IV starts in the AC/antecubital- how do you keep from bleeding?

[lfolou]

This may sound like a dumb question, but I am a new graduate resident in the emergency room.

I have no problem finding veins and getting the catheter in, but for some reason, lately i CANNOT occlude the veins for the life of me and I have no idea why.

When they're in the hand, or finger etc. I have no problem occluding the vein after I retract the needle.

But I feel super dumb for not being able to figure out where exactly I should be occluding the vein to keep it from bleeding once I get flashback/retract the needle in the AC- HELP.

What are the steps you take exactly to keep it from bleeding? (1. Insert 2. Retract needle and occlude vein 3. Remove tourniquet 4. Flush with NS)?

Yes, sometimes I can keep it from bleeding, but I'm not consistent.

How far above the hug should I be pressing down? How hard? Should I use all fingers?

Am I just not pressing down hard enough? I'm open to all suggestions at this point, because this seems super strange to me...

Love, a fellow nurse

[offlabel]

Try taking the tourniquet off before pulling the needle back and waiting a couple of seconds. That'll decompress the vein and make it easier to tamponade.

[brownbook]

Perhaps you are moving too quickly once you get a good blood return and retract the needle?

There is an excellent You Tube Video, "IV Access, best 10 Tips" by "The Stabber". You won't believe how long he leaves the needle inside the cannula after a successfully cannulation. It is hard to explain, a picture is worth a 1000 words. But maybe that You Tube video, or any of the other You Tube videos on starting IV's (I know you don't need that part, you can skip through prepping, finding, cannulating, the vein), then watch their technique to occlude the vein and connect the IV tubing.

[JKL33]

Take a look at the cather portion of your set. The length will be the distance "above the hub" that you want to occlude. And yes it is fairly firm pressure. If you use the lateral edge of your hand you still have your fingers free to stabilize the hub at the same time. Remove tourniquet first.

[liluiass]

I generally put a little cotton ball bellow the end of the catheter so I don't get a bloody mess

aaaaand I elevate the hand above the chest of the patient that is if I fail at occluding in the right place ^^

[nursephillyphil, BSN, RN]

do you have any nexiva closed catheter systems? those dont require the y tubing and dont leak blood once you get flashback. the straight needle ones you are using however, are better for hard sticks

[akulahawkRN, ADN, RN, EMT-P]

While it may be uncomfortable for some patients, I do press quite firmly with my pinkie, ring, and middle fingers along the line where the catheter is. This usually quite effectively stops the bleeding while also allowing my index and thumb to be able to manipulate and/or secure the hub from moving while I attach tubing to the hub. Now do note that I made no specific reference to body part as I use the same technique everywhere and every time I start a peripheral line. The hand that I use to do this is the one that's closest to the core as I face the patient. So if I'm on the patient's right side, I'll use my left hand to tamponade the blood flow. If I'm on the patient's left side, I use my right hand to tamponade blood flow. The other hand is the one that I'll use to attach the tubing. This "tubing" can be a direct connection to the line or it can be an extension set or even a simple clave port that I've flooded and could connect directly to the IV hub.

Using this technique, I can start a line without any bleeding most of the time. Sometimes I'll put a 2x2 under the hub to catch any wayward blood drops...

[IVRUS, BSN, RN]

If one uses the Introcan Safety 3, one will not be exposed to patients blood as it is a valved peripheral IV catheter.