eXistenZe

Self-confidence during procedure is crucial. Observe as much as possible, train your fingers into feeling both arterial pulses and venous collapse on pressure, only then start making decisions. Take your time. Keep the patients arm warm (yours too, icy fingers feel nothing) and if he has a history of fainting or any other procedure complication, start with him comfortably laid down. Pick the location of the cannulation according to the what the patient will need. You will master them all in time. Antecubital is a good choice for blood samples and short term drugs such as adenosine, but nothing more. Start with the hand or forearm to promote comfort and upkeep on the long run. You don't want an easy access you have to replace the next day (unless it's an emergent procedure, obviously). Always start the procedure with the arm lowered. It promotes arterial flow and make the venous return harder, dilating the veins. Never use a curved back position for yourself and never hold your breath. Keep yourself straight and face forward. I am a tall nurse, and I place my knee on the floor from time to time so that my chin is not touching my chest when I place IVs. Raise the patient's bed or chair if possible (I work in ER so not quite easy). Whatever the location, I always place the non dominant hand bellow the hand/arm and make sure the skin is not going to bend on the tip of the needle. Do not overstretch, but also keep the skin tight (use the main hand to feel the tension while cleansing, making sure the vein did not collapse). For the procedure itself you need to train your fingers into actually doing what you want. I have colleges that place more than 1cm of needle almost horizontally inside the vein and only then remove it. I usually just insert the tip of the needle and then push the plastic tube with the index while the other fingers hold the needle. You need the find the technique that works best for you. No right or wrong here. I work with adults, so I always place 20g or greater (in emergencies). There is no guarantee that a smaller tube will make the procedure successful. In fact, I find it way harder to place smaller tubes on adults. It's either a 20g or I call for help.