IV tips and tricks

Specialties Emergency

Published

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.

Thanks in advance!

------------------

Katharina Loock, RN, BSN

Department of Education

Wadley Regional Medical Center

1000 Pine Street

Texarkana,TX 75501

Specializes in ER, IICU, PCU, PACU, EMS.
Unless you need something in the AC for a CT angio/PE study. There's always an exception to everything, right? ;)

Or if you're going to push adenosine....exceptions, exceptions...right? :D

Up Vote Up Vote ×
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Yep! :D

Up Vote Up Vote ×
Specializes in ER.

Ok, I have a dumb question. I am a soon to be new grad, and while my school's program is awesome, the one thing I feel poorly prepared for is IV starts. We don't get to use the computer-simulation IV thing until right before our last semester, we don't get an in-person skills lab like we do for everything else, and most of us do not get to start IVs until senior practicum (last semester). I attempted 5 during my practicum, and only got two. Oddly, one of the ones that was sucessful was on a little old lady while several of the unsucessful ones were on younger, healthier patients. Anyway, my dumb question is this- several of you mentioned "obvious valves". I will admit I suck at palpating veins at this point, so there's not really an obvious valve to me... what should I be looking for?

Up Vote Up Vote ×
Specializes in Women's Health/Pediatrics.

Don't quote me on this (I am a new nurse with only 1 year IV background) but the "obvious valves" that I have experience with usually feel/look like lumps or curves in the veins; these are especially prominent in the hand and in older patients.

Also, I was probably in a worse boat than you are in when I was in nursing school. We did not get ANY introduction to IV starts except if we had extra time during one of our skill lab days (which we didn't) and only then on a fake arm. No "computer simulation." They attributed this to "most" hospitals now having IV teams. Of course, the one I work at now does not and practicing on a fake arm is NOTHING like real life.

To be truthful, my job as a patient care technician in my last year of nursing school helped me the most (PCTs start IVs and draw blood at my hospital.) However, if you can't get this experience, practice on whoever you can! (my boyfriend has been incredibly understanding.)

There is a definite art to IV starts that only comes with time and practice. As others have said before, palpate EVERY time so you can learn the feel of good veins vs bad and come up with some sort of a routine. Even though missing is discouraging, we all miss sometimes and its important to take a deep breath, loosen up and maintain confidence for your patient.

Hope this helps. Sorry such a long post. Good luck!

Up Vote Up Vote ×
Specializes in Women's Health/Pediatrics.
Ok, I have a dumb question. I am a soon to be new grad, and while my school's program is awesome, the one thing I feel poorly prepared for is IV starts. We don't get to use the computer-simulation IV thing until right before our last semester, we don't get an in-person skills lab like we do for everything else, and most of us do not get to start IVs until senior practicum (last semester). I attempted 5 during my practicum, and only got two. Oddly, one of the ones that was sucessful was on a little old lady while several of the unsucessful ones were on younger, healthier patients. Anyway, my dumb question is this- several of you mentioned "obvious valves". I will admit I suck at palpating veins at this point, so there's not really an obvious valve to me... what should I be looking for?

Don't quote me on this (I am a new nurse with only 1 year IV background) but the "obvious valves" that I have experience with usually feel/look like lumps or curves in the veins; these are especially prominent in the hand and in older patients.

Also, I was probably in a worse boat than you are in when I was in nursing school. We did not get ANY introduction to IV starts except if we had extra time during one of our skill lab days (which we didn't) and only then on a fake arm. No "computer simulation." They attributed this to "most" hospitals now having IV teams. Of course, the one I work at now does not and practicing on a fake arm is NOTHING like real life.

To be truthful, my job as a patient care technician in my last year of nursing school helped me the most (PCTs start IVs and draw blood at my hospital.) However, if you can't get this experience, practice on whoever you can! (my boyfriend has been incredibly understanding.)

There is a definite art to IV starts that only comes with time and practice. As others have said before, palpate EVERY time so you can learn the feel of good veins vs bad and come up with some sort of a routine. Even though missing is discouraging, we all miss sometimes and its important to take a deep breath, loosen up and maintain confidence for your patient.

Hope this helps. Sorry such a long post. Good luck!

Up Vote Up Vote ×

When the IV is in the AC, the pump alarm goes off as soon as they try to lift a fork. As soon as the IV is "occluded" that awful noise errupts. It is a problem when pts try to sleep as well as most people bend their arm while asleep. That is until the pump alarm goes off!

Up Vote Up Vote ×

24 gauge 20ml/min =1200cc/hr

22gauge 35ml/min =2100cc/hr (can give blood but not prefered )

20 gauge 60ml/min= 3600cc/hr

18 gauge 105cc/min=6300cc/hr

16 gauge 220cc/min=13200cc/hr

14 gauge 330cc/min=19800cc/hr

figure out how much fluid your pt needs and use the appropriate gauge the smaller the better

Up Vote Up Vote ×
this has been discussed ad nauseam. try a search.

That's how I got here.:D

Up Vote Up Vote ×
Specializes in ER/PICU.

Try ultrasound! Its not very difficult, just takes practice.

Up Vote Up Vote ×

After I clean the site I always clean my gloved fingers because we always touch the pt again to feel for the vein. I cannot tell you how many times I have noticed that nobody does this.

Up Vote Up Vote ×

granted ive never done IV's yet so I dont have many tips but when i was in my phlebotomy class I found it very helpful to close my eyes as I was palpating the veins b/c sometimes your eyes can trick you into thinking theres something there when it could just be a blemish on the skin, shadow or a tendon or ligament. They say that your other senses are hightened when one is taken away and it seemed to work for me. And dont be afraid to check the other arm. Just b/c you've already put the tourniquet on one arm doesnt mean you have to try to wing it with that one and hope you get blood out of them. Lastly, you can always ask the pt if there is an arm that is better to use. Afterall, it is their arm.... they'd be the best one to ask. lol! hope this helps! thanks for posting this!

Up Vote Up Vote ×

I disagree with those who say 22g are useless you can bolus fluids through a 22g 2500ml/hr as well as blood, in very dehydrated people, elderly and even trauma patient we can and do put in 22g.

Up Vote Up Vote ×
+ Add a Comment