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IV starts

Ob/Gyn   (4,966 Views 18 Comments)
by nurse79 nurse79 (Member)

nurse79 has 8 years experience and specializes in Mother/Baby;L/D.

4,541 Profile Views; 157 Posts

Hi All...

Just wondering what are some tricks of the trade on IV starts ?? I'm about 65% success rate when it comes to them (and obviously depending on how swollen mom is) but i would love to become more efficient with these. I hate having to pull another L/D nurse away to do my IV! I know it comes with practice...i usally can get them in the hand but i try to use that as a last resort. Our standard is to draw CBC and Hold clots , then we usually start the IV from the same site. Half of the time my veins BLOW...HELP HELP HELP!! :o

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vampiregirl has 10 years experience as a BSN, RN and specializes in Hospice.

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When are your veins blowing- with the initial stick or after the IV itself is started (labs already drawn)?

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Dixielee has 38 years experience as a BSN, RN and specializes in ER.

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I have very good success with IV's, but I have been doing it for many years. I will run thru my technique:

Assemble all supplies, tear tape, have everything open and ready on a tray next to patient. Occasionally I set up on the patient bed, but if they move or jump, then your supplies are on the floor.

Apply tourniquet, shop for vein. In the ER we usually go for the AC because you don't know what you will be looking at, possible CT scan, large volume fluid replacement, blood transfusion. Depending on your situation, you may look at hands, wrist, forearm. Upper arms sometimes have a little treasure in elderly, but not always. You will get used to the "feel" of a good vein. Visualization is generally not an option. Once you find your vein, take off your tourniquet, don your gloves and get ready to prep the site. If you are drawing blood cultures it takes a bit longer, so I do it before I put the tourniquet back on.

Put the tourniquet back on and find the vein again, doing a final prep. I always have an INT cap and pigtail ready, unflushed. Loosen the cannula where it attaches to the needle then replace, sometimes when you are in the vein it is hard to detach and you want a smooth movement. Enter the vein at a fairly narrow angle, I think many go too steep and go straight thru the vein. Sometimes you need to put a little tension on the skin to straighten the vein, or see it better, especially if the vein is tortuorous. Enter the vein slowly with out a "stab", watch for blood flashback. As soon as you see the flash, enter just a little farther to make sure the cannula is in the vein and not just the needle.

Once you are in, gently slide the cannula into the vein as you withdraw the needle. Once you are in, then pop off the tourniquet, hold pressure at the end of the cannula so you will not bleed back. Attach the pigtail to the cannula and put one piece of tape over the area where the cannula attaches to the pigtail. Because the pigtail is capped with the INT cap, you will not bleed back at this point.

NOW, I draw my blood. I do it after I have attached the pigtail and not directly from the cannula, because it causes less movement and pain to the patient and you are less likely to lose your line. You can draw with a syringe and then with an adaptor, put your blood into the tubes, still keeping the needleless approach. Flush your line well, continue to tape with tegaderm and one other piece of tape to secure it well.

Unless the patient is doing backflips down the hall, you do not need to take the heck out of it. I found that one piece across my cannula connection, then tegaderm over the pigtail and cannula connection, then one piece to circle the pigtail back over the tegaderm area for security. If you add IV fluids, then add one piece to secure the line.

I have found that using the pigtail makes it much more comfortable for the patient. As you give meds, draw labs, change IV tubing, etc. you are not moving the insersion site, only the tubing.

Always, always use and INT cap. I hate getting a transfer from another hospital where the tubing is plugged directly into the cannula and taped to the max. We have to change to our IV tubing and it is very easy to lose the line when you have to take it down to the line, especially if the patient can't be still. So do yourself, your co-workers and your patients a break and use a INT cap.

Most of IV starts require experience, and the only way you get that is to keep trying. Get comfortable with the "good veins", get your technique down, and use the same system every time. Then you can move on to the more difficult ones. Give yourself time. Good luck.

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nurse79 has 8 years experience and specializes in Mother/Baby;L/D.

157 Posts; 4,541 Profile Views

thanks guys i will def try those tricks...!!

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iHeartNICU specializes in NICU.

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What is an INT cap? I haven't heard that term before.

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crissrn27 has 8 years experience as a RN and specializes in nursery, L and D.

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I think many nurses try to put the whole needle in, when what you need to do is as Dixielee described. Put the needle in until flashback, then push the cath. forward and remove needle. Much less chance of blowing a vein, because, in my experience, blowing is usually caused by stabbing through the vein by trying to insert the whole needle. Oh, and practice!! Tell everyone (if possible) that you would like to try to start their IVs.....more work but worth it!

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nurse79 has 8 years experience and specializes in Mother/Baby;L/D.

157 Posts; 4,541 Profile Views

yes i agree. thats what my preceptor had suggested, that i decrease the angle when entering the vein, and go in parallel. I also find that i feel more comfortable when i can actually see the vein as oposed to ONLY feeling it. I just feel that if i cant see it, i dont have as good success. But thanks for all the advice, it totally helps.

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nurse79 has 8 years experience and specializes in Mother/Baby;L/D.

157 Posts; 4,541 Profile Views

yea what is an INT cap

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Dixielee has 38 years experience as a BSN, RN and specializes in ER.

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INT caps are called by other names, the INT stands for intermittent, but it is the cap you put on the end of tubing or the cannula to turn a regular IV into a saline lock so you can flush it intermittently and maintain your line. I am old, and we called them INT's, not sure what the real name is. Back in the day, we called them heparin locks because we flushed them with heparin every shift.

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