IV advice

JVoEDrn · Oct 21, 2015

Are you flushing before or after you've removed the needle to leave the catheter in place? It helps to remove the tourniquet once you've verified a flash. Going slow on the flush will preserve fragile veins. Be mindful of where the tourniquet is, how long it stays on and exactly how tight you need it on! Some people (Peds in particular) don't need a tourniquet and only require a finger around the extremity. When getting a flash, advance a little further with the needle before removing it. If you don't See a flow coming down the Hun after removing the needle, you've lost it. Sometimes the flash is the initial nick of the vein, progress further to verify placement.

Hope that helps

remotefuse · Oct 21, 2015

I have been flushing after I removed the needle.

I will definitely try to remove the tourniquet after the flashback, and try moving it around a bit more. I haven't thought much about tourniquet placement before. Thanks for the advice!

amoLucia · Oct 21, 2015

I found that advancing the catheter with real SLOW flow helps the advancement. The trick was real SLOW flow (tourniquet off, stylus out).

And always be on your guard when a sclerotic venous knot is seen. Sometimes patency will be OK; sometimes NOT.

AnnieOaklyRN, BSN, RN, EMT-P · Oct 22, 2015

1) You are probably either going through the vein, or...

2) you are not advancing far enough for the catheter to get into the vein, just the needle.

Next time you are at work take out an IV catheter and look at how far the needles extends beyond the actual catheter.

Make sure after you see a flash you advance a tiny bit so that you make sure the actually catheter has also gotten into the vein. A trick I use, that works on smaller veins with a slower flash, is that I advance until I note a flash, then I advance a tiny bit more, but BEFORE WITHDRAWING THE NEEDLE I then look again to see if the blood is still flowing into the flash chamber, if not I know I went through it, and I need to back it up a tiny bit. A lot of folks don't make full use of the flash chamber. You can only use this trick in smaller veins since larger veins will fill the chamber up almost instantly once the needle is in. This is a really good trick for young pedi patients.

Good luck!

Annie

iluvivt, BSN, RN · Oct 22, 2015

Are you still getting a blood return as you advance.....I bet not! Here is what you are probably doing incorrectly.

It sounds like you are able to hit the vein and get a good flashback so I will start from there. Please do not stop at this point and fumble with your tourniquet or the odds are you will lose your chance to make this a successful attempt.

.1. Once you see a good flashback ( in that it it keeps flowing and it is not just a speck of blood) drop your angle flush (close as you can get it) to the skin if not there already and advance the catheter about 1-3 more mms. This is why you should carefully select where you will enter the skin so you can estimate where you will hit the vein. You want to enter the vein at a fairly straight section of the vein so when you advance you will decrease your chance of going out the side wall of the vein. By dropping your angle flush to the skin you are decreasing your chances of going through the back wall of the vein and doing a through and through puncture. You must do this advancement since the needle protrudes a few cms (depends upon the product and gauge) beyond the cannula and this is most likely what you are not doing.

2. After you advance a few more mms pull your needle back a few mms. You just need to do enough so the needle is not at the end scraping the vein as you advance the cannula. The needle actually keeps the cannula stiff and can aid in advancement. You really need this stiffness especially is you are using an intima.and if the patient has thick skin so the catheter will not buckle. If you are using a product that allows you to monitor your flashback please do so as the blood should keep flowing if you are in the vein. Some catheters have blood control technology that makes this more difficult. Please monitor how the advancement feels..it should feel smooth and easy as you advance. Now pull needle back,or activate your safety mechanism to shield your needle..what product are you using because I can make this eve more specific

3.Now pop your tourniquet and flush

If you think you are going through the back or side wall of the vein then I have a bit of different advice..if you can describe in detail a typical attempt with this problem than I can help you pinpoint the exact problem so we can fix it!

RescueNinjaKy · Oct 28, 2015

Look at the flash chamber. Just cuz you see a little flash back doesn't necessary mean you're in. You could've just nicked the vein and gotten a tiny flash back. Gotta advanced a little bit more otherwise you're not in and you're just gonna see it "blow". Also don't advance too much or you're gonna poke thru the other side and end up really blowing it.