IV insertion techniques!!

Nurses General Nursing

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Hello everyone!!! I am a nursing student currently enrolled in my program's IV therapy class. I was just wondering if any of you experienced nurses out there can give some tips and trick for inserting an IV. We practice on each other, (OUCH!) and so far I have had one successful out of 4 attepmts. It is so frustrating not to be able to get the vein, or when it rolls, etc. I could use some great advice!!! What angle do you usually go in at? How do you put traction on the vein? Do you really feel or hear a pop when you get in?? Do you use one hand to thread the catheter in?? Any other tips or tricks would be greatly appreciated!!! Thanks in advance!!!

Erika Ann

Specializes in ED, ICU, Heme/Onc.

Practice, practice, practice. The larger the gauge, the better... (that's the ER nurse in me...)

Have all your supplies ready, take your time, and don't fish. As soon as you strike "gold" - advance that catheter. If it's a "good" stick, it will go right in. With our safety needles, I rarely feel a "pop" unless the patient has unusually tough veins.

One nurse I used to work with would pull up a chair and chew a piece of gum. She swore by the gum, said it helped her concentrate on the patient and not her nerves.

I just raise the bed high enough so that I'm not all hunched over. My back is bad enough without poor positioning.

Blee

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Specializes in Medical/Surgical, L&D, Postpartum.
when i learned how to start IV's in paramedic school, i couldn't hit the broad side of a barn, and being left handed didnt help. the best way to be an awesome IV starter is to have your own technique (its just like an art form, i think) and lots of practice of different kinds of patients. now i am the go-to person when anesthesia cannot get an IV and am super awesome at them.

here are some tips to keep in mind:

1. BE CONFIDENT. if you walk over to the patient and you have sweat on your hands already, they are going to be anxious. anxiety makes veins disappear. and your own nervousness will cause your hand to be less steady, making it more difficult to get an IV in. if you act like you know what you are doing, no one is going to know its your first IV but you, and that will put the pt at ease greatly.

2. have everything ready. fumbling for tape when you are trying to secure a catheter is not easy. have your skin prep open, your tegaderm and/or tape ready, and your J-loop or port already primed.

3. take your time scoping out veins. dont go for the ones you can see right on the surface all the time. those are the rollers. feel for that nice, fluffy, spongy vein that is nice and strong. check both arms. sometimes tying the tourniquet lower and/or lowering the arm will help you find a hand/wrist vein better. you can even keep the tourniquet tied while you prep your stuff to get the blood pooling better. what i used to do when i was still learning was close my eyes and feel for the spongy vein. relying on your touch is actually much more reliable than sight in starting IV's sometimes. also, dont be afraid to go for a vein in a weird place. if you cant feel an anything anywhere else, but can feel a big squishy one in the thumb, go for it!

4. for pts with very small veins, warm their arms up! you can rub them with your hands, put a warm towel or compress, or (i know this is a no-no) put a tiny tiny little dab of Nitro-bid where you feel a vein and it will puff it up really nice. also, dont slap people. again, the anxiety thing. the best way to to dilate the vein is to thump it gently and rub in the direction of the vein. that way you can also scope it out for valves, improve the flow and not freak the patient out by getting their arm whacked. and sometimes, a BP cuff works better than a tournquet.

5. ANCHOR! anchor, anchor and anchor! pull that vein as tight as you can when you select your site and straighten it out. my technique, which may not work for everyone, is to anchor the vein until i almost cant see it anymore, and go almost flat on the pts skin at an angle, and then catch the vein and straighten it out.

6. dont go fishing or diving. if you dont get a flash back, you make be in over the vein, under the vein, or out the side of the vein. if you pull back and redirect the needle and still cannot get a flash, you are probably not where you need to be, and the patient is probably starting to have alot of discomfort.

7. one you insert the needle and get a nice flash of blood in the IV hub, gently flick the catheter as you are retracting the needle and flush the catheter into the vein. if your flow of blood stops when the needle is retracted, gently pull back on the IV catheter, and if the blood begins to flow, flush the catheter in while carefully observing for infiltration.

8. distraction is great tool for squirmy patients. engage them in conversation or give them a focal point on the wall or TV.

9. remember everyone has days where we couldnt hit the broad side of a barn, and thats ok. being good at IV's is fun, but doesnt make you the best nurse in the world. its OK to ask for help. if you stick once or twice and cant get it, ask a senior nurse and observe her technique. know your limits. if right off the bat, you cant find anything, ask for help. remember the pt doesnt want to be a pin cushion as much as you want to get an IV in them.

10. PRACTICE! spend the day in the ER, outpt or same day, or on a floor where you know there are a ton of IV sticks to be had. watch different people and their techqniues, and then work on your own. once you start a bunch of IV's, you will get better with each stick and more confident in your skills and development of your own successful technique.

thats all i can think of for now. good luck!!!

ETA: i thought of another tip for you. this is one i still use if its a very deep vein or a pedi patient. once you locate your vein, anchor it and palpate again. then, take the your pen, clean the tip with alcohol and just make a small indent with it (dont click the writing part out and draw on them) so you have a little circle left on the arm. that should be your point of insertion.

Wow!!! These are some amazing tips!!! Thank you everyone who responded to my post!!! I was just so frustrated yesterday when I coud'nt get a successful IV in!! I will definitely use these tips posted here!! I have another question though, I have heard that some nurses go into the vein at an angle, rather than directly into the vein. For example, instead of going into the vein straight, they will insert the needle on the side and hit the vein from there. I don't know if this makes sense, it is hard to explain without actually showing you. But thanks for all the tips and please keep them coming, I love hearing all your stories!!

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That's is some of the best advice. I want to add that you must get used to using gloves at all times. Old school has gloves as optional to "feel." RNs at my faciltiy are getting written up for no gloves during IV sticks!

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Specializes in Med-Surg, ER.
Practice, practice, practice. The larger the gauge, the better... (that's the ER nurse in me...)

Bilateral 14's for everyone! :yeah:

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unfortunately, experience is going to be your best teacher. the people needing iv's are often the most incredibily difficult sticks.... there are all sorts of ways to handle the needle, and you've got to experiment until you get your own way down.

that's why above all else, you've got to treat a good site like it's gold. if they're confused, you'd better tape and wrap it :).

i find that far too many nurses give up on iv's, saying "i can't do it". don't give up. keep sticking, and you'll get a lot better.

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Specializes in med/surg, cardiology, advanced care.

Lots of good info from flightnurse2b:yeah: Here's my :twocents:. For some reason I find that Intimas or other butterflies are dull, I like to use angiocaths and usually can get access on the 1st attempt. I also use the thumb of my non-dominant hand to anchor the vein pulling the skin tightly. On older pts don't tie the tourniquet too tight. Good luck!

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one thing that will improve your percentage dramatically....... or it has mine.. let's say you miss, and then you're slowly pulling the cathetar out and you hit blood... immediately flatten the cathetar to the skin, and flick if off the needle into the vein. even if it doesn't go in, you can often flush it in from there..

this has turned a miss into a hit for me many times of late. in the past, i'd always miss those.

i've also learned that a little upward pressure on the needle after i'm under the skin tends to help. this is all about subtle hand tricks, and practice helps immensely.

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a few techniques I use are these:

Try using a blood pressure cuff: I It's more comfortable for the patient.. I use 50-60mm/hg on most veins, 40mm/hg on veins with good bounce to them and 20mm/hg on the big honkers or veins that seem to easily rupture when punctured. i knew a nurse that didn't use anything on fragile veins visible through skin! Place the b/p cuff upside down to keep the tubes out of your way...and use only a manual cuff (that doesn't leak).

Occasionally I float the catheter in...meaning...after I get flash with just about 1/4 of inch in. ,connect your primed extension set (with remaining flush syringe still attached) to the catheter hub while appying pressure above the site ( like when you're hooking up the vacutainer or syringe when pulling labs or plugging in the IV line) and as you are slowly flushing the catheter simultaneously advance the catheter to its hub and then release the cuffs pressure.

This seems to "float" the catheter past any valves and bifurcations. Works most of the time. There are times when the catheter cannot advance without occluding the blood return and I back it out 1/8 of an inch and opsite it there.

If you are concerned about possibly losing the site when advancing the catheter and need the labs big time I've went ahead and pulled the labs and then used the "floating" method to advance the catheter. I've been Nursing a long time and can usually get those difficult veins but you can still have a bad day or meet those "veins with brains" that think back at you. Don't be discouraged or afraid to pass the priviledge to another nurse. We're a team and

that is what nursing is all about. You'll learn to feel a "confidence' when assessing which vein to cannulate, and a lack of "confidence" on the ones to avoid, over time. Hope this info is helpful. Hang in ther and I wish you a great career! DeejRN

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I am left handed and according to some people have a weird technique.

My hands tend to shake especially if I am doing something that requires me to be close and precise, so I need to have the edges of my hands resting on the patient.

In my left hand I have my needle, which I hold from underneath almost like a dart with my thumb and index finger, but that's not how I treat it. If I'm inserting on the back of the hand, I rest my pinkie, ring finger, etc on the distal portion of my pt's fingers. Then I take my right hand and place my fourth finger above my insertion site, careful not to touch my insertion site with my thumb, index finger, or middle finger. My fourth finger provides slight pressure above the site, which serves as my anchor. I am careful not to totally occlude the vein.

I go in at a 30 degree angle and smoothly reduce that angle as I advance. When I see the blood flashback I remove the tourniquet with my left hand and return it (my left hand) to the needle and stabilize. I then use my right thumb and index finger to thread the angiocath in. I then place pressure with my right fourth finger (still above the site) and remove the needle with my left hand while stabilizing the angiocath with my right thumb and index finger. Then I connect my INT, etc.

For the most part this stabilizes me. Some people have commented on how I do it, but no one has ever "complained."

But I've really never encountered anyone who does it quite like me either.

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