IV's on obese patients

marikabw · Jul 9, 2006

heat, tourniquet and dangle.

NurseguyFL · Jul 9, 2006

When the patient is so obese that I cant feel or see anything I use the doppler and then go in with a big needle, preferably an 18 gauge.

steelydanfan · Jul 9, 2006

If your pt. is so obese that the above suggestions don't work, then I would ask the attending for a central line. If you can't find a vein, the the lab techs won't be able to either, and it will all lead to many delays in treatment.

Krysten · Jul 9, 2006

What works for me sometimes is if you double up the tourny (having two on top of each other) it helps pop the veins out. It is very tight though so don't have it sit on the pt's arm for too long

EricJRN, MSN, RN · Jul 9, 2006

heat, tourniquet and dangle.

:yeahthat:

I've also found that the best tourniquet for the real toughies is a BP cuff inflated to 80-100 and then clamped. Also, don't forget to check the underside of the forearm. Looks like a terribly awkward place to start a line, but I've found a few good ones there when our options were running out. In many cases, the patients can tell you which veins typically work.

vamedic4, EMT-P · Jul 10, 2006

sands...

Funny you posted this - I just started an IV on a 17 y/o, 204 kg renal patient.

You may try the normal places, back of the hand, thumb side of the wrist...

Obviously you're going to have to "feel" your way...not too may big people have veins that actually stick up.

Be aware also that people who have been hospitalized multiple times have scarring on their skin, and that can alter your perception of a vein underneath.

See if you can trace the veins track up/down the arm. Pick a midpoint and shoot for a vein.

Many times it's a matter of where you think (and hope) the veins are. Most people think IVs on babies are hard...not so for me...adults have WAYYY more "room"...and much bigger margin for error.

You may have to search around a bit if you stick blindly (not recommended but sometimes absolutely necessary)...just remember to do so SLOWLY. If you think you hit a vein and the patient screams and jerks their arm...chances are you've hit a tendon or some other structure that doesn't like you.

Hope this helps.

Have a good night

vamedic4

Trauma Columnist · Jul 10, 2006

EJ? I am also a fan of heat and dependent positioning. I also like feet (if not diabetic of course).

twinmommy+2, ADN, BSN, MSN · Jul 10, 2006

Its funny you ask this question lol. Another nurse had a patient this week while I was working on the same floor who couldn't get an IV started on someone who's pressure was dropping. We called IV therapy who came up and couldn't find a good one either. But she did fine just one...in her boob!

mandana · Jul 10, 2006

I also watched a nurse start one on a VERY obese patient recently and used a pretty cool trick - two tournicates but one above the intended site and one below the intended site (which was the dorsal forearm). Occluding the blood in both locations filled up that little vein nicely and he got the stick on the first try.

I never would have thought of it.

Amanda

Antikigirl, ASN, RN · Jul 10, 2006

Also, remember to tell your patients like this about bruising! I have so many obese pts hold up their arms to show me the bruising they got when they got an IV. And they tend to show more bruising than most of my other patients (the other bad bruisers are elderly with frail skin and on coumadin therapy...and they blame the RN! LOL!).

They tend to get very angry and blame the nurse that did it, when infact, it is their conditions and difficulty in finding a vein that is the cause..not the nurse! And yes, I tell that to them gently, and warn them that bruising occurs with even the best IV starter!

enfermeraSG · Jul 10, 2006

I also watched a nurse start one on a VERY obese patient recently and used a pretty cool trick - two tournicates but one above the intended site and one below the intended site (which was the dorsal forearm). Occluding the blood in both locations filled up that little vein nicely and he got the stick on the first try.
I never would have thought of it.
Amanda

This trick actually works quite well, just dangle and milk the arm first to up the odds even more before applying the proximal and distal tourniquets. SG