IV starts, umm help

dusky1228 · Jan 6, 2009

As a long-time IV starter (and been on the receiving end way too often too, and I have collapsible threads for veins ), here are some tips.

1-if you have trouble getting a vein to "pop", try using a wide tourniquet, or use a BP cuff and lock the stopcock after you've pumped it up.

2-hang the arm slightly down-allows the vein to pump up a little

3-only apply the tourniquet tight enough to block off some blood flow. If you do it too tight, then you block all blood flow, and the vein will shrink. You want the blood to flow into the area, but be restricted in flowing out

4-stabilize not only the arm, but use your thumb or forefinger to pull down on the skin just below your entry point, right over the same vein you are sticking. This stabilizes the vein, makes rolling harder, and keeps the vein taut for easier penetration by the IV

5-after the flashback, while holding that skin and vein taut, advance the catheter another mm, THEN try the flush. I use my thumbnail on the catheter hub, holding the skin taut. Usually advancing the catheter another 1 mm after flashback is enough, if not, "floating" it in with the flush usually will do the trick.

I've got other tips, just don't have a lot of room here. Feel free to email or PM me directly.

And yes, it *will* come in time.

justdeda · Jan 6, 2009

dear diva,

i think the best thing you can do is hit the books! read, read, and re-read anatomy charts, phlebotomy websites, hints, tips, war stories and anything and everything you can get your hands on that will give you more information on what to do, with whom, and when.

dont feel stupid or inadequate when you have to call in the iv team. your facility wouldnt have an iv team if every nurse on the floor could put in a line every time. take the time to ask the rescue nurse to explain to you how she has analyzed the problem, and what is her plan of action for solution.

practice on your mother, daughter, cousin or uncle. look at veins on friends and family. close your eyes and feel them, especially the older ones. if you open yourself up to active and aggressive learning, you will find active and aggressive teachers!

good luck :)

justdeda:nurse:

home iv nurse

iluvivt, BSN, RN · Jan 8, 2009

Based upon what you said in your post I think one of your problems could be a common one nurses make when starting an IV. Sometime look at an IV catheter closely....look at the bevel and the end of the catheter. You will notice that the larger the catheter you use the greater the distance between the edge of the catheter and the needle. Because of this when you are accessing a vein you can get a flashback with only the needle in the vein....and then if you pull the needle back you are now out of the vein. You said your catheter was bent. it is probably bent because you are no longer in the vein and you are threading the catheter into tissue. this is what you need to do.

Once you have hit the vein and you see the flashback in your flashback chamber or flashing into your tubing ( depends upon the product you are using) drop your angle flush with the skin and then advance just a bit more, about 1/8 of an inch...pull your needle back then and then advance the remainder of the catheter into the vein.

The other common mistake I see is nurses starting out with a very sharp angle and they are actually nicking the vein underneath it or doing a through and through puncture....you will usually get a blood return with both of these and they are almost impossible to salvage unless you have very advanced skills and are very quick to fix it ( i will not go into that) So try changing your angle. This depends on how deep the vein is you are going for...but keep in mind veins are very shallow. Try decreasing your angle to a 15-20 angle. if you can give some more detailed examples (as you did) I can give you some corrective actions to try