IV insertion issues

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Hi all, I've been working in NICU for about 8 months now and I'm having issues with starting IVs.

It usually goes like this: Insert, see flashback right away, remove needle, no more flashback, try to adjust catheter to get flashback again, FAIL.

Or: Insert, see flashback, remove needle, attach flush, flush, VEIN BLOWN.

It's usually the first scenario. Can some of you experienced nurses and IV insertion superheroes troubleshoot what exactly is happening when I get a flashback and then lose it? I've tried IVs with and without using a "tourniquet" aka rubber band, but that doesn't seem to make a difference. Any tips will be appreciated, thank you! :)

Specializes in NICU.

I would try advancing just a bit further after you get the flash in case the needle is in the vein but the catheter is not yet. I am talking maybe 2-3mm more of an advance. And then advance the catheter off the needle and try flushing.

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Wow it's been almost a year since I started this thread and I'm happy to say that I've been kicking some rear-end on IVs for the past 6 months now. I was going too deep before.

Tips for people who are having the same problems that I was: I pretty much stay very superficial and straight with the catheter and it works. I also was paying too much attention to the catheter going in and not watching the vein at the same time. You have to watch both the catheter and the vein. Holding the skin above taut also helps. Make your environment comfortable (as in, remove the rolls around the baby so that you have a better grip on their extremity, etc.). I also don't turn out all the lights like some other nurses do - I want to see the blood return right away.

Now, taping by myself is another story :confused:

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Specializes in Infusion Nursing, Home Health Infusion.

Yes! that is the one of the most common mistakes I see is that the angle of approach is too steep. In you patient population you need to be going in flush and then if needed adjust your angle. It sounds like you are getting better at keeping track at bothe the flashback chamber and an eye on the target vein as well. As you get better you will have a sense of when you are just about at the outside wall of he vein and about to enter. The feeling is one of slight tension and resistance and this part is generally uncomfortable for the patient. One ED nurse that would panic at the point the patient complained of increased pain and would just take the catheter out told me this was the best advice I gave him for his problem: Do not pull out the cannula unless the patient demands it and do not tell the patient that that is an option prior to the stick but be aware as you are at that point in the procedure and feel a change in the tension as you are just about to pop int the vein..stay in control and proceed with advancing the catheter as you are just about to get a flashback. That taught me that I can help others learn if I can find out what exactly the problem they are having so I can exaplin why that happens and steps to have increase success.

Congrats on hanging in there as it truly is an art and takes a lot of practice,patience and skill. A few months I got called to ED to start a PIV and get some blood on a 6 mo old. I took a very experienced IV nurse with me. This baby boy had many birth defects and no one could get any access. We both looked and could not find a thing. My partner decided to try US and actually hit a vein but it blew with the flush as we had not selected a long enough catheter and we had no 22 Gauge longer than one inch. Our long 20 gauge may have been too large. I finally got it after my second attempt but we were down there and at least an hour and half and the place was loud and a zoo that day. So even IV nurses with a combined 65 years of experience have challenges.

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Specializes in Neonatal ICU (Cardiothoracic).

Think about it this way: Look at the end of your angiocath. The tip/bevel of the needle juts out past the end of the actual plastic cannula. When you see a flash, just the metal part is in the vein, not the actual part that needs to be in for it to slide the rest of the way in. When you see that flash, stop, advance the entire unit a hair more, and then start to slide the plastic cannula in. Blowing the vein usually happens when you only have the needle part in, and try to shove in a plastic cannula that isn't in the vein.

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Does anyone have a policy or advice on the max number of IV attempts allowed on a newborn

ty

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Specializes in NICU, Infection Control.

Most units tell you to limit to 2 or 3 max--you get too frustrated! Get a colleague to take a look. If you've been "shopping", you'll know where the veins are, and you can help. Reswaddle, leaving the proposed limb out, and take control of the baby. Or the head if that's where you're going to try.

Tear your tape ahead, and unwrapped the op-site/transderm dressing. Once you or your colleague are 'in', the other partner can start grabbing tape.

Only thing missing is a round of applause for the victorious IV shooter. I never could get that going, no matter how much I deserved it!!

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Specializes in Community, OB, Nursery.

Our limit is 2 as well. This goes for everyone from regular newborn nursery RNs to RTs (art sticks occasionally) to NNPs.

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Specializes in Emergency Nursing.

2x's then someone else looks. After I try and another RN tries if we can't get it I report it to the MD and they take care of it with ultrasound.

I'm not telling you it's going to be easy, I'm telling you it's going to be worth it.

Author: Art Williams

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