Need IV advice

Specialties Geriatric


In my facility, it is often necessary to start (or restart) IV's, and draw blood. My problem comes with those pts who are dehydrated, etc. with small, fragile veins, or veins that roll and move when you approach with a needle. It breaks my heart when multiple attempts are needed. These people have been through so much already....Any tips for making these procedures easier will be greatly appreciated ( by me,AND THE PATIENT!)

[This message has been edited by tinkertoys (edited January 14, 2000).]

keep trying. difficult veins are just difficult. I would suggest with the veins that "blow" easily to just forget the tournaquet or else apply it with very little tension.

My father in law was in hospital a while back, and his veins kept blowing. Since he was bed-bound anyway, they put his IV in his FOOT instead...PROBABLY have to re-vamp facility policy to get THAT one through, though!!!!


Tinker --

I am not an IV nurse, so take this for what it's worth, but I have been a nurse administrator and I think your DON might listen to you if s/he thinks you have the patient's best interests at heart.

Consider having a certified IV nurse therapist available to your facility (you could probably rent one from a local hospital). This should be someone certified to insert pic lines (these last much longer than an ordinary IV insert). It will require re-educating your MDs, but your patients (especially those who need frequent or on-going IV therapy) may well be spared the painful re-starts you describe.

You may need to collect re-start data to convince your DON that the suggestion is worthy of his/her consideration. Think about keeping tabs on the following:

*Number of restarts (by day of week, time of day)

*Number of complications (sort by type: infection, phlebitis, etc.)

*Demographics of patients (age, race, sex, etc.)

*Qualifications of those available at the time to start an IV (were you the only RN on that night? were you needed elsewhere while you struggled with an impossible IV?)

And also, give some consideration to what you said about "dehydrated patients". Current literature indicates that dyhydration in the elderly may be responsible for all manner of other difficulties (including dementia). Be sure the Nursing Aides in your facility know how to encourage fluids and monitor I&O so that nurses can make thoughtful judgments about how to PREVENT the need for IVs on many of your patients!

Good luck and good practice!

I'll give you a little advice that a nurse gave me years ago. When you are attempting an IV, pull up a chair and sit down. This bending over the bed is hurting your back and putting you at an odd angle. Take your time and as far as veins that roll, take a side approach instead of directly into the top of the vein. The bevelled edge of the needle with more often than not catch the side because the pressure is different and easier to manage. Hope this helps.

In our facility we know who are the "good" IV starters are so when a difficult stick arises, we call on them. One simple technique that I have used for years is to warm pack their arm. Use one or two towels soaked in warm water and wrap with chux or something and let sit 10 to 15 minutes. You need to have an idea ahead of time where you want to stick as the warmth effect will go fairly quickly. There are also very small needles, 5/8th inch jelcos that might help. Be very careful about the feet!!! You need a special policy for that and the chance of problems is much higher. I saw a nurse practitioner do one at our facility and the resident ended up with a terrible ulcer. The chance of phlebitis is much greater in the foot and it is terribly painful. I know it is antiquated, but hypodermoclysis does just need to find an "old nurse" who has experience with this.

For fragile veins in geriatric patients, dehydrated patients, and premature babies...mostly success NOT using a tourniquet.

You could try using a blood pressure cuff instead of a tour. and use 24g angio. Set up everything in reach and take the time to assess the site. Sit down so you are comfortable.

As an IV therapist for years, and now an ecf nurse in a facility that houses approximately 650 residents, all of the previously mentioned tips are good, but one thing I do find is that most nurses that are attempting to start or restart IV's on the elderly or any chronically ill patient who has had multiple venipunctures, the tourniquet is the answer. The onews that come in our start kits aren't very good. They tend not to have much return snap. I carry my own. If the veins are fairly visible, it's possible no tourniquet is needed, or sometimes mere pressure from a finger above the intended site is enough. If no veins are visible at all, be sure and apply the tourniquet with enough pressure or you won't be able to visualize anything. Most of the time I use a 22ga ONC. Theh 24's don't seem to be as stable and require more frequent restarts. Also limit your sticks to two. Ask someone else to try! Sometimes a fresh perspective works.


Try "floating" the iv in, ie insert the cath halfway, stop just when you get return, then hook your iv fluid up and start it very slowly, it will float right in, and won't blow.

I haven't done this yet myself, but my husband had knee surgery twice this year, once in January and again in Feb. 2000. When they started his IV, first they injected a numbing solution, subcutaneously, and in about 15 seconds, his site was numb and he didn't feel the IV insertion. They did this both times. I thought it was great.

Wow!!!! Great advice from you guys! Unfortunately, I have been designated as one of the "lucky" ones who can hit..only because I succeeded once on a VERY difficult stick. I've started others, but this poor patient had the worst veins and was on a Vanco drip which was causing all of her sites to blow.

It's so true that you should take your time...pull up a chair, sit on the bed. Start searching low. I love the tip about starting the drip just after you get return, and will try that the next time. I also like using a 22g cath, and have found that letting the arm hang for a few minutes helps to plump up the veins.

Thanks again for the great tips everyone!


Laurie :)

so many patients...

so little time.....

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