IV Placement Hacks

[KeepinitrealCCRN]

@SaltySarcasticSally once you get the flash try lowering your angle to 5 degrees or so and going in a pinch more before advancing this should help.

[gemmi999]

I work in a community ER with a lot of either drug abusing patient's or elderly. A couple tips that work well for me:

1) look above the AC! A lot of nurses stop at the AC but if you look 2-4 inches above you can typically find something (even if it's only for a 22)

2) Unusual spots -- back of arm, thumb, top of arm towards chest, feet if not diabetic. In EMERGENCY situations I'll look in breast or belly tissue. I've seen nurses get 18 g. IV in ascites bellies--those veins can be gigantic.

3) set yourself up for success! get a team in there if the patient is a fighter, double tourniquet if you need to, ask a phlebotomist if they feel anything, etc.

4) A lot of times as soon as I get the flash I stop the needle and retrieve it, even if the catheter is 1/2 inch out. I then flush the catheter in or manually kind of slid it in from the hub. Especially on Wiggling patients! that way the needle doesn't poke through and blow the vein!

[Kebner]

When, I start an IV on an elderly person, whose veins pop like a balloon:

1. I use a manual blood pressure cuff pumped up to 60 mmHg - 100 mmHg

Just enough pressure to see the weak veins start to bulge..

If, the vein becomes too full, a sharp needle will act the same way as on a balloon.

2. If, no manual cuff is available, then apply tourniquet look for what you want.

Remove the tourniquet, then when all items are ready apply again, and stick fast.

You don't want to wait for the vein to become over inflated again, the vein gets taught

like a balloon and pop. So, apply and stick.

3. Okay, so every know and then, you have nothing to work with to make this easy.

The elderly person's veins are just bulging, full already, they are thin and veins are

looking like sausages wrapped in tissue paper.

Apply hand pressure, like a tourniquet 3 to 4 inches above location, as noted in this

article. You will see, the vein bulge a bit more. With hand pressure, hold, stick, and

a second person can help out with attaching, taping.

Before I start, after someone has had failed attempts.

1. Ask, why could you not get the IV placement?

a) Did the vein blow/pop?

b) Is it edema in the way?

c) Could not locate the vein?

2. This way you can prepare equipment, and know what supplies you may need.

a) Manual bp cuff

b) Press many areas of the person's bony areas for edema, and under there, you may just see a very good vein.

c) Patient may need to heat up, turn up the temp in the room (if patient is free of fever), get a warm compress (not too hot:), dangle that arm. Make sure that Tourniquet is tight.

Long ago, I had no option, had to place an 18g in a thumb vein. Saw the flash, and floated it in with a little NS gently.

I'm not good at getting IV's, I know people who are amazing. However, with these little tricks it is often, I do get it in.

Thank you for reading:) It's so important that we share experiences, to improve the nursing we provide to our patients today.

[Fleur deLirious]

@SaltySarcasticSally -- You may not be fully into the vein. When you see the blood flashback, continue advancing just a smidge to make sure that the plastic cannula, and not just the needle tip, has entered the vein lumen.You should be more successful.

[MJW1962]

This is a huge help but my problem is management AFTER I get blood return; coordinating the bandage without spilling blood everywhere. It can make the patient, let's say... a little less than confident in me, the nurse! Help!!! Please & Thanks!!!

[gemmi999]

@MJW1962 -- have you started by 1) informing the patient it might be a bit bloody; 2) placing gauze under the site of the catheter; 3) Placing a finger above the catheter to occlude blood flow; 4) having everything set up ahead of time so you can grab the connector hub and place it and then 5) tegaderm it?

I'm sure you're doing all those steps, but it not only takes practice, but it can be bloody. I tell patient's that from the get go. Once the hub is on, I clean up the area with alcohol swabs before I tegaderm it.

Good luck!

[RNKPCE]

This is a huge help but my problem is management AFTER I get blood return; coordinating the bandage without spilling blood everywhere. It can make the patient, let's say... a little less than confident in me, the nurse! Help!!! Please & Thanks!!!

I second what a previous poster said about placing a 2x2 under the hub before removing the needle. I also have the covers to all connections loosened so I can easily remove the cover and hook up the IV. All tape torn and ready to go. I also use another finger to put pressure at the tip of the catheter to stop the flow of blood coming out and going everywhere, but the 2x2 is there just in case. It takes a little practice but I rarely have a bloody mess when starting IVs.

[CKPM2RN, ASN, EMT-P]

VaccineQueen said:

Do you have any tips for little old ladies whose skin bunches up? Usually I'll get in but even holding traction with my thumb is just sometimes not enough!

In cases like these, or people who've had extreme weight loss I will often used another person to hold the excess skin away from the IV site.

[dodah677]

In my 46 years as an RN I have observed 2 problems with starting IV's. 1) using the wrong size butterfly/catheter. 2) placing the tourniquet to tight that it restricts the arterial flow. The tourniquet should only restrict the venous flow back to the heart. Perhaps we should come up with another name for the tourniquet, due to it's real definition.