU ATTEMPT TO THREAD. SOMETIME YOU HIT A VALVE AND THE PUSH OF SALINE HELPS TO OPEN IT.

ANNE

OpenHeartRN · Dec 6, 2001

I picture in my head exactly what is happening as I perform the venipuncture. Be aware of the angle of the bevel and the distance between the end of the cannula and the TOP of the bevel. You will get a flashback as soon as the tip of the bevel penetrates the vein wall, but you are not in the vein yet with the cannula. My motto is "Low and Slow". If you lift up slightly with the needle, it helps to separate the top of the vein and the bottom, allowing you to continue to advance the catheter/needle slightly (like 1 mm) without puncturing the bottom wall. Make sure that you still see active blood return, and advance the cannula. This should work with ANY brand of IV catheter

REMEMBER: Once cell layer separates a good IV from a bad one.

Groovydogg · Apr 7, 2002

all this advice is good. warmth, gravity, if you have the time, make sure they are well hydrated, etc. My advice is to take as much time as possible to look for the best place. I notice that a lot of people only look at one arm for a little bit of time. By look I mean with the eyes AND fingers. A good feeling vein is so much better than a good looking vein. You may be tempted to go with what you can see but fight that urge and go with what you feel.

Editorial Team / Admin · May 9, 2002

By all means, very important to get comfy yourself, as has been stated. I prefer pts lying down, arm supported rather than sitting, but may sit as long as arm is well supported. I usually roll two towels under the ac or forearm, or fold a pillow in half to support the arm (for the sitting ones). Talk to pts, great distraction for them, helps relax them - they know you're on their side, so to speak. Take your time, slow is best for the scrawney, fragile veins. Anchor the vein securely (traction on skin below stick or from sides of site) so it doesn't wiggle/trauma to vein is decreased. One tip I heard from a NICU nurse: if you see a streak of blue, go for it (even if you feel nothing) -- if that's all you have! I work in a Radiology Dept, and can do 20+ sticks a day for outpt CTs and IVPs (multiply that X20yr!!). Go where the veins are, not where the book sez they should be. I have found great veins under watchbands too, as well as in knuckles and thumbs (only when there is nothing else and pt absolutely needs IV!) --- those I always numb first, with 1% Lido, TB syringe, little wheal. I also numb for pts who are ABSOLUTELY TERRIFIED of needles. Otherwise they tense up so much no vein dares show itself! Have had thanks from many patients who found the IV experience easier with a little local anesthesia, in spite of other nurses' comments about "then the patient is stuck twice!" As they say, the proof is in the pudding; so, when the patients thank me, it's worth extra time/effort. Keep on keeping on! -- Diana

nightingale, RN · May 9, 2002

These are all excellent posts. Thank you.

KakNurse: The website you posted is excellent and has many subindexes that look very hlepful for futre information. Thank you.