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Need some advice on how to start an IV on pt with severe edema

Hi everyone.

I have been an avid reader of AN, and this time I have decided to create an account and join the community.

So listen, last week.. I have this hard stick pt who had a severe edema on her upper extremities. She has severe renal failure, and her mediport was clotted so as a student nurse, I have to start a peripheral line.

My challenge was, I could never find a vein on this big, chunky woman... I have tried all my best, but it wasn't my day.

I would love to hear some tips on how can I successfully start an IV on this type of pt.

Thank you very much!

-Heparinized,SPN

Hi. Practice and more practice will help you get the "feel" of what your looking for and more importantly what you are feeling for. Swabbing the area alcohol will help the vein become more visible. If the patient has pitting edema you can press firmly on the area and "push" the fluid away and the vein will become more visible. This is what helps me the most. And knowing where veins typically are or should be will help you direct your focus. Practice practice practice though.

larger people are usualy harder to find veins on, look in the joints where veins are more superficial (ie. AC, wrist, anterior shoulder, popliteal, ankle). as for the edema try to press all the fluid out of the area so that you can see the veins. get a flashlight and shine it through the hand to illuminate the veins, be careful though some lights will be hot. lastly, and only if all else fails, go fishing there is a vein there somewhere.

if this is an emergency and they need IV access now call the doc to get an IO or picc.

The lower the albumin level, the tougher the stick. My supervisor gave me a good tip: Use two tourniquets, one in the usual place, the other about three inches above that. Works well with hands to really concentrate blood in a small area. You might also have a colleague pull back the skin and hold it taught. When all else fails, I look along the ring finger, along the feet, and between the armpit and breast.

bp cuff pumped up to 60mmhg also helps. use it upside down so the bulb does not get in the way!

ObtundedRN, BSN, RN

Specializes in Critical Care. Has 6 years experience.

Using. Strong penlight works well for them. You shine in into the skin and the vein will be darker. With all the fluid, the light passes through easily. You can shine it from the underside of the hand. Or just directly down into the skin where you're looking. Be a mentioned above, becareful of the heat from some penlights. LEDs are cool, but a halogen bulb is going to get very hot.

Munch

Specializes in Med-Surg/Neuro/Oncology floor nursing.. Has 10 years experience.

When I had my 10 day stint in the hospital I used to work at my roommate who was great and friendly and we remain friends to this day was on the heavier side and was a REALLY REALLY tough stick. 5 different nurses at different times came to try but no dice. Then the PA came in and tried and again...no dice. Finally they had to call the house doctor to put the IV in and he finally got it....after an hour. Some people are just hard sticks. This girl who I was in the ER overflow with who was skinny(but not TOO skinny) was a tough stick too. NO ONE and I mean NO one could get an IV in her...not even doctors(no track marks or anything like that). They tried putting a picc line in and that didn't work so finally they had to put a port-a-cath in her.

It's true, some people are nearly impossible. But I'll say this, as one of my patients recently pointed out: My charge nurse could start an IV on a dead man. She's that good. I have never seen her miss.

When I started, she told me to find a man with muscular forearms and study his vasculature so that I could understand where to palpate. She's right. That's better than looking at any text book.

FlyingScot, RN

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc. Has 28 years experience.

Why didn't they just Alteplase her port?

tokmom, BSN, RN

Specializes in Certified Med/Surg tele, and other stuff. Has 30 years experience.

It's true, some people are nearly impossible. But I'll say this, as one of my patients recently pointed out: My charge nurse could start an IV on a dead man. She's that good. I have never seen her miss.

When I started, she told me to find a man with muscular forearms and study his vasculature so that I could understand where to palpate. She's right. That's better than looking at any text book.

I agree on that one, but do I just have to stop at the veins?:D

vanburbian

Specializes in ER. Has 27 years experience.

It's true, some people are nearly impossible. But I'll say this, as one of my patients recently pointed out: My charge nurse could start an IV on a dead man. She's that good. I have never seen her miss.

When I started, she told me to find a man with muscular forearms and study his vasculature so that I could understand where to palpate. She's right. That's better than looking at any text book.

Exactly why I have a file on my laptop with pics of shirtless men-i.e David Beckham, etc., though this pic of Angelina Jolie is educational as well.

http://thesuperficial.com/2007/01/12/angelina-jolie-veins.jpg

Wave Watcher

Specializes in Community Health/School Nursing. Has 7 years experience.

I agree on that one, but do I just have to stop at the veins?:D

Sweetie, the veins will take you anywhere you want to go. :yeah:

Music in My Heart

Specializes in being a Credible Source. Has 10 years experience.

If you've got access to a vascular ultrasound, bust it out. It's sure helpful to find those veins that are simply too deep or too flooded to see or feel. they also have a scale on 'em so you have an idea of how deep the vein actually is and how big it actually is.

Music in My Heart

Specializes in being a Credible Source. Has 10 years experience.

Exactly why I have a file on my laptop with pics of shirtless men-i.e David Beckham, etc., though this pic of Angelina Jolie is educational as well.

http://thesuperficial.com/2007/01/12/angelina-jolie-veins.jpg

Holy cow... now this gal's got some veins. I could pop a 14 into her blindfolded and wearing thick leather gloves.

nerdtonurse?, BSN, RN

Specializes in ICU, Telemetry.

When I've got a person with +4 edema, I get a manual BP cuff, put it midforearm, and pump it up, then let it sit there for about a minute while I get cannula and J loop ready. The BP cuff is pushing all of the fluid out of the area. The second you deflate the cuff, swoop in and feel for the vein -- they'll plump back up first.

The only bad thing about whatever trick you use with the fluffy ones is that it's very easy for the IV to infiltrate -- There are folks where there's just so much swelling I know I've probably only got the tip of the cannula in the vein. If they're getting anything serious, like levophed or IV pushes of anything that can cause necrosis if it infiltrates, try to get a doc to write for a central line. If not, watch that site like a hawk.

beckster_01, BSN, RN

Specializes in MICU. Has 12 years experience.

First of all, to the OP: Don't get discouraged. For most people it will take a good year before you become semi-decent at those tough sticks, unless you are super talented or put them in constantly (Pre-An, ED, Endoscopy). As far as patients with edema, the only thing I can add to previous posts is that hot packs work wonders :)

Thank you all very much for these vast information yall shared. I will definitely put this all in my pocket so whenever I have a hard stick, I know what to do now.

amber_energy_RN

Has 2 years experience.

The lower the albumin level, the tougher the stick. My supervisor gave me a good tip: Use two tourniquets, one in the usual place, the other about three inches above that. Works well with hands to really concentrate blood in a small area. You might also have a colleague pull back the skin and hold it taught. When all else fails, I look along the ring finger, along the feet, between the armpit and
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