IV tips and tricks

kmrmom42 · Oct 8, 2004

In L&D we always try to use 18 g. We need to have a large bore for fluid resucitation fetus, for hypotension r/t epidurals, for stat c-sections or for blood. I will only use a 20 if I have no other choice.

fergus51 · Oct 8, 2004

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

I'm terrible at palpating too. I need to see it, and I admit, I can seldom feel that "pop" in my babies. I also don't like using that wierdo light thingy, but a good 80% of the nurses here seem to.

avahsmiles · Oct 8, 2004

... those docs that put them on the inside of the wrist should be shot.

Ain't that the truth!! I had a nurse that put an IV in my wrist when i was admitted to deliver my 2nd child. I still remember the IV pain was worst in comparison to the actual natural birth pain! :eek:

elnski · Oct 9, 2004

thats just it, its not done by sight, its done by feel. some veins are better than others.
i think IVs hurt no matter where u out them. of course, those docs that put them on the inside of the wrist should be shot.

###

Oh yeah..shoot em all:angryfire ....when i was admitted for ?AGN, this doc cant get through my visible, bouncing veins on my hands and forearms..twas d 6th cannulla on the inside of my wrist she got.... i asked is ther sumthing wrong w/ my veins?..well, she politely sed, "no, ur veins r perfect..twas me..cuz i know ur a nurse"....:uhoh21:

CRNAsoon · Oct 9, 2004

... IVs are standardized everywhere in the world--18G is green, 20 is pink, 22 is blue, 24 is yellow--regardless of brand.

I've seen grey catheters before. Anyone know what size they are?

thanatos · Oct 9, 2004

I've seen grey catheters before. Anyone know what size they are?

grey = 16g

orange = 14g

at least at my hospital and with our local ambulance/fire services

CRNAsoon · Oct 9, 2004

grey = 16g
orange = 14g
at least at my hospital and with our local ambulance/fire services

Thank you for the information!

jasonn · Oct 9, 2004

Have not read all the replys..so i am sorry if this was stated......

But if when advancing a cannula and you realize that you are up against a valve, remove the needle and attach a 3cc hep flush.

Push the saline while simultaneously advancing the cath. Good trick. :smokin:

Joshua21 · Oct 10, 2004

I'm sure this has been mentioned elsewhere but two other tips:

1. throw some alcohol on a general area where you suspect a vein and then hold the site at an oblique angle to your light source. Sometimes the light reflects off of the hand and shows the contours of the vien in very subtle shadows.

2. place a thumb on either side of the prey (insert vein for those of weak mind) and tug the skin left and right repeatedly. I find that viens that move as one with the skin are buried in the dermis and are usually very shallow, tiny veins. The ones that move a little incongruently with the skin are below the dermis and hold an IV rather nicely.

That dummy vein everyone is so hot for? My experiences have always been negagtive. I'll hit the vein and the pt will turn grey, grossly diaphoretic and be too busy trying to vagal out to complain. I read an article in Nursing 2003 or 04 about this, apparently the radial? nerve has (in the majority of people) 2-3 branches cross over the "dummy vein" just proximal to the wrist and nicking one of those creates this vagal like response or atleast a lot of discomfort. The article recommended going like a couple inches more proximal. I've tried it and had much better response from pt's.

I want to thank you all for your great ideas. Had never heard of the NTG paste. Many of the others I had simply forgotten.

Could someone explain the bifurcation one to me? Your inserting before or after the bifurcation? And it's a good anchor? It doesn't blow?

jannecdote · Oct 10, 2004

1. Be confident! Do not go in to the pt and say I'm going to "try" to start your IV. Would you like the nurse who's going to try or the one who's going to get it?
I was on the IV Team for 3 years and we each started about 3000 IVs a year. There is no substitute for practice. IV therapy is 10% talent and 90% practice. Good luck! (:) GREAT ADVICE HERE :) )
PS I was also the only IV nurse on nights, so I had no backup. It's amazing how good you get when you don't have a choice.
Age, skin types, skin tones, diseases, etc., require different approaches when starting IV's. Putting the patient at ease through confidence and easy-going conversation goes a long way! Just about every time a frustrated patient tells me "You only get one shot", I almost always blow it. And I'm pretty good at starting IV's. Gotta put yourself at ease, too.
I've learned that veins other nurses dismissed as not being "deep" enough can actually last until a resite is due. Since I work almost exclusively with geriatric patients now, I don't always use a tourniquet because it's not necessary and causes veins to blow. If the vein is sticking up so high you can shoot it with a dart from the door, what's the sense in putting more pressure on it??? On fragile, transparent skin, forget the tourniquet, anchor the vein, stick and wait a few seconds and you'll see the blood return.
When I worked as an IV nurse, our nurse manager said if we used anything smaller than a 20 gauge there was no sense in starting an IV in the first place. I've learned that is not true. In the absence of a central line, a 22 gauge works for needed IV fluids, pain meds, etc. until that CVC is in place.
I work extended care now--VRE, MRSA, long term abx treatment-- and most of our patients have been stuck every place imaginable for labs and IV's. Yet most of them don't have central lines. Their veins are pretty well shot by the time we get them. So, 22's are actually the norm here unless they are getting blood.
If a patient has generalized or pitting BUE edema, palpating for a vein is next to impossible. But if you press down on an area where a good vein is located, you can actually see the vein running through the indentation left in the skin.
Reading through these posts, it's obvious that the situation of the patient merits what type of gauge they require. But since this post was about tips for starting IV's, I concur with the above post about practice. Bottom line is that the more you do, the better you get.

DutchgirlRN, ASN, RN · Oct 10, 2004

Do any of you use NS as a anesthetic? I learned this trick from an agency nurse. I only use it on adults who seem really anxious and definately on children. You take a TB syringe and make a small blip (just like a TB skin test) right where you plan to stick for the IV. You have to stick again immediately before the blip goes away. It amazing how it works. Pt's say "I didn't even feel that". They can deal with the 25G prick. I would definately agree with the 10% talent and 90% experience theory and with the feel not by sight theory. So true, so true.... I have never inserted anything larger than a 20G. We don't even stock anything larger on the med/surg floor. I'd hate to see a nurse come after me with such a large bore IV unless there was an anesthetic to accompany it. We don't get patients from the ER with anything larger either. Occasionally we'll get a patient who comes in with an IV started by an EMT and they are almost always a 18G and almost always in the antecubical and shortly thereafter need restarting because the pump won't stop beeping and driving both the pt and nurse crazy. Thanks for all the great info everybody!

SarasotaRN2b · Oct 10, 2004

Very informative thread. I think that is my major concern...I don't want to cause any more pain to a patient.