IV tips and tricks

veegeern, BSN, RN · Nov 30, 2005

I'm a novice RN, so I just have to ask...Why does the site have to be in the AC for a CT PE protocol? Thanks.

UM Review RN, ASN, RN · Nov 30, 2005

I'm a novice RN, so I just have to ask...Why does the site have to be in the AC for a CT PE protocol? Thanks.

I was told that it's because the force of the injection will blow small veins. The contrast can cause necrosis to the tissue if it extravasates.

Therefore, our hospital will only do a CT Angio with no less than a #20 to the AC or higher.

Hope that answers your question satisfactorily.

veegeern, BSN, RN · Nov 30, 2005

Thanks! I'm a "why" person, so that helps, and it makes sense.

guzzebear · Dec 1, 2005

Thanks for the great tip!!!!

lisabeth · Dec 10, 2005

I am just wondering, what makes a vein roll? What actually happens when it does if there is an iv already in the vein? Is that what makes the stinging sensation? One time it felt like the iv had punctured through another part of the vein.

I am just starting my pre-requisites. A&P and Psychology. By the way, when you go to practicing in the clinicals and you are practicing on each other, do you just stick the iv in and then pull it out?

I had better toughen up fast:nono: I am already nervous about the iv's and drawing blood. I dont think giving shots would be that hard.

yoga crna · Dec 10, 2005

Some tips from an old pro.

Find your vein first, before poking around.
Use a heating pad on a cold patient. About 5 min. on medium and you will see great vaso-dilatation. I use this all the time on my elderly patients and they love it.
Use a skin wheal of local (lidocaine 0.5%, plain with 4:1 dilution of bicarb) with a 30 gauge needle.
Use the size catheter appropriate for the patient's needs. In anesthesia, I generally use a 20 gauge or 18 gauge if I think I am going to need to give rapid fluid infusion.
Give sedation PO or IM about 20 minutes prior to difficult IV starts, the patient will really appreciate it and will be relaxed.
In anesthesia, if I have a difficult IV, I give mask nitrous oxide and oxygen and have the circulating nurse start the IV when the patient is relaxed. This doesn't work in emergency situations or in patients with a full stomach.
After three sticks--get someone else to try. It becomes a psychological issue at that point.

Take my word for it, try the electic heating pad and local anesthesia and you will be the hero of the patient.

Yoga CRNA

searchforacure · Dec 16, 2005

wow you all have some great tips. I'm hoping there's a few more out there for finding a vein in an 11 year old autistic boy. Doctor/Nursing staff tried 12 sticks. Said his veins are too small and want him to have a picc line or hickman put in. Would like to avoid this if at all possible. Any suggestions would be greatly appreciated.

mandana · Dec 16, 2005

Question for you pros.

I was wondering why Emla cream isn't used routinely prior to IV starts. Seems to me that the stick with lido or NS first is just as painful to some people as to just go for it. Of course, I recently had a pre-op patient who needed a 16 gauge and according to her, she had crappy veins. As you might expect, she was right - and she said that she really appreciated the lido first. Said it made a big difference and didn't hurt at all going in.

Never did get that 16 gauge in her but I got a 22 in, the CRNA said that would be sufficient until she was asleep - then he put the 16 in!

Thanks,

Amanda

Daytonite, BSN, RN · Dec 16, 2005

some great tips. . .for finding a vein in an 11 year old autistic boy. . .

Old IV therapist here. . .kids veins are not that different from adults, they're just newer! If he's not too wiggly, look in the same places you would for an adult. Try for the cephalic at the wrist. In kids, you won't always see it, but you can feel it and it is often pretty large. Also, try looking at the basilic vein in the back of the arm as it is often ignored. You have to sometimes stand on your head to get it (:chuckle), but it's usually a really good vein. If think you might have a problem with the kid holding still if he's autistic, so you might need some assistance restraining his arm.

To bring up small veins, place warm towels around the arm you want to look in, have the kid turn to that side and dangle or let that arm hang as far below the level of the heart as you can comfortably get it for at least 10 or 15 minutes. Don't waste time finding a vein and sticking once you get the warm pack off, so have everything ready when you start looking for the vein. In fact, I'd just pull up a chair, place the tourniquet, remove the warm pack and then go vein hunting while the kid was still turned on his side with has arm down.

Daytonite, BSN, RN · Dec 16, 2005

Question for you pros. . .I was wondering why Emla cream isn't used routinely prior to IV starts.

We were told it was because Emla is too expensive and our pharmacy wouldn't stock it. A multi-dose vial of 1% lidocaine and a syringe are much cheaper. Guess that's a result of Medicare and the prospective payment systems they and the commercial insurance companies have bestowed on our healthcare system. :bowingpur

milky · Dec 16, 2005

Amen!!!

mandana · Dec 16, 2005

We were told it was because Emla is too expensive and our pharmacy wouldn't stock it. A multi-dose vial of 1% lidocaine and a syringe are much cheaper. Guess that's a result of Medicare and the prospective payment systems they and the commercial insurance companies have bestowed on our healthcare system. :bowingpur

That's what I suspected.

Thanks for the info!

Amanda