IV start trouble

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Specializes in L&D all the way baby!.

HELP! I have had no problem in the past with my IV starts. I thought I had pretty good technique. BUT in the last two weeks 8/10 IV's I have started have blown. I know it's me because a RN can come behind me and get it every time (granted some of these gals are just puffy pregnant ladies who are tough sticks anyway).

So what could it be??? I go in and once I get flash I advance just a tiny bit and then thread the cath off the needle while pulling the needle back slowly. Usually it's about then that I can see it going. Am I at too much of an angle maybe or advancing too far? Or maybe nicking the backside? Tourniquette on too long (1-2 min or so)? What are the usual reasons that IV's blow?

Any advice appreciated here.

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Try advancing the whole thing a tad more, you might not be far enough in for the cath to thread into the vein.

AND.......everyone has days or weeks when it seems like you can't hit the side of a barn, much less a vein. Starting IVs is one of my strengths, but even nurses like me have days when we can't start lines to save our souls.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

most likely what is happening is that you have managed to do an in and out puncture of the vein. you get a blood return because you got into the vein. when you advanced the device that "tiny bit" you punctured the other side of the vein, so, yes, you are nicking the backside. when inserting an iv, stop and watch for blood return in your flash chamber. drop the angle of the device so it is nearly parallel with the skin before you advance it to assure you are still in the vein. there's no hurry to pull the stylet out. if you want to stop the back flow of blood simply put one finger over the place where the tip of the needle is in the vein and occlude the blood flow. i also used to very gently press downward on the end of the iv device that i was holding. if you're in the vein, you will see the distal end of it and the skin over it lift up nicely and reveal some of the vein ahead of it. if you've poked through the side of the vein or missed it, you'll see your needle going in one direction while the intended vein is headed in another almost immediately when you do this.

it's very important when you are inserting ivs that you have a very good idea of the position and direction of your iv device and where the vein is going. i've stood by and watched a lot of people learning to insert ivs and time and time again the vein is running north and south and the nurse is holding that device so it is slightly pointed to the left or right of north/south and they'll blow the vein every time if they don't correct the direction their needle is pointed. keep in mind that you are putting a rod into a pipe. there's very little room for error. a slight movement of a degree to the left or right and you're going to go in and right out of the vein. you also do the same if you have too steep of an angle going in. you have got to be dead on and get that rod (the iv device) smack into the middle of the pipe (the vein).

check out this thread on the er forum: https://allnurses.com/forums/f18/iv-tips-tricks-3793.html - iv tips and tricks

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Specializes in L&D all the way baby!.

Thanks for great advice. I might not be parallel enough when I advance... I can see that as a problem. SO discouraging to be good at the book stuff and struggle with skills like IV's (I did get my vag exam's down pretty quick though... I work in L&D ;o) What was troubling was I never had problems until now. I try to be very careful and that might be a problem. It seems like the RN's I watch are stabbing the pt. Maybe I need to commit and move even more quickly.

Our insytes are the kind that don't return blood out of the end until you completely remove the needle so you get you flash that fills the chamber, then occlude the vien with your non-dominant hand while getting ready to draw labs... that is WHEN I don't blow it!

Thanks again.;)

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Another great tip I learned from an ER nurse is to float the insyte in . So you puncture the vein and you get a little flashback then remove your needle a little bit. Now this would be the part where you advance your catheter. dont. occlude the vein and connect the catheter to the iv tubing. Open your clamp about 1/2 way slowly move the catheter into the vien.

This way you will never blow a valve or preforate the other side of the vein

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I just got done doing IV's in the hospital, the hospital just got new needles and after we got are flash back hooked the solution tubing up let a little fluid running and that will open the vein so you can advance the cath in.

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Specializes in peds med surg,.

Hi! Sometimes we all just have a bad week or 2. I really like doing IV's and usually don't have trouble, but I have experienced bad weeks. It is hard to say if you are doing anything wrong without observing. Maybe once you get the flash advance just a little more. Also, after looking for a vein I take the tourniquet off, maybe for 30 sec. and then proceed with the stick. Ask for advice from your preceptor. Most of all, don't get discouraged!

Cherise07

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Specializes in med/surg, telemetry, IV therapy, mgmt.
Our insytes are the kind that don't return blood out of the end until you completely remove the needle so you get you flash that fills the chamber, then occlude the vien with your non-dominant hand while getting ready to draw labs... that is WHEN I don't blow it!

Before puncturing the skin with the Insyte you should always break the seal between the cannula and the stylet by holding the end of the stylet with one hand and the hub of the cannula with the other hand and twisting gently until you hear and/or feel the seal between these two pieces break. Then once you have done your puncture and entered the vein, you will be able to pull the stylet out about 1/8th of an inch just enough to sheath the metal bevel of the needle within the very tip of the cannula. Use your thumb to stabilize the entire unit (hub of cannula and stylet). Now, you will be getting a flashback of blood. Keeping your thumb in place to stabilize all the parts of the unit, advance it further into the vein. If you're in, you should still be getting your flashback of blood. If the flash chamber is full and you want to confirm placement, then pull the stylet out a bit, stabilize the device again, take hold of the hub of the cannula and S-L-I-D-E it forward into the vein and off the stylet. If you're in the vein it should slide right off. If you're not, you'll meet resistance and if you continue to push hard enough the cannula will crumple up on you.

Another great tip I learned from an ER nurse is to float the insyte in . So you puncture the vein and you get a little flashback then remove your needle a little bit.

Floating should only be done if you are in the vein and the cannula won't advance up into the vein, otherwise you are risking damaging the IV. Floating works when the tip of the cannula is hitting up against a valve of a vein or the cannula is too big and the vein too small. It you are not squarely in the vein, you're going to get a GREAT BIG INFILTRATE.

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