Need Help with IV Insertion

[bruceirving]

I am a nursing student whose almost finished with the program. I've had less than twenty IV attempts so far with only 3 successful. Two of those were under the direct instruction of a nurse who was awesome at teaching and gave me the play by play. I've about made every mistake I can think of. However, I've learned from each one and have rarely repeated the same mistake except for one.

I'm coming along well at identifying a locating veins even by feel. My angle is good and I know to anchor the vein. I tend to poke slowly, as I've been told, because I'm slightly hesitant. When I do pierce the vein, I can see the flash. This is where I mess up. My fear is infiltrating the vein so I tend to pull the needle back too soon before the catheter is threaded. The catheter will run into resistance because I don't think its in the vein probably because I've pulled the needle back to soon. Its happened on several occasions.

Advice? Also, when I see the flash, should I begin level out my angle to be sure that I don't blow the vein?

[roser13, ASN, RN]

Have you asked your instructor (who observed your IV attempt) for his/her advice?

[akulahawkRN, ADN, RN, EMT-P]

Once you're through the skin, start making the angle more parallel to the skin while still advancing toward the vein. This will help prevent you from piercing the other side of the vein. Also, you can go fast or slow, but whichever you choose, do it smoothly and confidently. Once you're in, advance the whole assembly about 2-3 mm. This is about the distance from tip of the bevel to the catheter itself and should ensure that the catheter is inside the lumen. Advance the cath into the vein and keep everything else stationary and you should then have a properly inserted IV catheter. If you watch some of the videos on youtube, you'll see that's pretty much how they do it.

ETA: Always ask someone (like your instructor) for advice while you're doing lV inserts to see where you're not doing something quite right.

[eroc]

I hate that…generally it's tough skin or a valve that won't let me thread it in.

Just make sure you go in just a tad more once you see flash. Floating it in with a flush is an option. But practice and luck can play a huge part in getting hard sticks.

I almost always never insert the needle too far into the vein….and I am usually the guy people ask to help them out. But I too, have a lot to learn and improve.

[Caffeine_IV]

Remember the needle is your also your anchor and guide. You have to advance just a bit more after the flash then slide the catheter off the needle. If you try thread it too soon, the flexible catheter will bend and you can't slide it in.

Confidence is also key.

[LadyFree28, BSN, LPN, RN]

Remember the needle is your also your anchor and guide. You have to advance just a bit more after the flash then slide the catheter off the needle. If you try thread it too soon, the flexible catheter will bend and you can't slide it in.

Confidence is also key.

This.

Remain pt for the flash, level and advance slightly, then slide the catheter off the needle.

What also helped me was getting a feel of advancing the catheter; one of the tips I was advised was to practice on a ripe banana, which, to me, helped.

[bruceirving]

Thank you all for your advice. Ive only had one nurse tell me all of that in detail. I needed to verify from a different source. I've had separate nurses tell me different things and others that have simply demonstrated without breaking down the component parts. I go back to clinicals next week. I will try to seamlessly integrate all the above steps. Once again, thank you!

[suanna]

I've posted this before but here it is again: Invert your needle. They teach inserting the needle tip down bevel up. When you do this the tip of the needle enters the vein beefore anything else. It then scoops/wicks blood back into the catheter giving you a false flash. If you invert the bevel, go in at an acute angle to pierce the skin, but flatten out quickly aiming the bevel as if it were a paper punch flat to the vein, the needle enters the vein not tip first, but along the entire lumen of the needle. You don't get a flash until the whole lumen of the needle is in the vein and you can advance the catheter easily. Yep, it hurts a very little bit more-but you only have to stick once. Also NEVER use a tourniquet when starting an IV. Use a manual BP cuff and deflate it to about 20-30 mmHg below systole. That way the vein dosn't blow out like an over-inflated innertube when it gets pricked with the needle.

[akulahawkRN, ADN, RN, EMT-P]

I've posted this before but here it is again: Invert your needle. They teach inserting the needle tip down bevel up. When you do this the tip of the needle enters the vein beefore anything else. It then scoops/wicks blood back into the catheter giving you a false flash. If you invert the bevel, go in at an acute angle to pierce the skin, but flatten out quickly aiming the bevel as if it were a paper punch flat to the vein, the needle enters the vein not tip first, but along the entire lumen of the needle. You don't get a flash until the whole lumen of the needle is in the vein and you can advance the catheter easily. Yep, it hurts a very little bit more-but you only have to stick once. Also NEVER use a tourniquet when starting an IV. Use a manual BP cuff and deflate it to about 20-30 mmHg below systole. That way the vein dosn't blow out like an over-inflated innertube when it gets pricked with the needle.

The downside to "bevel down" technique is that because the tip is on top, you're not using the tip to cut into the vein efficiently so you could actually end up with more damage to the vein by using the technique incorrectly. If the angle is steep enough throughout the whole insertion process, you should be well into the lumen before the tip pierces the opposite side and get a good positive flash. I have used the BP cuff method before. It's more comfortable for the patient but it's also not as easy to apply or remove as a tourniquet. That's the trade-off for using a BP cuff vs disposable tourniquet.

[Caffeine_IV]

I wouldn't recommend a student that isn't comfortable with the traditional technique to go off using a bevel down technique. The IV/jelcos we use have a notch for you to slide the needle off the catheter. I'm not sure how that would work upside down. Seems awkward.

[akulahawkRN, ADN, RN, EMT-P]

I wouldn't recommend a student that isn't comfortable with the traditional technique to go off using a bevel down technique. The IV/jelcos we use have a notch for you to slide the needle off the catheter. I'm not sure how that would work upside down. Seems awkward.

The Jelco catheters that protect the needle as you advance the hub are great for one-handed advancement because of the little tab that's in place. Going bevel down with those would be less convenient. I agree that people should learn the bevel up technique first and later add the bevel down technique as an additional tool for placement. The ones I use at work right now are the push-button ones. Those can be used either way but again, I seem to recall a small tab on the catheter hub that helps with one-handed catheter advancement. Bevel down makes the process a little more cumbersome.