DeejRN

a few techniques I use are these: Try using a blood pressure cuff: I It's more comfortable for the patient.. I use 50-60mm/hg on most veins, 40mm/hg on veins with good bounce to them and 20mm/hg on the big honkers or veins that seem to easily rupture when punctured. i knew a nurse that didn't use anything on fragile veins visible through skin! Place the b/p cuff upside down to keep the tubes out of your way...and use only a manual cuff (that doesn't leak). Occasionally I float the catheter in...meaning...after I get flash with just about 1/4 of inch in. ,connect your primed extension set (with remaining flush syringe still attached) to the catheter hub while appying pressure above the site ( like when you're hooking up the vacutainer or syringe when pulling labs or plugging in the IV line) and as you are slowly flushing the catheter simultaneously advance the catheter to its hub and then release the cuffs pressure. This seems to "float" the catheter past any valves and bifurcations. Works most of the time. There are times when the catheter cannot advance without occluding the blood return and I back it out 1/8 of an inch and opsite it there. If you are concerned about possibly losing the site when advancing the catheter and need the labs big time I've went ahead and pulled the labs and then used the "floating" method to advance the catheter. I've been Nursing a long time and can usually get those difficult veins but you can still have a bad day or meet those "veins with brains" that think back at you. Don't be discouraged or afraid to pass the priviledge to another nurse. We're a team and that is what nursing is all about. You'll learn to feel a "confidence' when assessing which vein to cannulate, and a lack of "confidence" on the ones to avoid, over time. Hope this info is helpful. Hang in ther and I wish you a great career! DeejRN