IV starts

MollyMo · Sep 15, 2002

Make sure you have the brightest light possible in the room. And make sure the patient is warm. Use warm washcloths if you need to. If you have to use a hand vein, hang their hand down off the bed to help visualize the vein. I can't think of anything else except to say relax. Everybody misses once in a while. :)

caroladybelle, BSN, RN · Sep 15, 2002

Practice!Practice!Practice!

(I love how the public expects us to be good IV starters w/o practice)

fab4fan · Sep 15, 2002

I have this mantra, "Let the vein come to you". I see so many people that put the tourniquet on and just stick at the first thing they see...I'll put one on and look around for a while.

Don't give up right away if you stick and get no return...try repositioning the arm, redirecting the cathlon, etc. Sometimes in very dehydrated people there's a bit of a delay with blood return.

Get creative...try some spots that you don't usually use. Develop your own "fail-safe" sites (mine is the radial vein...even if you can't see it well, you know anatomically that it's there.

And of course, practice, practice, practice. Grab every opportunity to start one; pretty soon, you'll be the one the others call when they can't get it (and that's a pretty neat feeling:) )

Youda · Sep 15, 2002

Take your time. Don't always feel like you have to just slide it in within 2 seconds. Once you pierce the skin and don't get a return, don't pull the needle out. Sometimes the stick makes the vein disappear for a minute, or it rolls away. Change the angle, or go a little deeper, or a little more superficial, just don't pull out the needle. Since you've already poked them, just as well stay hunting around until you either hit the vein or blow the vein!

cactus wren · Sep 15, 2002

I`ve discovered that an old fashioned bp cuff works very well in lieu of tournaquit.....Pump it up high, then let it go down to around 80 or so and thighten it down....Makes veins show up much better........I have stashed a 'real" bp cuff in my locker for just that purpose.....very rare around here, what with dynamaps,hp`s, etc.And Practice, practice, practice....

James Huffman · Sep 15, 2002

Patients sometimes get nervous if you take a minute starting an IV, so I always warn people that -- in a non-emergency situation, of course -- I take a few more minutes. 'Better to look twice than to stick twice' is my motto. As others said, warmth is good. Bright light is very good. And adequate hydration is even better.

No one gets every stick right. You will have days when -- for whatever reason -- you're just not having a lot of luck. Nurses tend to get very down on themselves when this happens, but the best thing is to remember that tomorrow will be better, and not get some complex that you are no good at sticks. Keep at it. Do as many sticks as you can. Learn from those around you who are good at it. You WILL get better.

Jim Huffman, RN

http://www.NetworkforNurses.com

Editorial Team / Admin · Sep 15, 2002

:) Helps me if I make myself comfortable before (no leaning over, bending down) - may even pull up a chair. Place a rolled towel or some kind of pad under the elbow, not to hyper-extend it but to support it. Very important to apply traction to the skin below your stick site, to immobilize the vein and decrease trauma to it when it is cannulated. Check out back issues of Nursing 2002, there was one issue within the last year with a great article on just this topic. Check out the Intravenous specialty on this site, there have been many similar threads you could access there.

I'm with the others: take your time and keep trying!! Best to you! -- D:)

fab4fan · Sep 15, 2002

James is right...there are days that you feel like you couldn't hit the broad side of a barn, then others when you get a vein that seems to come out from nowhere.

But I agree, don't pull the cathlon out immed. if you don't get an initial blood return (this is part of that mantra I mentioned earlier). About the only time I'll take one out right away is if the pt complains that the site is very painful (for some, the wrist area is too tender).

Another thing I forgot...a lot of people will sort of "slap" the area where they are going to stick, trying to raise the vein. This will actually make the vein shrink down. The best technique I've tried, and use it all the time, is to just very lightly tap the area with your fingertip. You would be amazed at the veins that pop up by doing this. Another is to stroke the vein very lightly in the opposite direction of the blood flow.

And one thing that wasn't mentioned...choose the appropriate size cathlon. A #20 or #22 will usually be sufficient, but in extremely difficult sticks, like people whose veins are sclerosed or just have "SFV", I've used a #24...we were still able to run fluids at 125cc/h, and I got the blood for the bloodwork with the IV start.

For the very anxious pt, the stress can make your vein vanish just as you're getting ready to stick, so I've used guided imagery with some adults and older kids, had younger kids blow soap bubbles while I'm sticking, let the kids try to pick the site, etc. Lots of hugs and + reinforcement when it's over.

One last thing...pts who seem to get a perverse pleasure out of trying to jinx you ("You'll never get it...the last time I needed an IV they had to stick me 8,456,293 times...I have terrible veins.") I love to just smile and say, "Well, then today is your lucky day, because I'm the one that is going to be starting your IV." Don't let them try to psych you out...tell them how good you are (even if you're not the greatest yet, keep telling yourself you are doing great and are getting better every day...a little bit of confidence goes a long way in being able to get an IV).

Youda · Sep 16, 2002

Yep. I always tell them not to worry about how long I take, because I take a lot of time so I only have to stick them once. Then, I do pull up a chair and get comfortable and start chatting away while I'm setting up, sometimes just stopping what I'm doing to listen to what they're saying. Trying to get their minds on our conversation instead of the nail I'm able to stick in their arm. If they are tensing up, I just keep talking and asking questions. If they're real tensed, I sorta dig my fingernail into the forearm just a bit so they are focusing on that . . . then stick 'em before they realize that I'm in!

Good thread! I'm getting some new ideas, too!

extremebean · Sep 16, 2002

a thing i've found helpful more than once: seems pretty simple BUT listen to your pt. i've seen too many people with that "I do this all the time" attitude, then they stick all around and guess what??? end up getting the stick where the pt told them they would in the first place. i've seen veins i never would have guessed were there after a patient said "they always get me right here". your patient has been stuck more times than you've stuck your patient.

Jen911 · Sep 16, 2002

Okay, I seem to be just the opposite of everyone else on the lighting issue. I prefer dim light, as I can see those dark veins easier, and if I absolutely can NOT see a vein, I somehow think I can feel it better (must be psyching myself out).. Those dark veins just tend to show up better for me in the dim light. Remember, vampires like to work in the dark. Everyone comes into my roooms and flips on the lights as I'm about to poke a patient and I glare at them, then they remember and turn the lights back off. It also helps keep my patients calmer not having those bright lights in their faces. (I work in ER, they're already stressed enough, and usually dehydrated or without veins to start).

One other note, if you're able, try to use some humor... If your patient happens to ask if you've done this before, try this line, "I saw it on an episode of ER once!" I can't remember where I picked this up from, might have even been from this BB, but it works every time!

We all have our bad days at IV sticks... I have a 2-3 poke limit... if I can't get an IV on my patient in 2-3 sticks, I'll go get another nurse, and they'll all do the same.

My final tip... the veins in the dominant arm are generally going to be larger! if the patient is right handed, check the right arm, it'll have nicer veins. I know we always try to put it in the opposite arm, but the better veins are in the right arm! LOL

Good luck!