Question for nurses who advance both needle & cath all the way

[enfermeraSG]

Hi, this is just curiosity, but any of you out there advance the entire needle and catheter when starting IV's? (You know, instead of just gaining access to the vein with the stick, advance slightly after flash, then slide the catheter off the needle into vein). There are the nurses that get flash and continue on to advance the whole needle into the vein before removing it from the catheter. How does this not traumatize the vessel, and how do you not tear through the vein and blow it? I have watched these nurses start IV's with fascination because they make it look so easy, but how on earth do you keep that needle positioned inside the vein for the entire length? Over a decade ago, I learned the textbook method so I just can't get over how this other method works.

SG

[Mandolyn]

SG,

I have no idea how those nurses are able to not penetrate through the vein by doing it that way. No one should be advancing the entire length of the needle into the vein. That was the textbook way when you went through it and that is the textbook standard now. The needle is only to gain access to the vein, then the catheter is advanced and the needle is removed.

It is very risky to do it any other way.

[MeryMellen]

I know that it seems like you would blow the vein. But if you're inserting an IV with a 1 inch catheter or 1-1/4 inch you should be pretty confident that you have a straight vein of that length because either method of inserting the IV something is going to go wrong. If you wait for flash back and then advance just the catheter and it's not going in the direction of the vein you could kink the catheter and then it's of no use. And obviously if you advance with the needle you could blow a vein. It's really all about being able to feel a good straight vein. I have better luck advancing the catheter with the needle it's less painful for the pt. believe it or not and when I do advance just the catheter half the time it's kinked. Hope this helps.

[enfermeraSG]

Thanks Merymellen! I guess I just pictured the tip of that needle tearing little holes or shredding the vein all the way in. Obviously it doesn't or no one would start IV's that way, and some of these nurses are seriously pros, they could start an IV on a rock! That is interesting that you say it is less painful for the patient, I wonder why? I would love to get the courage to try one this way, but I chicken out everytime I think about it. Were you taught that way or did you learn it along the way? SG

[MeryMellen]

I did learn to advance the catheter once I had access to the vein, but it's a technique I picked up watching other nurses, I found I had more success with this method so I've stuck to it. I think it's less painful because it's quick. With getting access with the needle then advancing the catheter I think patients become a little sqeamish because they can actually feel the catheter sliding into place, if you do it quickly with the needle and catheter it's fast. That's my theory anyways.