IV Catheter Insertion Tips

AuntieRN · Oct 13, 2006

noel...congrats on your first f/c...IVs make me nervous too. I was taught to take the tourniquet off after you get the flashback too. I also have managed to blow a vein or two after I got the flashback. I also manage to make a mess with blood. I can not seem to figure out where to put the pressure so that the blood does not come out as I am hooking up the extension set. They tell me it just takes practice. I just graduated so I am a newbie as well. I really do not have any advice just wanted to give you some support. Good luck in school and on your ventures.

Daytonite, BSN, RN · Oct 13, 2006

what happened was that you didn't have the tip of the needle and the cannula far enough into the vein in order for the cannula to be inserted into the vein. that, or else the point of your needle did a through-and through stick of the vein. actually, it doesn't matter if you take the tourniquet off or on when you are ready to thread the cannula. the tourniquet is only there to help dilate the vein and make the target bigger for you. a problem with it, however, is that the longer the tourniquet stays on the patient, the more pressure that builds up in that vein. if a vein is really fragile, like in some of the little old people, it will pop little a needle that punctures a balloon the minute the tip of your iv needle pierces it. some advice i can give you is to always visualize in your mind where the intended vein is going for the first inch or so beyond where you are actually sticking that patient. that helps you point your iv device in the right direction. secondly, remember that you are, in essence, putting one rigid pipe inside another kind of flexible pipe. think about that. your iv needle has no flexibility, so you need to s-l-i-d-e that sucker just a little bit more into that venous pipe to make sure the cannula, and not just the tip of the stylet, is in that vein before you finally detach the cannula and slide it forward and off the stylet. you can make this procedure nearly bloodless, even when you miss, by using the last couple of fingers on your free hand to press down over the end of the tip of where ever the stylet is. this is another reason why you need to know where that vein is going beyond your puncture site. (what i actually do is ever so gently press down on the part of the iv device that i'm holding and look for the slight "bump" under the skin which tells me where the sharp tip of the device is located so i can be ready to occlude the vein at that point before i remove the stylet. this also stops any blood from leaking out of the hub of the cannula once the stylet is pulled back from it's seated position.) that occludes the vein and stops the backflow of blood. it also minimizes the hematoma that is going to form when you've had a "blow". you should also have one or two 2x2's ready to place under or in the area of your "stick" to mop up any inadvertent blood spill.

i'm glad you're thinking about this. there are reasons for all things that happen with ivs. keep on working to improve your technique and success with insertions and you'll get very good at it. :yelclap:

here are a couple of places where you can read up on all kinds of advice for starting ivs.

https://allnurses.com/forums/f18/iv-tips-tricks-3793.html - iv tips and tricks

http://enw.org/ivstarts.htm - iv starts. . .improving your odds! a very nice article on starting ivs.

noel_nsg · Oct 13, 2006

Thank you BOTH!! I am still learning my way around the site and didn't realize I could do a search for threads. Thank you for the encouragement and the wonderful tips. I wish I could practice on myself. I feel horrible sticking family members, but unfortunately our opportunities in our clinical thus far, are scarce and fought for when the opportunities arrise. I woke up at 4am going over and over in my head the process of the IV and how I could have made it better. I didn't realize once I hit the flashback I still slide the needle a little. Then I push the cannula in. My instructor also had me advancing the cannula and at the same time pulling the needle back until it locked. Is this right? I seemed like I needed more fingers and better coordination to feel comfortable in what I was doing. Daytonite, I know you said you slightly push down on the hub so you can see where you needle is. Do you remove the needle once the entire cannula is in? Once again I can't thank you bot enough for the info and support.

Daytonite, BSN, RN · Oct 13, 2006

You can take the stylet out when ever you want. I have advanced the entire unit into a patient's vein with the stylet still seated into the cannula. I've also pulled the stylet out about ¼ to ½ inch (they call this "hooding" the needle), held my finger against the side of the entire unit to stabilize it, and then slid it into the vein. And, I've also stabilized the stylet once I was sure I had the unit in the vein and slide the cannula off into the vein. Sometimes it depends on the circumstances. Sometimes the cannula won't slide into the vein easily. In that case, I needed the rigidity of the stylet to help advance the cannula. The toughest veins to cannulate are the big burly guys with garden hoses for veins. They look easy to stick and their veins are real easy to find! But, their skin and veins are usually tough and take some strength to push that IV stylet and cannula into them! Experience will dictate which works better for you. Sometimes it's just a matter of the habit you develop in inserting these devices. Everybody has their own style. The main thing is that you follow aseptic technique and you don't end up traumatizing the veins.

The fumble-fingers problem goes away after you've done a number of sticks. After doing a number of these, you begin to figure out that you've got a few fingers (remember you've got 10!) that aren't doing anything. I started thinking about what they could be doing to help out. I also use the lateral side of my hand to apply pressure to occlude veins and stop blood flow back out the cannula hubs or needle punctures. Learning to put your hands and fingers to work will result in minimal to no blood loss and the same with hematomas if you do miss and spear the vein through and through.

Don't beat yourself up over this. It took me a long time to master IVs. Somewhere buried in all the posts I've made on allnurses are bits and pieces of my IV stories. I've started thousands of IVs. I told newbies who rounded with me when I worked on an IV team that when you start 20 - 30 IVs a day, 5 days a week, for a couple of years, you tend to learn a few tricks and get good at what you do. When I was a staff nurse I only started 2 or 3 IVs a shift. And, that wasn't every day. Anything more than that was a BAD shift considering all the other things that were going on.