IV Question!

[tennisace95]

Every once in a while I have been having trouble threading off IVs. I am lowering my angle after flash, advancing a little, then trying to thread off but sometimes I still just get resistance. The last few times it has happened I have blamed it on tiny fragile veins on really thin patients. Sometime Is even feel like the needle doesn't pierce some patient's skin enough and that's why the catheter won't budge. 

Anyway, I encountered something weird and I can't stop worrying. This patient was was very anxious, and made little to no conversation. I got a beautiful flash on her hand vein, but I didn't lower my angle like I usually did since the vein was very superficial, my angle was already very low, and I felt like I was in it. The catheter advanced a little but then budged, I tried to push a little more to see if I could get it to continue to advance but in the process I pulled the needle back a bit and the flexible catheter bent where the needle was no longer in it and where the needle was met. The patient saw what I did and gave me a dirty look, I apologized but she said nothing. I know that I didn't pierce the catheter because I would have felt/saw it and the catheter end was intact after removal. I'm assuming I was just hitting a valve and that's why I couldn't advance.

I retracted the needle and the hub filled with blood. I tried to save the site by floating the catheter in but with no luck. Luckily I was quickly able to start her IV in the other hand and move on but now I'm worrying over my technique mess up. Just reaching out for insights on this situation. Is it possible for small piece of the internal catheter lining to shear from the bending? I always have a fear of catheter embolus and I tend think of far-fetched situations. Obviously the catheter was never placed inside her vein, I just feel like I shouldn't have tried to float it in. Any responses are greatly appreciated!

[JKL33]

4 hours ago, tennisace95 said:

I always have a fear of catheter embolus and I tend think of far-fetched situations.

Yes. You are catastrophizing.

It's okay.

Two common ways to get the situation you've described (in general, where catheter won't slide):

1) You've pierced the vein with the tip of the needle but not  with the catheter (haven't actually advanced those couple of mms needed to actually get the catheter into the vein)

2) You've grazed the vein or gone through it--with either the needle and the catheter tip or just the tip of the needle itself. It isn't uncommon for people to unintentionally push the needle forward while they're trying to push the catheter off. If even the tiny tip of the needle goes through the other side of the vein, the catheter can't be pushed off into the vein because it has to follow the same track as the needle until it is free of the needle.

Choose the best sites, anchor and stabilize everything before you poke, and then just work on tweaking your catheter advancement. Take a look at the set up sometime and pay close attention to the distance between the point of the needle and the end of the catheter. That's how far you have to advance before you can slide.

??

[IVRUS, BSN, RN]

Another important thing to remember is that some IV catheters are packaged and sent to you "heat sealed".  Insyte Autoguard IV catheters used to be that way.  Therefore, the junction of the IV catheter and the needle hub must be separated first and then put back into position.  If this is NOT done, one will have a difficult time threading that catheter off of the needle and into the vein.