[COLOR=#9b00d3]Anchoring/keeping the skin taut;
Insertion to the forearm
Say, I have a client with very loose, tissue-like skin. I choose the anterior forearm(where I might do a TB test) Although, this would probably NOT be my first choice, as it is extremely sensitive. I place my tourniquet ABOVE theelbow, prep the site (betadine, alcohol) per your hosp. policy. I always slightly twist the needle/cath to make sure the catheter will advance smoothly. Then I grasp the client's arm(on the opposite side I intend to insert the IV) posteriorly, and gently pull the skin toward the palm of my hand (this is the only way I can think to describe it, for you to get a visual). Obviously, I don't fill my hand with skin...but enough to smooth out the skin on the anterior side. As I smooth out the skin gently/firmly, I'm hopefully immobilizing and straightening out the vein underneath.
Insertion to hand (posterior);
[COLOR=#9b00d3]I hold the hand (as though I am going to kiss it ) and using my thumb gently/firmly pull downward to smooth the skin and straighten the vein.
Depending on the site I choose. I will firmly "push" the skin up, above the area I'm intending to insert the IV so I can straighten/anchor the vein and smooth out the skin. Or, using your forefinger and thumb (as though your zooming in on an iphone) above and below the insertion site will help to smooth skin and straighten/immobilize the vein).
[COLOR=#9b00d3]**If veins are really torturous you WILL have to keep it anchored until the catheter is completely advanced.
Thick, rolling veins
...[COLOR=#9b00d3]**[COLOR=#9b00d3]Imagine cruising[COLOR=#9b00d3] next to another car and suddenly turning the wheel 45 degrees to hit it. (it's kind of a quick jab) you see a flash of blood then advance the needle a mm to insure your catheter is also in the vein before you move the shringe to a more parallel position, then continue to advance the catheter (otherwise, the catheter may bend)
DO NOT PULL THE NEEDLE OUT OF THE CATHETER
or push the mechanism that causes it to retract) before advancing catheter ....if you do, you may have alot of difficulty advancing the catheter esp.on clients with weathered, tough skin [COLOR=#9b00d3]**I have had the catheter tip wrinkle up as I'm trying to advance it over the needle.
REMEMBER, YOU CAN NEVER RE-INSERT A NEEDLE THROUGH THE INSIDE OF AN IV CATHETER ONCE IT HAS BEEN REMOVED. (shearing of the tip may occur and cause an emboli to the patient)
If a lot of blood is escaping I will place my ring finger from my non-dominant hand above the insertion site and over the underlying IV catheter [COLOR=#9b00d3]...**[COLOR=#9b00d3]never on the insertion site (remember, aseptic technique) to decrease the flow, and attach the "pigtail" (AKA; Lock, PRN adapter)