IV tips and tricks

NYNewGrad · Sep 25, 2005

Great thread...

BrownLA2 · Oct 28, 2005

In regards to dcatheter gauge and giving blood:

Anyone who has ever worked in Neonatal ICU can tell you that RBCs, Platelets, whatever, can be easily and safely infused with a pump through even a 24 or 25g.

And by the way, to new RNs, remember, no question is a dumb question.

tlhubbard · Oct 28, 2005

I have NEVER been able to develop the skill of FEELING for good veins. Am I just stupid??? ugh.

The best advice I can give on this one is to say they feel like "soft IV tubing" under the skin. Good bounce, and don't go flat and stay flat when blanched with the tourniquet on.

Also, sometimes all you can do is go for what you can see. I was at an INS (infusion nurses society) meeting recently. Sometimes the "blue hue" or a lovely "blind stick" based on your knowledge of the venous anatomy is all you have to go on in a pinch.(especially those who are extremely obese or edematous)

tlhubbard · Oct 28, 2005

Forgot to mention that I work with the elderly. Sometimes a washcloth under the tourniquet can make a world of difference in those awful marks that never know when to go away.

I know some don't agree, but I feel that my patient's comfort is a priority at any time. I've never had a problem with it making my tourniquet any less useful.

Also for those who have the luxury of time with their IV placement. Clysis is coming back into favor. Where we can get them rehydrated and then attempt an IV later. Makes a world of difference in the vein choices and their ability to tolerate the fluid.

teeituptom, BSN, RN · Nov 14, 2005

I havent seen clysis used in decades

I did work though

tlhubbard · Nov 14, 2005

Additional thought on the saline injection under the skin. When you create the bubble under the skin, pull the skin over and inject and then when you release the skin it puts the bubble over the vein where you want it and keeps you from accidentally puncturing the vein.

Great trick, however it does obscure your sight of the vein a bit.

teeituptom, BSN, RN · Nov 14, 2005

Vision the Vein

Be the needle

N.S.46 · Nov 15, 2005

Thanx to all of you for the suggestions. I hope the person who started this thread will post it all together when it's complete.

As a nurse wanna-be & a previous patient on a few occasions with IV's, I would like to contribute.

This was stated before but PLEASE listen to the patient. Personal experience...I tell the nurse I have thin, easily blown veins. I'm told no I don't, I just think I do. Five sticks later & she wants to try again. Why??? Because the veins are thin & she has pushed the needle through each time. This was not my only terrible experience with IV's, but I won't bore you with them now.

For those of us that are skinny, don't try to put them in the backs of our hands. Extremely painful & usually blow.

Please give patients a few minutes to relax before starting an IV if possible. The poster who suggested talking to the patient really does help, so does humor.

Please don't think patients are dart boards, the more times you try, the more points you get.

Don't lie by saying it won't hurt or "it's just a little stick". It does hurt & it's not "just a little stick".

Tell the patient what you are going to do & why. Don't just say "because the dr. ordered it".

Do have everything ready. Nothing is more unnerving than having your nurse say "Oh, I forgot something". It may not be true but it may make the pt. wonder about the nurses competency.

Please don't "dig" around for a vein. It's really very painful.

If you can't find a vein, call someone who can. Another unnerving thing is hearing your nurse say "Oh, I can't find anything, but we're going to try anyway".

Just a few suggestions from an alert, patient's point of view.

Now a question. What do you do with pts. who have really skinny veins??? Do you start the IV differently???

Danianne · Nov 15, 2005

.
This was stated before but PLEASE listen to the patient. Personal experience...I tell the nurse I have thin, easily blown veins. I'm told no I don't, I just think I do. Five sticks later & she wants to try again. Why??? Because the veins are thin & she has pushed the needle through each time. This was not my only terrible experience with IV's, but I won't bore you with them now.
For those of us that are skinny, don't try to put them in the backs of our hands. Extremely painful & usually blow.
Please give patients a few minutes to relax before starting an IV if possible. The poster who suggested talking to the patient really does help, so does humor.
Please don't think patients are dart boards, the more times you try, the more points you get.
Don't lie by saying it won't hurt or "it's just a little stick". It does hurt & it's not "just a little stick".
Tell the patient what you are going to do & why. Don't just say "because the dr. ordered it".
Do have everything ready. Nothing is more unnerving than having your nurse say "Oh, I forgot something". It may not be true but it may make the pt. wonder about the nurses competency.
Please don't "dig" around for a vein. It's really very painful.
If you can't find a vein, call someone who can. Another unnerving thing is hearing your nurse say "Oh, I can't find anything, but we're going to try anyway".
.
:yeahthat:
Just a few suggestions from an alert, patient's point of view.

Sadie04 · Nov 16, 2005

Thanx to all of you for the suggestions. I hope the person who started this thread will post it all together when it's complete.
As a nurse wanna-be & a previous patient on a few occasions with IV's, I would like to contribute.
This was stated before but PLEASE listen to the patient. Personal experience...I tell the nurse I have thin, easily blown veins. I'm told no I don't, I just think I do. Five sticks later & she wants to try again. Why??? Because the veins are thin & she has pushed the needle through each time. This was not my only terrible experience with IV's, but I won't bore you with them now.
For those of us that are skinny, don't try to put them in the backs of our hands. Extremely painful & usually blow.
Please give patients a few minutes to relax before starting an IV if possible. The poster who suggested talking to the patient really does help, so does humor.
Please don't think patients are dart boards, the more times you try, the more points you get.
Don't lie by saying it won't hurt or "it's just a little stick". It does hurt & it's not "just a little stick".
Tell the patient what you are going to do & why. Don't just say "because the dr. ordered it".
Do have everything ready. Nothing is more unnerving than having your nurse say "Oh, I forgot something". It may not be true but it may make the pt. wonder about the nurses competency.
Please don't "dig" around for a vein. It's really very painful.
If you can't find a vein, call someone who can. Another unnerving thing is hearing your nurse say "Oh, I can't find anything, but we're going to try anyway".
Just a few suggestions from an alert, patient's point of view.
Now a question. What do you do with pts. who have really skinny veins??? Do you start the IV differently???

N.S.46,

Thanks for your insight. I often try to put myself in the patient's position - I too have been a patient, and I have small veins - they always go for my hand:rolleyes:

That said, I work in an outpatient oncology clinic and start about 10-15 IVs a day, many on emaciated and/or elderly patients with small delicate veins. With these patients, I always use a heat pack or have the patient soak their arm in the sink - I have found that gravity and warm water work wonders for small veins. Then I choose the smallest gauge needle possible - sometimes even a 24g angio, since the needle is smaller and the catheter is shorter (less to thread). If I encounter resistance when trying to slide the angio off the needle, I retract the needle, attach the saline syringe, and try to float the angio in while flushing with saline. If I still meet resistance, I pull back slightly on the angio until and aspirate the saline syringe until I see a strong flashback and can more often than not flush again and get past the valve or scar tissue that is causing the resistance.

It's true that practice makes perfect:p

N.S.46 · Nov 17, 2005

Sadie04 & all other posters for this thread,

Thanx for the response. These tips are soooooooo helpful not only for experienced nurses but especially "newbies" or those of us not there yet. I'll be compiling them in my paper notes & PDA.

In all the times I've had to have an IV, not one of the nurses offered a heat pack or any kind of numbing med. I wish they would have.

The above mentioned incident was not the only bad experience. Another time I was in pre-op. Now you would think these nurses would be pros at starting IV's. She wouldn't listen to me, after 4 tries in one arm, twice in the other, digging around, refusing to get another nurse, my ob/gyn came in & wanted to know why I was still there & not ready for surgery. By then I'm white as a ghost, feeling light-headed & about ready to pass out. He took one look at me, came over to ask me if I'm ok, put his hand on my forehead, & lost his temper. Now mind you, my dr. is usually very cool, calm & collected but he let them have it. He was upset that she poked me so many times so he chewed her out & then chewed out what I'm assuming was the charge nurse for letting her do that. And of course he was pissed that I wasn't ready. He wouldn't let them start the IV after that. We had to wait for someone else to come & start it. I don't know where she came from but she got me first try. Where was she 6 pokes ago???

I'm more than understanding when they can't get it the first time, but 6 times??? :angryfire Come on!!!

My best experience: Pre-op for knee surgery, different hospital. The nurse came over & made small talk. I told her about my small veins & my last experience. She went & got a smaller gauge needle, had me hang my arm down over the side of the bed, pulled up a chair & sat down. She took her time & made sure she had a "good" vein, for me anyway. She chatted with me the whole time which helped me to relax. She got me first try & I hardly felt it. I thanked her profusely, teased her that I was going to steal her & take her with me. She was wonderful & had a great bedside manner.

I know from my own personal bad experiences, I will be much more patient & not poke multiple times if I can't hit the vein. I will call someone to help me or start it. I'll certainly have my list of tips with me & use them.

ABlackRN · Nov 30, 2005

When I worked in London we would use NTG spray on those hard to find veins, and they would pop right out.

Also have found through the advice of an Air Force medic that if you have a hard time with "large" patients, close your eyes and feel, then when you are ready, GO BEVEL DOWN. Sounds crazy, and hard to override the training, but believe me IT WORKS!

Good luck