IV specialists please, please help me

Nurses General Nursing

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I really need help selecting the best vein to use when putting in an IV. I have searched allnurses.com as well as the rest of the internet, and found lot's of techniques for putting in an IV, but most of them just say select a good vein. Well, there is my problem. What constitutes a good vein. What should I feel for when I am trying to find it?

These are some descriptions I have found so far:

"The cephalic, accessory cephalic, or basilic vein would be ideal"

"feel and anchor a vein"

"Using the index and middle finger of your nondominant hand, palpate the vessels. (Fingers on the nondominant hand tend to be more sensitive.) A healthy vein feels soft, elastic, resilient, and pulseless. If you feel a pulse, look elsewhere: Only arteries pulsate."

"Avoid inserting the catheter near vein valves, which appear as knots or feel bumpy. Insert the needle just above or a full catheter length below a valve."

"Avoid bifurcations, the Y where two veins meet. Insert the catheter just above or well below this area to keep the tip away from the valve located in the Y."

"Also when you palpate the vein, "bounce" your finger. Veins bounce, other things don't (like tendons).

Engorged veins have a kind of bouncy feeling to them. Educate your fingers to that feeling. "

So, all of the above are the best descriptions I have found, but I still struggle. I tried to put in 3 IV's on Friday, and I totally failed :cry:(I'm in nursing school and still learning). The question I have is:

1. Is there something else the feel of a good vein can be compared to. Example: pressing on a baloon. Do you have any examples for me?

2. Is the cephallic vein usually the best choice?

3. I have many tricks that have been discussed in previous posts that I have written down, but I just need to know how to pick the right vein. Everytime I failed, my preceptor picked a good vein and got it on the first stick. So I believe my problem is picking the right vein. She tried to explain to me why she did not choose the same vein as me, but I didn't really get it. What is it you feel for when you pick the vein?

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In my experience, and I'm certainly no expert/have had my share of unsuccessful pokes, the best vein to pick is the one you think you can get. Of course you want to avoid joints/going below old insertion sights in the same vein... all the basic things you know about starting an IV. However, veins differ not only from person to person but the same person's hand to hand. Some veins are deep, some are superficial. Some roll, some are thick/resistant. I use my eyes more than my fingers when I'm looking for a vein but that's me.

Don't be discouraged! The more you try, the better you'll get!

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Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

The best way to go is by feel, not sight. I have been an er and sicu sup. for along time and I was an lpn before I became an RN, Im also Picc cert., and I also insert a-lines in ICU, but you always want to go for the biggest most engorged vein you can find and ones that are really bouncy, and using the joint spots sometimes are a good thing as they will act like a splint, It may also be the caths your choosing, you always want to pick the right size gauge which is small enough to get in the vein and stay in the vein, but big enough to get your fluids, meds, blood,etc.. through,

If in er or ICU the AC is a great spot but the floor nurses hate the AC so if there going to the floor you definitely dont want to put it in the AC, the hand or forearm is best if there being admittied. My favorite spot is on the side of the AC torwards the elbow its my favorite because this is usually a pretty big vein. Also tighten up your tourniquet some. You might also try a bp cuff it works great, I also like to go in from a 45 degree angle from the side of the vein. Good luck and practice, practice, and practice!!!!

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Specializes in Orthopedics/Med-Surg, LDRP.

You already have a good list of things. Do you know how many sticks I had to do before I got my first successful one? Probably almost 20. It's really an experience thing and it will come with time. We don't learn IV sticks in nursing school, so I didn't get my first experience with it until I was in the hospital setting and that was nerve wracking!

Make sure you tie the tourniquet tight - it helps to engorge the veins better. If you're going to look for veins in the hand first, tie it at the forearm. If you're going to look on the forearm, tie it just below the elbow. IF you want the AC, then tie it above the elbow. I find veins in the hand don't pop as well when you tie the tourniquet way high. Work quick. If the tourniquet is on too long, you start to lose veins - and the pt's arms start to turn blue, lol. Find the straightest vein possible and you're right, without veins or forks. If you have a squiggly one, straighten it out with your non-dominant hand. Use a gauge that is smaller than the vein and think about what you're infusing. If you're going to need blood or high volume, you're going to need an 18 or 20. If it's just IVF's you can get by with a 22 and if it's just a daily or BID antibiotic, you can get away with a 24.

My biggest mistake in the beginning? I would have a really bad angle - either too high or too low and I'd either go through the vein and blow it or not go in enough and the catheter wouldn't advance and I'd have to take it out and start over. I also only torture people twice before getting a more experienced person and I like to watch them and gain insight on how they seem to do so well with it and perhaps improve my technique. Good luck!

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Specializes in Med-Surg, ED.

A good vein is a bouncy one. Beware the ones that are REALLY juicy looking though, because the ropy ones tend to roll away if not anchored really well.

While you are learning, just do them all in the AC. That way, you will have a better chance of getting a good stick. Then, when you are comfortable with your technique, try the hands, wrists etc.

When I was learning, it was very stressful. I believe it all comes with practice. I was almost in tears for several weeks til I finally got the technique down.

Its like any other skill--you will get it with practice.

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There is no "best vein" to choose. When choosing a site you must take into account the medicines that you will be giving through it, how long the patient will need the IV, whether or not the patient is ambulatory, what the patient's range of motion is, what condition the patient is in (critical vs non-critical), the patient's level of hydration, the patient's skin integrity, and the list goes on. No one pt is the same. As time goes by you will learn what works best for which patient and all the surrounding issues.

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Specializes in Emergency & Trauma/Adult ICU.

You're looking for the best descriptive word and that's difficult since you'll get a variety of answers.

A good vein feels, to me, "juicy" or "spongy". I certainly wouldn't argue with "bouncy".

In other words, you may feel the veins of a patient with long-term illness or extensive recent hospitalizations and though the veins may be very prominent and easy to identify, they might feel like a piece of uncooked spaghetti.

Keep at it - just like any other manual skill the only way to improve is to practice.

Let us know when you get a good stick! :)

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Thank you for the encouragement. I'm copying all of your suggestions into my notes right now. I'll take any suggestions I can get. It was so discouraging to miss 3 times (3 different pt's), did only try once on each patient, before I had my preceptor take over. Right now I keep on using a b/p cuff on myself and evaluating which one of my own veins would be good. To bad we can't practice on each other anymore. I'm looking at my own veins and thinking spongy, bouncy. I will try the ac ones until I get better at this. It is just frustrating. I'l have my chance at trying again on Friday. If I can't get it this semester, I will see if I can volunteer at a blood bank or look for a summer phlebotomy course.

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Specializes in Step-Down Vascular, Renal, ESRD.

Use what you already know and practice, practice, practice.

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I really does take practice, practice and more. Dont get discouraged, I have been doing them 10 yrs and there was one time I actually counted 20 in a row I got. But some days I can't hit them for crap. Practice feeling the veins. Feel what normal skin feels like with a tourniquet on and then feel where the ones you can see. You will be able to tell the difference. I also know that someone who has tough skin it is really easier to use a bigger catheter because the needles are stronger. Also some veins will blow easy then the 2nd try I will let go of the tournequet right before I stick so the pressure is eased up. Just don't be afraid to try...

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Are yuu getting a flash when you insert the catheter? Are you having trouble threading the catheter? Or are you just getting nothing and really not feeling the vein?

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Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

My all time favorite way is observation. In the elevator, at school, at church look around and see what other folks veins look like. Feel your own for the "bounciness" etc. Also look for the length before a branching or a change in appearance. If you are using a 1" cath don't aim for a 1/2" vein.

Don't use those on the inside of the wrist near the palm. I had one there back in Feb and the darned thing STILL hurts. It was changed while I was still in pacu I guess 'cause it started out in the back of my hand. (which doesn't feel too awful good either.)

Going for the AC may get you a successful start but think about your poor patient not being able to bend her arm.

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