IV placement

[Alexis White]

I placed an IV the other day. I got a flash and tried to advance the needle slightly. I ended up moving the needle back and going at a different angle. I ended up taking the needle out and pulling back on the catheter with a blood return. I flushed to catheter and advanced it smoothly. I flushed and got blood return. Is this a good way to place an IV. How do I know definitely if it’s in the vein?

 

[speedynurse, ADN, BSN, RN, EMT-P]

Sometimes the technique differs depending on the type of IV (ex. Nexiva VA Autoguard angiocath, etc.). 
 

1. Definitely always look for a primary and secondary flash (which you will only see in a nexiva. 
 

2. As you remove the needle, gently push the catheter in. If it slides easily in enough, you are likely in the vein. If not, either you are not in the vein or you may be against a valve.

3. Does it flush without infiltrating? Sometimes an IV can look a little puffy or bruised but you can feel it flushing all the way up the vein. When in doubt....flush and then flush again ?

[Alexis White]

3 minutes ago, speedynurse said:

Sometimes the technique differs depending on the type of IV (ex. Nexiva VA Autoguard angiocath, etc.). 
 

1. Definitely always look for a primary and secondary flash (which you will only see in a nexiva. 
 

2. As you remove the needle, gently push the catheter in. If it slides easily in enough, you are likely in the vein. If not, either you are not in the vein or you may be against a valve.

3. Does it flush without infiltrating? Sometimes an IV can look a little puffy or bruised but you can feel it flushing all the way up the vein. When in doubt....flush and then flush again ?

So I got a decent flash but the cath wouldn’t advance so I kept pulling just the cath back without the needle until I got a good blood return with labs. Then I couldn’t push the cath in with just my hands so I used a saline flush to push it in. Once it was in I flushed again with ease and pulled back for a blood return which I got. It didn’t look swollen and the pt did not complain of anything at the time.

[speedynurse, ADN, BSN, RN, EMT-P]

1 hour ago, Alexis White said:

So I got a decent flash but the cath wouldn’t advance so I kept pulling just the cath back without the needle until I got a good blood return with labs. Then I couldn’t push the cath in with just my hands so I used a saline flush to push it in. Once it was in I flushed again with ease and pulled back for a blood return which I got. It didn’t look swollen and the pt did not complain of anything at the time.

If that happened, it was likely against a valve. That’s when floating it in works (flushing while advancing catheter). I always attempt to float a line in before I pull it.

[HiddencatBSN, BSN]

It sounds like you floated it in. For tough sticks that’s fine.

As soon as I get the flash, I advance the needle just slightly, then drop my angle and slide the catheter in while engaging safety on the sharp. I almost never have the entire needly part onside the vein. If the catheter doesn’t advance but I am getting good blood return and it doesn’t look blown, advancing while flushing can help navigate through valves.

[Tweety, BSN, RN]

 Not all sticks go in easily and some need to be floated in while flushing.  The two things that indicate you are in the vein and that is is a good IV is that you get a blood return and it flushes without infiltration.

Good work.