Lots of blood... starting IV's HELP!

[Epona]

Hi all! Been a LONG day.....

Hey... I wanted to ask those experienced RN's out there... when putting in an IV, how do you keep it from bleeding all over the place?? I am told that is normal, BUT I don't think it is. I remember getting an IV before and there was no blood all over the place... I mean it was running down the pt's arm, on the floor, on the bed, etc.

I can get the vein on the first try and I am in, BUT when I disconnect the plunger (not exactly sure what the name is) and try and connect the connector, blood is literally gushing out of the vein through the opening. I try to apply pressure on the catheter, but it still comes out everywhere.

What am I doing wrong, or what can I do to prevent the blood from flowing out once I remove the plunger that has pushed the catheter in??? Once I connect the connector, it's fine and it stops, but in the meantime, it's a river!! HELP!

[wooh, BSN, RN]

Hehe, I remember first working in ER and getting labs with the IV. And yep, blood was EVERYWHERE. It does take a few to get into the habit of grabbing the right thing quickly. Pressure, and have it all close. (Of course, then I go back to the floor and have to re-habitize myself to taking the tourniquet off!)

On the plus side, you're getting in the vein, so you've got the hard part down! The rest is just mastering the art of having 2 hands do the work of 5!

[merlee]

As soon as you can slide the catheter in, RELEASE THE TOURNIQUET!!! Then place a finger on the arm where the tip of the catheter is and press gently while holding the catheter hub as you attach your lock system.

Best wishes!!!

[Anna Flaxis, BSN, RN]

Pay attention to the length of the catheter and occlude the vein above where the tip should be.

Also, as others have mentioned, have your pigtail primed and ready to go.

[littlewingrn]

Once you have your catheter in place (after removing the tourniquet) , before you disconnect the device, take your ring finger of your non-dominant hand and place it where you think the end of the catheter in the vein is. You can feel it. Apply pressure. Press your middle finger down next to your ring finger. Apply pressure. Use your forefinger as a stabilizer against the hub. Slowly begin to disconnect. If you start to see blood coming to the hub, apply more pressure. Remind your patient that they are only feeling pressure and that the needle is out (relieves anxiety). You will stop the blood flow. Have your other supplies ready to finish up. I recently started in the ED and was so proud that I began to get really good at IV starts (relatively speaking of course). A seasoned nurse gave me this advice and it works every time. I was so grateful and my patients didn't look like major trauma patients anymore! Hope this helps!

[Horseshoe, BSN, RN]

barbyann said:

tourniquet is off, right?

I wondered the same thing.

[Esme12, ASN, BSN, RN]

before you start have verything ready....everything. Tape (cut and ready), flush (atttached to the pigtailand ready to go), bio-occlusive (or what ever is used), chux (for under the arm), tourniquet. Once you have your flash like everyone else has said....REMOVE the tourniquet. Press with your finger tips ( usually use my middle finger on my non dominant hand)at the approximate end of the IV cath. You need to press firmly after the neelde/hub has been removed to prevent flow back. I am sure there is a lot of blood but it's less than what you think. Of course it's better after you attach the pig-tail/j-loop because you've shut off the faucet.

Relax it will get easier. :)

[patrick1rn, MSN, RN, NP]

I have been an RN since 1998, but I have been an Army medic since 1990.. Here is a trick that will help you.. you use your hand that you didnt start the IV with and put that hand where the IV is and you make your hand like your going to do a karate chop.. you then can use your thumb and index finger of the same hand to apply direct pressure to the IV Cath while you connect the IV to the pig tail.. and note on the pig tail.. already have it flushed with some NACL and take the cap off the pig tail and leave it in its sterile container.. also put a chux underneath while your doing all this from the beginning. I actually have an IV class on my website that wil be comeing out in the next few days that demonstrates this at www.armycombatmedic.com I have taught IV classes to army soldiers and part of the combat lifesaver course.. They quit doing the IV portion of the training the past year.. combat lifesavers are non medical soldiers who know some basic emergency skills.. Good luck in developing your skill..

[OCNRN63, RN]

Slip a 2x2 under the cathlon after you get your flash. That way when you go to connect your extension set, any blood that drips out will drip onto the cathlon, not run down the pt. arm. I always put a chux under the pt arm as well. I hate it when it looks like Sweeny Todd started the IV.

[canoehead, BSN, RN]

Keep practicing all these techniques, but use a towel. Eventually you will get the hang of it. Until then just warn the patient that it's a messy process sometimes. And don't worry, if you got the vein everything else is gravy.

[roma4204, BSN, RN]

Oh my goodness, haha. I have been a nurse for over a year now and I didn't know to release the tourniquet before you take the plunger out. OH the things you learn. Holding down the skin above the cath is what has helped me.

[Rob72, ASN, RN]

~*Stargazer*~ said:

Pay attention to the length of the catheter and occlude the vein above where the tip should be.

Also, as others have mentioned, have your pigtail primed and ready to go.

^ This.^ Lordy, folks, its not (hopefully!!) a femoral stick, you should not need "much" pressure. Spatial orientation is a significant part of phlebotomy and IV starts, and its harder for some than other- especially when it isn't taught.

When you learn the location "sweet spot", covering the end of the cath inside the vein(1-1.5"), you'll rarely have more than a rosette of blood in the hub of the cath. With or w/o the TQ in place, BTW...

[klone, MSN, RN]

roma4204 said:

Oh my goodness, haha. I have been a nurse for over a year now and I didn't know to release the tourniquet before you take the plunger out. OH the things you learn. Holding down the skin above the cath is what has helped me.

That only works if you don't have to draw labs, though. We almost always have to draw labs from the site before attaching the IV line.

Like others have said, always always always put a chux down.