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!

[Horseshoe, BSN, RN]

I never use a chux pad. Between putting a gauze pad under the hub and holding pressure, I never have a problem with excess blood flow from the catheter hub.

The catheters that the CRNA's at my facility prefer require quite a bit more pressure to stop blood flow than the ones the pre-op RN's prefer. The type of catheter used could explain the differences in blood flow that are being expressed here.

[ZippyGBR, BSN, RN]

LR59 said:

First always wear gloves, I put a towel below the arm to keep things clean have your flushed pigtail ready pullback and put it on You can put pressure on skin behind Iv catheter But most of just takes practice practice practice Good Luck

I'd agree with all the above - especially about having your equipment ready to get the extension set ( I presume this is what is meant by pigtail) on as soon as possible

also think about releasing your tourniquet and exactly how and where you apply pressure to attempt to occlude the distal end of the cannula

also if it looks like it's going to be a fast flowing one raising the arm helps slow the flow - basic first aid principle there of controlling bleeding ...

[ZippyGBR, BSN, RN]

klone said:

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.

we in that case be ready with the vacutainer / monovette or whatever adaptor to draw your samples ...

[Esme12, ASN, BSN, RN]

Horseshoe said:

I never use a chux pad. Between putting a gauze pad under the hub and holding pressure, I never have a problem with excess blood flow from the catheter hub.

The catheters that the CRNA's at my facility prefer require quite a bit more pressure to stop blood flow than the ones the pre-op RN's prefer. The type of catheter used could explain the differences in blood flow that are being expressed here.

I never do either, but if it's the blood bath she describes......it's probably a prudent thing to do...it will save a lot on clean up and disposal.

[Noimanurse]

Pressure in the right spot, paper towels before hand, and tell'em, "if it gets bloody, thats good...I won't have to stick you again."

[PAROPPY, BSN, RN]

I like to stick a 2x2 or 4x4 under the angio hub before I disconnect so that any blood I do get back doesn't go all over the pt.'s arm, gown, and bedsheets. Also, like everyone else said attach flush to J loop prior to actually starting IV. Hope this helps!

[DogWmn]

barbyann said:

tourniquet is off, right?

This was my first thought

[Tantette]

I get upset when I start an IV and I get more than 2 drops of blood out. You should be ready to connect your extention as soon as you remove the "plunger" like you said. But, before you remove it, you need to apply pressure directly to the vein above your jelco. Connect your extention or INT immediatly. You should not have blood all over the place. Good luck to you for next time

[PediNurse3]

Have everything primed and ready to go...

-Get your flash

-Advance the catheter

-Undo the tourniquet

-4x4's under the hub

-Pressure above the insertion site

It took me awhile to find the sweet spot, and even after years of practice I occassionally have a 'gusher'. I can't say that I've ever used chux or a towel, but I never disconnect without 4x4's underneath. I made it a habit when I was getting my method down and it stuck with me.

Keep at it! One day it will just click and the gushers will be few and far between.

[Epona]

WOW!! I cannot thank you all enough!! Yesterday, I had NO IV's to start, but the day before had many and it was a blood bath! These are some EXCELLENT pointers. I will review this thread before I go back into the clinic.....

THANK YOU AGAIN!

[Horseshoe, BSN, RN]

Esme12 said:

I never do either, but if it's the blood bath she describes......it's probably a prudent thing to do...it will save a lot on clean up and disposal.

In the environment where she practices (and given her current difficulties), it could very well be the prudent thing to do. In my unit, we start 50-60 IV's a day. If we used chux pads on every patient, our cost control officer would have a fit. The 2 by 2's work just fine and are a lot less expensive.

[jujuseah, RN]

find the right spot to the pressure on. (dont mean to sound dirty here )