Initiating Intravenous Access

SleeepyRN · Aug 27, 2015

I don't think anything of it when I'm complimented on "not feeling" a poke. At one of my jobs, all I do is give sub-q allergy shots. So I give hundreds of injections a week. Whenever I hear, "Oh, I didn't even feel it! With everyone else it always hurts!" I tell them that each injection is hit or miss

That the patient before them DID feel the poke and thinks I'm terrible at shots. IV'S though...that requires more finesse. So I'd take that as a compliment.

I know what you mean by that "ahhh" feeling of getting a flash.

Karou · Aug 27, 2015

I've successfully gotten more IV's that I have not, but when I am going to insert one, I still feel kind of discombobulated. I am a new grad, so IV's are new to me, but I am not a newbie to phlebo... obviously theres a huge difference between using a butterfly and a big #18.
My question... what is the order that you do things to insert an IV?
Tourniquet > Find a vein > Cleanse per protocol > Insert catheter at a very flat angle > Get flashback > Try to advance the catheter/withdraw needle > Release tourniquet > Hold pressure on vein > Hook up to saline line..etc
Is this how everybody does it? Sometimes I can't get the catheter to advance, so I worry if I should have released the tourniquet sooner.. help ?

Personally, I eyeball the vein prior to the tourniquet. I also pop it as soon as I get flash or just before I slide the catheter in. I blow less veins that way. Honestly, I rarely use the tourniquet anymore. Many of my patients are elderly and the pressure contributes to veins blowing. If I need a better visual of the vein (and I am a visual person, even if I can feel a garden hose in that arm I need to see it also don't know why but I do) then I apply a hot pack for about five minutes first. I also slip a 2x2 under the cannula before I detach the needle device (after the safety is engaged) so that if blood oozes while I am holding pressure, it doesn't get all over the place.

Farawyn · Aug 27, 2015

OP: YES!!!

It may be a little weird, though, at least for me, because I am happy simply reading this thread about it. :blink:

I also love the "spring" of a good vein under my finger. I love drawing blood and inserting IVs. I miss it.

Gosh!

emtb2rn, BSN, RN, EMT-B · Aug 27, 2015

Ahh yes, the flash rush. Love it. Do the happy dance in my head. And i do a lot of ivs in the ed.

And the absolute best is when the pt says "you're done and you got the lab work too?!" Yessssssss!!!!!!!

Anna Flaxis, BSN, RN · Aug 27, 2015

My question... what is the order that you do things to insert an IV?
Tourniquet > Find a vein > Cleanse per protocol > Insert catheter at a very flat angle > Get flashback > Try to advance the catheter/withdraw needle > Release tourniquet > Hold pressure on vein > Hook up to saline line..etc
Is this how everybody does it? Sometimes I can't get the catheter to advance, so I worry if I should have released the tourniquet sooner.. help ?

I usually survey potential sites prior to applying the tourniquet. When advancing the catheter, you are not withdrawing the needle. You are sliding the catheter forward off the needle. If you have trouble advancing the catheter, it could be because you went in at too steep of an angle, or the vein is not straight and so the catheter is hitting the vein wall where it curves, or it's hitting a valve.

Like the above poster, I also place a 2x2 just under the hub to catch any drips when I remove the needle and place the extension set.

la_chica_suerte85, BSN, RN · Aug 28, 2015

I've successfully gotten more IV's that I have not, but when I am going to insert one, I still feel kind of discombobulated. I am a new grad, so IV's are new to me, but I am not a newbie to phlebo... obviously theres a huge difference between using a butterfly and a big #18.
My question... what is the order that you do things to insert an IV?
Tourniquet > Find a vein > Cleanse per protocol > Insert catheter at a very flat angle > Get flashback > Try to advance the catheter/withdraw needle > Release tourniquet > Hold pressure on vein > Hook up to saline line..etc
Is this how everybody does it? Sometimes I can't get the catheter to advance, so I worry if I should have released the tourniquet sooner.. help ?

I was taught to take the tourniquet off first so 1) you don't forget it's on, 2) you can advance the catheter more easily, and 3) it's less painless for the pt when you withdraw the needle. Anytime I'm giving blood the tourniquet is always removed prior to the needle.

hawaiicarl, BSN, RN · Sep 1, 2015

I'll use the US to find veins on obese pts (>500 lbs), I locate them, make sure the track is good then I'll draw a guideline with a sharpy. Some of the younger nurses can start the IV at the same time they are manipulating the wand, but I am too old for that kind of finesse. I agree on the little old ladies with bulging veins that pop easy, skip the tourniquet. Also, pop the tourniquet as soon as you see flash, the return of blood up the vein will open otherwise closed valves. Another trick with stubborn valves is to atach a 10ml NS flush to the IV catheter, and inject as you advance, this will cause the valve to open with the fluid flow. "Prisoner" veins (the veins on the back of the forearms that you can usually only see when someone is in handcuffs) are usually the least used up on pts that are frequent flyers. Another good trick is to sit in a chair beside the pts bed, and dangle their arm down a bit, ensuring that you are in a comfortable, ergonomically correct position while starting the IV will increase your chance of success. A trick for rolly veins is to go in beside the vein, stabilize it with your thumb then hit it from the side (rotate the bevel 90 degrees).

Cheers