IV starts - losing blood return/can't thread catheter

Nurses General Nursing

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Specializes in Pediatrics Heme/Onc.

I've been having trouble starting IV's. I get a great flash with blood filling the hub (I use angiocaths), but then I can't thread the catheter and lose my blood return. What's happening? Am I piercing the opposite vein wall? Is the needle slipping out of the vein before I thread the catheter? Are the veins constricting as soon as the vein in punctured?

Of note: I've been practicing on myself because no one at work wants to get poked. It's actually not too hard one handed -I can get the extension screwed on with one hand. Is the problem with my technique or are my veins the problem - I have small veins that always like to hide once the needle is in. Thanks for your input!

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Specializes in intensive care major medical centers.

once you get the flash stop and take the tourniquet off and connect the saline syringe and gently flush the cath while advancing it 0.5 to 1 cc ( it opens the vein in front of the cath)

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Specializes in ICU, Telemetry.

Sometimes you bump up against a valve. What I do when I get good blood return but it won't thread is wait like 30 seconds, then attach a flush, and gently float the cannula up the vein -- you'll also be able to see immediately if you're not in the vein. Also, watch the angle on your arm and then the angle on a bad stick. Are you more shallow/deeper on the good hits?

With crappy veins, I use a BP cuff inflated to 100 rather than a tourny to make a vein pop up. And with some elderly, I don't use either, because the veins go "buh-bye" and disappear completely. I just stabilize and go for a site in the midforearm. Sometimes I can get the vein on the outside aspect down near the elbow when I can't get anything else, although I always feel like I should be standing on my head to get the right angle.

Some days, you hit every vein you touch. And some days you couldn't hit a sewer pipe. That's the way it works....

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First, stop practicing on yourself. It really has no more educational benefit than practicing on a fake arm. The situation is too controlled and you won't learn what to do in the real world. Just ask all your coworkers to tell you when they need an IV start and try as much as possible.

Second, when you get the flash, release the tourniquet. Then either advance the catheter manually first or attach a flush and advance it by flushing very slowly.

Third, some people are not good at IVs and even those people who are great at IVs have bad days. Its a hit or miss skill (no pun intended) and not worth a lot of stress. Good luck.

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Specializes in Surgery, Tele, OB, Peds,ED-True Float RN.

Agree with all of the above advice. I almost always flush in the angio cath. That is the method that works best for me. I do it just like the poster below...

once you get the flash stop and take the tourniquet off and connect the saline syringe and gently flush the cath while advancing it 0.5 to 1 cc ( it opens the vein in front of the cath)
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Specializes in ccu cardiovascular.

I agree don't practice on your self. It really serves no purpose other than you bruising up your own arms. I usually when I get the flash, take off the tourniquet, thread it gently, flush and then withdraw and reflush watching for any swelling. If you found you lost the flash, back it out a little and rethread searching for your blood flow. You probally are against the wall, valve ect... you are almost there. You just might need a lot more practice and need to get more starts in.

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Specializes in ER.

What I do is make sure you are almost completely flat against the skin once you get the flash. Go in at like a 10 degree angle. Once the you get the flash then lower and retract the needle, pop off the band/BP cuff. If the blood doesn't fill the extension set, pull the catheter out a bit and then try to advance it again. Also you can float it in too. If neither one of those tricks work then you probably are going through the other side of the vein. I like to use the veins on the underside of the forearm the most. I try to avoid the hand and wrist unless the veins are huge. Another good practice is to start all the IV's you can using a 18g or 20g. You will get better...1.5 years ago I couldn't start an IV if i had to and now I am doing the tough sticks.

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Specializes in Management, Emergency, Psych, Med Surg.

The valves can be a real problem and floating the iv in using some flush is really the best way to get the catheter to advance.

Another tip just as an FYI, when you have an elderly person or a person who has been on chronic steroids you should try to avoid using a tourniquet. Have the person hang their arm down and it will usually cause the veins to come up. You can then insert the catheter and you won't get the back pressure of the tourniquet which can cause the vein to blow.

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I'm crappy at IV starts and I'll fully admit it. A tip that was given to me for angiocaths was once you get your flash, lower your angle and advance a little, then thread and pop your tourniquet. Next time you open an angiocath, look at the tip of the needle and the catheter. There's a gap between the bevel of the needle and the end of the catheter... that's how far you need to advance before you try to thread. My problem for a long time was i'd get my flash and try to thread... aaand my catheter wasn't actually in the vein. The bevel of the needle was, but the catheter wasn't. Good luck!

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