IV starts turn into hematomas

[purple_nomad]

So I've been having this big blow to my confidence lately...

I'm a new nurse, just off orientation at a children's hospital ED. We do a lot of IV start s(obviously) and sometimes on very little veins. For the past two shifts, all of my starts have ended as hematomas. It's very discouarging and annoying to have to ask everyone else to try! And it delays Pt care, which doesn't look so good.

So I was wondering...any advice to avoid this from happening? Any tricks of the trade?

[dudette10, MSN, RN]

I'm a first year nurse, too, and I am looking forward to responses. I've occasionally caused hematomas, and I'd like to know what I'm doing wrong. Obviously, I've hit something, but I don't get flashback, and then the site bleeds when I remove the cannula to try again. I'm thinking I've gone through the vein (no flashback), and the bleeding is caused by the trauma to the vein. I've been able to avoid most hematomas by applying pressure immediately after removing the cannula. My IV start skills are, to use a euphemism that protects my ego, "developing."

I'm disappointed that this thread got moved to the first year forum. I suppose it got moved because you're a new nurse, which makes very little sense to me. It's not who is asking the question that should be the determining factor, but rather the nature of the thread, kwim? The experienced nurses are the ones who would be in a better position to answer this question, but most of them won't see it.

[LoveSbux]

I'm a brand new nurse as well but come to nursing with five years of paramedic experience and therefore about a million IVs under my belt. Not as many on kids, but I can still give some suggestions!

I would guess that the hematomas without flashback are, as you said from, going through the vein. The most common error when this happens is that your angle of penetration was probably too deep. If you think about the vein as a straw, holding the needle more parallel to the vein (so a 15-30 degree angle) would make the back wall further away from the pointy needle, right? If the vein is easily palpated, you probably don't need to stick the needle in too deep or too fast to penetrate it. After you get flash, you drop the angle even further, almost parallel with the skin, advance the needle and catheter another 1-2mm to ensure the catheter is in the vein, then thread the catheter off the needle.

A lot of people think that if there was no flash, there is no need to apply pressure after an unsuccessful stick. Not true--apply pressure either way, check the site after 30-60 seconds and evaluate whether it's bleeding or not. Put an ice pack on if you think a hematoma is going to develop.

Hope that helps a little.

-Alison