IV Insertion Problems..............Help!!

jmgrn65, RN · May 8, 2008

once you get a flashback stop advancing needle and just advance the cannula slowly. Sometimes what happens is as you are advancing the needle it goes through the vien. The cannula is less likley to go through. Hope this helps.

iluvivt, BSN, RN · May 9, 2008

Look at your IV catheter carefully and you will notice that the needle over the cannula is longer and the the larger you go (22 gauge vs 18 gauge) the distance between the bevel and the start of the cannula is greater. In other words your needle can be in the vein but not the cannula. So try this.....once you get your flashback drop your angle (usually flush with the skin) thread it an 1/8 of an inch or so (not very much) This assures you have the cannula in the vein and not just the needle. Then pull your needle back (just a bit so it is in the cannula and blocking blood from spilling all over then thread the remainder of the catheter. So hit the vein...drop the angle (if not already flush to skin) pull needle back ..thread remainder of catheter..activate the safety (needle into the needle trap )...add extension set and cap..verify blood return (usually present unless vein small etc,,) and flush Try that and let us know

dreamrider_212 · May 9, 2008

Thank you for your great suggestions, I will try them out and hopefully I can make them work for me and the patient. I have to say that this is one of the most frustrating jobs I have taken in the nursing field, but I am determined to beat it!!!

iluvivt, BSN, RN · May 10, 2008

Just be patient and keep trying it takes a while to get good at venipunture. Again I have found the two most common mistakes are one.....starting the venipuncture at an incredibly sharp angle (most veins are fairly shallow) and the second..is not advancing the catheter a bit as described after you get your initial flashback. Start there and I have many many more tips and suggestions

suanna · May 10, 2008

There are lots of great threads on this topic- it may be worth your time to do a search. I'll give my standard advise for tough sticks: 1}Use a cuff not a tourniquet- inflate the cuff to just below systole and make sure the pressure isn't leaking off. 2} Invert the bevil of the angiocath so you are inserting with the lumen flat to the skin/vein- this is more painful but you will not get a flash until the angiocath is fully into the vein. If you insert the normal way the tip of the needle pierces the vein and you get a flash from the blood wicking back up the needle but there isn't enough needle in the vein to provide a sure guide and access to the veins lumen for the IV. 3}All else fails get a second pair of hands- even a NA to stabilize the skin on eather side of the insertion site. Most "failed attempts" I've had were because I was chasing a vein around in old floppy tissue. 4} Stab with confidence-. a tenative stick is more painful and more likely to fail to enter the vein cleanly.

Tolos · May 12, 2008

I want to encourage you to keep trying, it takes time to be good at any specialty.

First take your time in searching for a vein, make sure that it is straight, long and juicy, you can feel a bounce when palpated, don't be in a hurry to stick.

Secondly, make sure that you are well seated and comfortable where you are in relation to the vein. Then make sure the vein is engorged with the tightening of the tourniquet, you may stabilize it with youl eft 2nd or 3rd finger and the thumb if you're right handed, since some veins move. With the bevel up insert at 10 to 15 degrees, and extend press on the safety button and the needle will be sucked back out of the cannula. Be sure you understand the equipments you are using, use a smaller guage needle like a 24g for a thin and short veins and about 22guage for a big vein. Most of all I like your attitude, you can do it !!!!!!!!!! :up:

Tolos · May 12, 2008

(I am fairly new to the world of infusion and am still struggling with the IV insertions. The main problem I seem to have (apart from vein selction) is when I insert and get a flashback, I advance the needle and then nothing.....the vein disappears and so does the blood. Not sure what to do from that point.)

When you get a flashback and advance and then nothing, slightly pull back the cannula as the needle is removed then you may get a blood flow because you may have extended past the vein.

Kotonoha · Mar 23, 2012

Hi!

I recently finished my training in IVT. So, yea. I'm a no0b.

I just have one query. Here's the situation . . .

Well, earlier this evening, I practiced inserting an IV cannula on my boyfriend. He's 21 but I used a gauge 22 cannula, because he was scared to death. His veins were fat and long. So, I tried inserting the cannula at a 20 degree angle. I advanced the needle a bit and he was ******* and moaning because he said it was really painful, lol. Problem tho is, no matter how much I advance the needle and lower the angle, no backflow ever shows up. When I tried moving the vein sideways, the cannula also moved correspondingly. IMO, it only proves that the needle got into the vein.

I'm sure the needle didn't go through the vein because my angle was really low. When I withdrew the whole cannula, he bled out from his veins. There was about 3 cc - 5 cc of "dark" blood.

So, why is there no backflow? Is it because the cannula is too small for him? It's the only reason I could think of.

Thanks!

IVRUS, BSN, RN · Mar 25, 2012

Hi!
I recently finished my training in IVT. So, yea. I'm a no0b.
I just have one query. Here's the situation . . .
Well, earlier this evening, I practiced inserting an IV cannula on my boyfriend. He's 21 but I used a gauge 22 cannula, because he was scared to death. His veins were fat and long. So, I tried inserting the cannula at a 20 degree angle. I advanced the needle a bit and he was ******* and moaning because he said it was really painful, lol. Problem tho is, no matter how much I advance the needle and lower the angle, no backflow ever shows up. When I tried moving the vein sideways, the cannula also moved correspondingly. IMO, it only proves that the needle got into the vein.
I'm sure the needle didn't go through the vein because my angle was really low. When I withdrew the whole cannula, he bled out from his veins. There was about 3 cc - 5 cc of "dark" blood.
So, why is there no backflow? Is it because the cannula is too small for him? It's the only reason I could think of.
Thanks!

If you did NOT get a backflow of blood in your flashback chamber, you were NOT in the vein. The catheter moved when you made attempts to "move the vein" because the catheter was still under the skin.

As far as bleeding, you withdrew the catheter, and the site bleed... No big revelation there. It takes approx. 2-6 minutes for the "clotting cascade" to occur on anyone with variances because of medications and/or disease processes. Bottom line... Since your "boyfriend" as you say (Which you must be really careful with because IV catheters are prescription items, which I'm sure you didn't have an order for) was so fearful of the process, I'm sure he probably had a vaso-vagal attack. This manifests in Vasoconstriction making it even harder to access the vein. The IV catheter WAS NOT too small. You were not in. Even the most hypotensive pt, will have a slight backflash in the flasback chamber.