IV tips and tricks

IVs are a huge problem for me too. I feel so incompetent, though I have confidence in all of my other clinical skills. This is an amazing thread! Now I've got some new stuff to try to take my mind off my failing record.

From a patient, experienced w/long-term IVs, hand sets are THE worst for most patients. I recognize the need in many instances, BUT - I've yet to have a hand IV set that didn't leave me w/bruised nerves in that hand and/or wrist. I've had no problems w/IVs set anywhere else, long or short term. My longest experience w/constant IV was 8 weeks.

Thanks for all the wonderful tips!

I also found this sight that has tips on IV's, NGtubes, catheters and Peds IV's, I found it very helpful!!

http://mynursingtips.com

this happened when I was a new RN and worked med-surg. I totally freaked out, and put the pt in trendelenberg, opened up the saline line and in a panic called the doc. The pt immediately vomited profusely and went hypotensive. The doc told me to calm down and explained that the half life of dobutamine was very short, I monitored him closely (he was already on a tele unit) and soon his BP returned to normal and things settled down. I think I wrote volumes of paperwork on it though. LOL

Um, unless I am completely blanking out Dobutamine would not cause hypotension. Also I dont beleive most hositals would allow a patient to be on that unless they are in an ICU setting.

Sweetooth

Do not be afraid of the needle. I was taught to go in slightly to one side of the vein.

sometimes that works, other times you go in right on top of it at a 45 degree angle - also if it's particularly hard to palpate, try a tourniquet above and below the site to pop it up - that works well.

Um, unless I am completely blanking out Dobutamine would not cause hypotension. Also I dont beleive most hositals would allow a patient to be on that unless they are in an ICU setting.

Sweetooth

Dobutamine S/E: tachydysrhythmias, VT, VF, HTN, N&V, H/A, AMI -

There are worse things to worry about with Dobutamine... hypotension is not oen of them..

My #1 rule, ALWAYS asses both arm's when looking for a good vein. After 22 yrs I still forget this rule and after an unsuccessful attempt, go to other arm and find the gold mine.

I get a kick out these threads as you can find who the gun-ho I never miss types are. I don't trust anyone who says they never mis or never make an med error. Those are the type of people who will cover up mistakes and not take accountability for mistake because they have to preserve their fragile ego's.

I put in what I can get in. If it's a kid 24 or 22. Medical's get 2o's, traumas get 16. But if a trauma comes in and I blow a 16, my next try will be a 18 to gain access, then when I do get access, I'll do another 16.

I've been doing IV access since 1980. It's practice, gain confidence, but don't get cocky because your as good as your next stick!

the first thing i tell everyone is that selecting a vein is never ever something you do with your eyes. you have to do it by feel. one vein might look good, but it is too frail. get to know your veins.

I have to disagree. I think you can be a see'r or a feeler when it comes to IV's. I am definately a see'r. If I can see the vein, even if it is a shadow I do MUCH better when sticking. Infact, if I can see the vein, I don't have to feel it to get a good IV. I don't ever put anything less than a 20 g in an adult. I have even started many 20 g IV's in Peds. Now infants I always use a 24 g. The best sites I have found of coorifice is the AC and the inner wrist behind the thumb. Also the dorsal aspect of the forearm has a great vein especially in males. You kind-of got to work upside down tho with this one. Here is some good information on IV's.

http://emprocedures.com/peripheralIV/anatomy.htm#sites

http://findarticles.com/p/articles/mi_qa3689/is_200308/ai_n9244918?tag=rbxcra.2.a.1

http://findarticles.com/p/articles/mi_qa3689/is_200004/ai_n8882846?tag=rbxcra.2.a.5

Also, be sure to look at all your options before sticking. The first vein you come across might not be your best.

Remember, there will be good days and bad. Some days I can't hit the broad side of a barn, but then others come and I have a good IV day. Not to say I hit everyone, because no one hits every IV on the first stick.

I have to disagree. I think you can be a see'r or a feeler when it comes to IV's. I am definately a see'r. If I can see the vein, even if it is a shadow I do MUCH better when sticking. Infact, if I can see the vein, I don't have to feel it to get a good IV. I don't ever put anything less than a 20 g in an adult. I have even started many 20 g IV's in Peds. Now infants I always use a 24 g. The best sites I have found of coorifice is the AC and the inner wrist behind the thumb. Also the dorsal aspect of the forearm has a great vein especially in males. You kind-of got to work upside down tho with this one. Here is some good information on IV's.

http://emprocedures.com/peripheralIV/anatomy.htm#sites

http://findarticles.com/p/articles/mi_qa3689/is_200308/ai_n9244918?tag=rbxcra.2.a.1

http://findarticles.com/p/articles/mi_qa3689/is_200004/ai_n8882846?tag=rbxcra.2.a.5

Also, be sure to look at all your options before sticking. The first vein you come across might not be your best.

Remember, there will be good days and bad. Some days I can't hit the broad side of a barn, but then others come and I have a good IV day. Not to say I hit everyone, because no one hits every IV on the first stick.

I think it is all feel - even if you see it, you need to be able to feel it - think about those with dark skin... sometimes you can't see anything there, so it's all about palpation...

I am a new pediatric nurse. I am almost totally dependant on seeing because I am not confident enough to know if I feel them or not. Any ideas on how to tell the difference especially on children and babies.

God Bless,

Mary Ann

I am a new pediatric nurse. I am almost totally dependant on seeing because I am not confident enough to know if I feel them or not. Any ideas on how to tell the difference especially on children and babies.

God Bless,

Mary Ann

The only ones you generally will be able to feel in infants and young children will be the AC and the saphenous. The remainder will be either done by the visual or the "Hail Mary" approach. The ones you can palpate feel just like adult veins only smaller. I would see if your unit would invest in a "Wee-lite" which is a tool to find veins by use of transillumination and works very well. Don't be afraid of scalp veins in sick infants. They are easy to get and well-tolerated by the patient (although the parents usually freak if you don't prepare them well). Finding veins by palpation on infants takes a lot of practice and sometimes is impossible even for skilled practitioners.

For the record, I don't have peds experience, so I don't intend anything that I say to be taken in reference to peds.

I have to agree with the many who have stated that it's all about feel. IT IS!! I started working in the ER as a nurse tech during my last semester of nursing school (3.5 yrs ago) and while starting an IV once, one of the paramedics I work with proceeded to tell me that I was doing it all wrong since I was relying on sight. Although she hurt my feelings a little bit, I feel I owe much of my IV skills to what she taught me that day. Sure, it is possible to stick a vein that you can't feel. But, if you can train yourself to be able to stick veins that you can feel and perhaps not see whatsoever, you'll find that it's actually much easier to find a vein. Many people have great veins that can only be felt, not seen.

And to the poster who suggested that there will always be a vein near where you feel the brachial pulse, great tip...it's true, and often forgotten.