lucy2196

When starting an IV, as a new nurse it is difficult to remember all the rules of infusion.....however, the one best piece of advice I can tell you is to be patient! You have to allow the vein to become engorged for it to be palpable. The hand is the easiest place to start until you get used to feeling deeper veins. There is usually no hair on the back of the hand and put the tourniquet tightly about 6-9 inches above the hand, let the hand dangle off the bed, and allow the veins to distend. This should only take a few minutes at most, although I remember sitting there thinking hours had certainly passed :) your skills will develop as your # of attempts increase! Next, use a little alcohol to wipe over the top of the hand when you do this, you will illuminate the vessels you can see them better. Next and very important look for a vessel that can accomodate the size catheter you are placing, avoid placing a 1.16" catheter with no more than .75" of vein that is without taking a turn (kind of looks like a fork in the road) if this process of selection has taken some time and the (patient/victim:) ) hand is changing colors, release the tourniquet for a few minutes allow circulation to resume and then reapply. Carefully assessing for a good site is essential to success! Your patient will prefer you take a little longer to choose the site, than to be stuck multiple times...trust me on this one, with more experience the time to select the vessel will almost become intuitive. OK, back to the process once you have selection, prepare your site, apply traction to stabelize the vessel you plan to stick, I would suggest using approaching the sidewall of the vessel until you gain experience to go on top of the vessel to prevent going completely through it, STICK it and pause, wait for the blood to flash in the catheter, then drop your insertion angle almost parallel to the skin, advance the catheter a little further into the vein and then thread off, release traction, tourniquet,apply pressure well above where the lie of the catheter tip is within the vessel to stop blood from spilling and activate the safety feature on the needle you are using then connect either your pre-primed IVset or extension set, and dress your site, then flush it.....Success!!!!! I work with alot of Nurses on IV therapy techniques and some of the observations I have made: Not waiting for the veins to fill up, releasing the traction on skin when they get a little flash, attempting to thread off when they see the flash (premature) instead of making sure the catheter is actually in the vein, sometimes the needle is in the vein, but the catheter (usually sits below the needle bevel by a small distance) is outside the vein, so when they attempt to thread off they are actually trying to push the catheter into the outer wall of the vessel, LOOK at your catheter be aware of the distance between the bevel of the needle and the catheter lie on the stylet....this will help you to avoid some of the pitfalls, but practice makes perfect, start with the most accessible veins first, as your confidence grows select the vessels higher up and those that lie a little deeper to get the feel of palpating for them, SOON you will be a FIRST STICK PRO, and everyone on the floor will want you to start their IV's!!!! Best of Luck and I hope this helps........ LUCY

First, you must be sure to adhere to the current policy within your facility whether 72 or 96 hours for an uncomplicated peripheral IV. Second, you must assess the site within the protocol allowed dwell time to see if a change is necessary. The current INS standards and current research suggest there is very little difference in the amount of phlebitis between 72-96 hours. However, if you are infusing :angryfire (jet fuel) think of vancomycin and other harsh medications the osmolality of the infusate will definitely impact the dwell time of any peripheral IV. For IV sites that are uncomplicated according to the standard it can remain 96 hours and the CDC also supports this. However, you are unprotected if you do not have a policy to support an extended dwell time without an MD order to extend the dwell time. If you think your facility would be better suited to a longer dwell time, I would bring this up for discussion with the Infection Control nurse in your facility. They are usually very involved when in comes to facility policy changes, they are generally aware of current guidelines, and attend APIC meetings where new guidelines lectures are presented. The other option is to do your own research: www.cdc.gov and check the Guidelines For the Prevention of Intravascular Catheter-Related Infections which addresses peripheral IV's, Central Lines, Mid-Lines and Picc's. The INS Intravenous Nurses Society has the "Infusion Nursing Standards of Practice" there is a ton of information out there, a prudent nurse must arm his or herself, always!! It is better to be aware of current literature and guidelines unfortunately, many nurses become complacent in their position and forget that the medical strategies of today are much different than those learned in nursing school. We have to be aware of changes in practice, so thanks for bringing up the issue and staying interested, I wish there were more folks out there interested in staying up to date!!! Lucy