"Floating" IV

[Marti17]

I have a question about a new IV start technique I was told about this evening. A bit of background for me, I am still a nursing student half way through my second try at nursing school, Failing out of a BSN school spring of last year and now in a Community College ADN program, anyway my wife and I had dinner this evening with some friends of ours who's wife is in Nursing school at my old BSN college, there are some new instructors there since my time at the school, anyway we were talking IV's and she mentioned "floating" in the IV on a patient with difficult veins and dehydration. This is something I had never heard of and so I went on an internet search for this technique, it brought me to allnurses.com to an old post from 2007 that spoke briefly about "floating" IV's, three of the four nurses that responded to that post did not like the idea of it. I am skeptical of it myself, I get the Idea of how it could help advance a catheter into a vein that is difficult but also the risks involved with it. I was hoping for some new responses to this idea, i am on summer break from my nursing school to ask any of my instructors about this but either way would like the opinion of the many knowledgeable nurses on this site. Thank You

[NicuGal, MSN, RN]

We use it pretty frequently on our babies who are bad sticks. Flush slowly while advancing the catheter works pretty well.

[Marti17]

wow i did not expect to get so many responses, and really all are on a positive side of this idea, I mean the whole idea makes sense and with more evidence based practice I would think this would or could be a more common thing, again I am still in nursing school, have done a few IV starts, some good some not so good, and in a couple of those not so good I think this technique would have been useful!. I will ask my instructors when I go back to classes after summer break about this also, but i know nursing school teaches us things based off of a perfect world, and as long as I have been at it being a nursing student i have seen there is no real such thing! Infiltration is the only major risk of the actually process, but if one is paying attention, as a good nurse should, then that shouldn't happen or at least be really bad, and if good technique is used risk for infection should also be to a minimum. Our main goal as nurses is to take care of the patient and to do as little harm during invasive procedures as possible, so I personally see no reason not to try this if the situation needs.. Thank you to all of you who have responded so far and I look forward to any other responses. I can not wait till I can stick RN behind my name, be part of so many awesome people who love to help others!

[Caffeine_IV]

I do this sometimes with an IV that won't thread all the way to hub. Gently float in and check for blood return as you advance.

[amoLucia]

I do this sometimes with an IV that won't thread all the way to hub. Gently float in and check for blood return as you advance.

This.

There's so many tips and tricks of the trade to help. I found this technique on my own. I 'float' the catheter in when I hook up the tubing. Remove the tourniquet and just open up the flow clamp really slowly and the cath just slides in with the flow. With 'pipeline' veins you can usually just advance the cath. I usually found the tourniquet to be so bothersome.

Everybody has their own technique. Some folk go straight in from the top; some go in off the side. Sometimes I have to 'traction back' the vein to stabilize it from wiggling all over the place.

Whatever floats the boat!

[iluvivt, BSN, RN]

Yes I know of this technique and but I rarely ever use it! You do have to have all your supplies at the ready so you do not contaminate anything that is meant to stay sterile. I prefer if I can to spend a bit of time selecting a good vein (at least good for for that patient). distending it appropriately and applying a warm pack (if needed) prior to the venipuncture, This included palpating it for its characteristics,selecting the location that I will actually perform the venipuncture to avoid sclerotic areas,valves,sharp turns and and avoiding areas of flexion not only at the point of insertion but also figuring out where the tip will ultimately reside. None of our IV team member really use the technique very often either. Some veins do not need all the extras it just depends upon you assessment. I prefer to do a one handed technique since I want my other hand free (traction and anything else I may need) and I use both a direct and indirect technique. I often use an intima for HIV positive,AIDS, and Hep B and C positive patients and attach a prefilled NS syringe to the at the Y site of the intima. Then I start my IV,pop the tourniquet and flush with the stylet/needle still in place so when I pull it out it is clean and bloodless. You could also use this set up on the intima or similar products and and use the NS to flush and advance the cannula if needed.

[jadelpn, LPN, EMT-B]

The best advice I can give is to really feel for your veins. Know what a "good" one feels like. Some are deeper than others. Don't be afraid to look or feel--especially when you are in school. I will often wear a size smaller gloves than I usually do, just so I can feel for what I need to have the IV insert smoothly.

As noted by pp, sometimes that is just not possible. You get the IV "in" on insertion, get a good blood return, but can not advance. That is when you need to feel for where the vein is going, pull back a tad, and attempt advancing SLOWLY in the direction of the vein. Hook up your flush, and advance while SLOWLY flushing. IF you are feeling and seeing an infiltrate with the flush, it is not going to work. IF you get blood return on pulling back on the flush, advance to hub while slowly flushing, and waaa-laaa you did it!!

It is so important to be sure that you do not get an infiltrate. Especially if the patient is going in for a IV contrast test. And I know there are nurses confident in, and competent in hooking up a bag to the IV for this purpose. I wouldn't be confident in doing that, until you are really, really competent in IV's. 10cc of flush is a heck of a lot less than a bag--and you really need to be sure you get some blood return, or do not see a "welt" developing. Especially in peds where a 24 gauge IV doesn't always give a great blood return.

But first things first. Get to know your patient's veins, the best ones should feel like an elastic band. On dehydrated people, that isn't the greatest of an elastic band, however, you need to feel them, and it comes with practice. SO if you have clincal patients who are allowing students, see if you can shadow the IV team for a day. I wouldn't get all up in a critical patient who needs an immediate IV, however, to be able to feel those veins of patients who are needing rotations, there is no better way to learn.

Good luck!! And here's an excerpt that may be helpful to you.

Plumer's Principles and Practice of Intravenous Therapy - Ada Lawrence Plumer - Google Books

[wooh, BSN, RN]

I've found helpful when floating it in is to have a second person doing the flushing. That way you can keep a good hand on the body and catheter and they can use two hands to flush, giving everyone more control. Of course, if it's a tough IV, I like to have the friendly support too. Especially if it's you versus a family glaring at you. :)

I don't really see an increased risk of infection because I've always hooked up an IV to flush anyway (give it a last flush to check it, pull back to check your blood return). Perhaps if you hook the flush directly to the catheter? Which I've never done, always just hook the extension and push the flush through it. The extension will be hooked up anyway, so why not?

[Surprised1, MSN, RN]

I've found helpful when floating it in is to have a second person doing the flushing. That way you can keep a good hand on the body and catheter and they can use two hands to flush, giving everyone more control. Of course, if it's a tough IV, I like to have the friendly support too. Especially if it's you versus a family glaring at you. :)

I don't really see an increased risk of infection because I've always hooked up an IV to flush anyway (give it a last flush to check it, pull back to check your blood return). Perhaps if you hook the flush directly to the catheter? Which I've never done, always just hook the extension and push the flush through it. The extension will be hooked up anyway, so why not?

Basically this whole post describes how we start IVs on our unit. I work peds, so we generally need at least one person to hold the patient still while the other person starts the IV. Also, we use extension tubes and smart sites. So we always hook up the smart site and extension tube to the flush, flush it, and leave the flush on. No break in sterility. Therefore, it's easy to float the catheter in if need be.

[applewhitern, BSN, RN]

I was taught to float the catheter years ago; this isn't "new."

[ama3t]

Can I just say... I'm a horrible stick. I'm six months in and hadn't had one successful IV start since clinicals... I read this a few hours ago then went into a patients room and saw his IV just sitting on his bedside table (Ugh). He was confused and took it out. He's a known difficult stick. I got the flash, advanced, crap, it won't go... Tried floating and I got it!! So glad I read this tonight IDK if I would have gotten it otherwise!

[classicdame, MSN, EdD]

Google ProtectIV Catheter by Smith's Medical. Look on the Education Resources tab and then "Access our TV Channels". Next, choose "Vascular Access", then click on the tab "Protect IV Catheter". You want the Inservice Video (third on the list). They show you how to float the catheter. The negative is that, unless you have CAREFULLY cleaned the site, there is an increased risk of introducing germs into the site, since the sterile catheter has been exposed to skin/air.

Hope this helps.

[SNB1014, RN]

People on this forum or so paranoid regarding basic techniques. I float IVs all the time and yes it works.....

I think they are paranoid because they are new and often are still functioning in the " check off vs instructor " mentality. Which is fine when you don't know the basics of an iv but once you do you have to find your own style!