I am starting to compile a list of tips and tricks concerning starting venipuncture. The goal is to share experiences and tricks of the trade.
Tips e.g. on how to find that elusive "best vein", would be greatly appreciated. (and if you have a few that are not to be taken entirely serious those would be welcome as well).
Please answer me directly - no need to clutter up the board with this. I will post the text once it is finished.
ALWAYS flush the angio with NS before you stick - you WILL get a flash everytime this way.
If you can't find a vein on a chubby baby, grasp the inner ankle with your thumb with the heel facing your hand. Rest the meaty part of your thumb on the malleolus and roll the thumb towards the anterior malleolous - make an indentation with your thumbnail where it hits (Short nails!) Stick where the indentation is! Bam - Saphenous!
If you can't find a vein on a chubby baby, grasp the inner ankle with your thumb with the heel facing your hand. Rest the meaty part of your thumb on the malleolus and roll the thumb towards the anterior malleolous - make an indentation with your thumbnail where it hits (Short nails!) Stick where the indentation is! Bam - Saphenous!
Cool trick! I gotta remember that, and try it ASAP! Thanx!
1st I tie the turniquet on super tight, and when running into a valve I stop apply buff cap then flush with 10cc's not 3cc 's works every time to get past that valve. We usually will draw blood off our IV's in the ER, I found that applying buff cap then using needle to take blood helps open that valve too and you can then thread needle in during blood draw..
Hi all,
I am starting to compile a list of tips and tricks concerning starting venipuncture. The goal is to share experiences and tricks of the trade.
Tips e.g. on how to find that elusive "best vein", would be greatly appreciated. (and if you have a few that are not to be taken entirely serious those would be welcome as well).
Please answer me directly - no need to clutter up the board with this. I will post the text once it is finished.
I am starting to compile a list of tips and tricks concerning starting venipuncture. The goal is to share experiences and tricks of the trade.
As a BSN student who is also a laboratory technologist I would suggest always leaving lab somewhere to draw the patient from, if at all possible, when choosing an IV site. Unfortunately new phlebs, and some old ones, will invariably draw above an IV (I know-this breaks all the rules) rather than ask for help. I always question them when I get a K+ of 8 or a 700 glucose, and ask for a redraw-but they usually deny the deed!!!!! ugg!!!!!!
Specializes in 6 years of ER fun, med/surg, blah, blah.
For an elderly patient, with fragile veins, I sometimes will not put the tourniquet one, because it causes the veins to blow. I prepare the site & pick a likely vein & put the angiocath in. The flashback will be small but once I have the IV in, secure it with the bioeclusive, etc., I can them draw labs from it carefully. Or just use it as an IV. I've been working in the ED for 3+ years now, after being a Med/Surg RN for several& found this to work well for me. An LPN buddy showed me this & I continue to pass it on.:balloons:
For those older patients with the "rope" veins, I often find they blow when you use a tourniquet. We've taken to using a BP cuff slightly inflated (60-80) on these patients and haven't had a problem since. It's an excellent technique taught to us by one of our paramedics.
also works well on infants/toddlers too.
Works incredibly well in the elderly with frail veins as well...let their arm hang down and allow gravity and their poor circulation to be your friend!
As a 63 year old patient with Crohn's disease who has had MANY IVs thru the years: PLEASE stay the heck away from my "dummy" vein; in fact, stay the heck away from my hands for an IV unless there is no choice - and then explain WHY to me first. In addition, I'd prefer you stay away from the inside of the elbow if possible as well.
And good Lord, is there really the need to tie that turniquet that tight?! By the time you remove it my entire arm has gone past the horrible dull ache to numb!!! Even for "just" a blood draw the phlebotomists get carried away with that turniquet! Usually my veins stand up and salute for a draw or IV any way so I fail to see the need for a turniquet that tight.
For sticks at the inside of the wrist, please move up far enough that there is room for bending the wrist w/o causing discomfort and bruising when the patient uses the hand and wrist.
In a true emergency I agree stick the best vein you can hit the fastest, but if it is in one of the above places, my preference is that the IV be replaced in a more comfortable area ASAP.
I really appreciate seeing so many caring nurses posting to this and other threads. THANK YOU, NURSES for ALL you do for us patients!
As a 63 year old patient with Crohn's disease who has had MANY IVs thru the years: PLEASE stay the heck away from my "dummy" vein; in fact, stay the heck away from my hands for an IV unless there is no choice - and then explain WHY to me first. In addition, I'd prefer you stay away from the inside of the elbow if possible as well.
And good Lord, is there really the need to tie that turniquet that tight?! By the time you remove it my entire arm has gone past the horrible dull ache to numb!!! Even for "just" a blood draw the phlebotomists get carried away with that turniquet! Usually my veins stand up and salute for a draw or IV any way so I fail to see the need for a turniquet that tight.
For sticks at the inside of the wrist, please move up far enough that there is room for bending the wrist w/o causing discomfort and bruising when the patient uses the hand and wrist.
In a true emergency I agree stick the best vein you can hit the fastest, but if it is in one of the above places, my preference is that the IV be replaced in a more comfortable area ASAP.
I really appreciate seeing so many caring nurses posting to this and other threads. THANK YOU, NURSES for ALL you do for us patients!
Specializes in med/surg, telemetry, IV therapy, mgmt.
My hospital just instituted a policy to give intradermal saline prior to each iv attempt. Has anyone heard of this? I'm curious what everyone thinks.
Yes. When I worked on an IV team we did this frequently. We used either 1% Lidocaine or saline. Either works very nicely to numb the skin before inserting the catheter. I can't confirm this, but I think it is partly due to the fact that you've already made a little puncture in the skin with the TB syringe. The IV catheter is inserted by sticking into the puncture you made with the TB syringe. It's nice that you have a policy to cover you to do this. Whenever we had a really anxious patient, we had to call for an order from the physician to numb the site first. Just make sure that when you insert the TB needle that you put it alongside the vein so you don't accidentally stick the vein. After you've done this a few times I think you will find it a really good tool to use--especially with patients who have a bit if a needle phobia.
As a 63 year old patient with Crohn's disease who has had MANY IVs thru the years: PLEASE stay the heck away from my "dummy" vein; in fact, stay the heck away from my hands for an IV unless there is no choice - and then explain WHY to me first. In addition, I'd prefer you stay away from the inside of the elbow if possible as well.
gauge14iv, MSN, APRN, NP
1,622 Posts
No fail trick for peds/infants -
ALWAYS flush the angio with NS before you stick - you WILL get a flash everytime this way.
If you can't find a vein on a chubby baby, grasp the inner ankle with your thumb with the heel facing your hand. Rest the meaty part of your thumb on the malleolus and roll the thumb towards the anterior malleolous - make an indentation with your thumbnail where it hits (Short nails!) Stick where the indentation is! Bam - Saphenous!