Speaking of IVs... Need help (long story longer)

zambezi, BSN, RN · May 18, 2005

Another easy way to find IV threads is go to the search button located in the first yellow toolbar on this page...search is located three from the right...type in IV insertion or IV and you should get a ton of hits from various sections on the board...

Sadie04 · May 18, 2005

Here's the IV tips and tricks thread: https://allnurses.com/forums/showthread.php?t=3793&page=7&pp=10

I started a new job in an oncology clinic a couple months ago and had to get very proficient at tough IV starts quickly - some of those chemo pts have the worst veins I've ever seen! Thank Goodness about half of them have mediports!

I usually anchor the skin around the vein I've chosen so it doesn't roll, then as soon as I get flashback I remove the tourniquet and slide the catheter off the needle. If I meet resistance, I tape it down, attach the saline and "float" the rest of the catheter in.

Good Luck, and practice makes perfect :)

stevierae · May 18, 2005

here are my own tricks from the er nursing thread, in blue. remember, these are unique to insyte autoguard by bd--that's the one with the button. with that brand, a 15 to 30 degree angle is what's recommended--the wheal you make with lidocaine makes a convenient little place to rest the needle (you've swabbed it with alcohol) while you contemplate your angulation. also, the amount of pressure needed to go through the wheal always seems to be exactly what you need to penetrate the vein without going through it.

just remember---"low and slow" when the iv catheter is an insyte auto guard. other brands have different recommendations about the approach. iag has a very, very sharp needle; therefore, the low and slow approach and less angulation is necessary.

i love the iag, but intracan, made by b braun, is an excellent iv as well. i do not care at all for the johnson and johnson brand--it is very dull.

blueiag 18s come in more than one length--just fyi--so you may see an 18 that is longer than your previous brand, and perceive it as bigger--that is, looking like a 16. but, ivs are standardized everywhere in the world--18g is green, 20 is pink, 22 is blue, 24 is yellow--regardless of brand. i agree with those who point out that you have to consider the situation and the patient. i trained as a corpsman during the vietnam era, so we learned on 18s, 16s and 14s--we were learning to address trauma situations. i, personally, like to start large bore ivs, but i have worked with many a fine anesthesiologist who routinely only put in 22s. if the patient needed more fluid, or faster, he could always speed up the drip rate. if more vigorous fluid, or blood, resucitation was needed, or we ran into problems, it only takes a second to start a second, bigger iv.

when i worked home infusion, they often gave blood through 24 g ivs. remember, this is not a truama situation, and there is no rush. for those who think it cannot be done, or is "asinine--"--check the ins (infusion nurses' society) standards and guidelines.

i have run into people who say they hate the insyte auto guard. it usually means they have not been trained to use it properly. let me give you some tips here that might come in handy.

here are a couple of tricks to avoid blowing the vein, (iag is sharper than most other iv catheters--the sharper the catheter, the less to the vein accessed)

---before you start, hold onto the catheter hub where it attaches to the clear flash chamber (just above the button.) you will see a slight notch there. be careful not to press the button!!!

---with the opposite hand, grasp the clear flash chamber at its base, and twist it--not the catheter itself-- to the right, a full circle, (360 degrees) until you hear a slight "click." you have brought it all the way back where you started, to that "notch." (the notch is just above the button; again, be careful not to press the button.)

we taught this step by saying "take it for a spin. " this action will loosen the heat seal between the catheter and the stylet, and allow the catheter to "glide" off the stylet easier. if you neglect this step, the catheter may feel "sticky" when you attempt to advance it off the stylet, and may cause you to inadvertently "blow" the vein when you struggle with it.

---here is the most important step: remember, your approach should be low and slow.

---place your thumb and index finger on the little "grooves" on the side of the flash chamber (created for that very reason.)

---angle the catheter, bevel up, at approximately 15 to 30 degrees above the skin.

---stick, (just enough to get the catheter tip in) stop, lower the catheter almost flush with the skin.

---as iag's stylet is sharper than some of the other brands, and thus cannulation less traumatic, you will not feel a pop as you enter the vein as you do with some other brands--that "pop" with other brands is trauma to the vein from a stylet that is not sharp enough.

---it may take a bit longer than some other brands to see the flash in the chamber--but if you have successfully accessed the vein, it will appear. be patient.

---now advance the entire unit--not just the catheter--approximately 1/8".

---this is important with any iv catheter, to make sure a good portion of the actual catheter is in the vein--not just the tip of the stylet.

---go ahead and thread your catheter off the stylet.

---push the button, stabilize your catheter, put digital pressure above your tourniquet, (this will cut down on "back-bleeding") and pull your tourniquet. ----dress iv site according to institutional policy.

fyi: the 22s and 24s have a "divet" cut into the tip of the stylet, which allow you to see a drop of blood in the catheter before you see it as a flashback in the chamber.

another fyi: one of the most common reasons for the complaint of "i got a flash, but the catheter won't thread" is failure to advance the entire unit another 1/8" into the vein before threading the catheter off the stylet--it means that only the tip of the stylet is in the vein, and not the tip of catheter itself.

imenid37 · May 18, 2005

Actually, it's better to advance the entire unit--stylet and catheter--perhaps another 1/8" once you have achieved a flash--THEN thread the catheter off the stylet, into the vein. In that way, you know the tip of your CATHETER (and NOT just the stylet) is actually in the vein.
This is a common mistake with many new to IV access--I remember doing it myself years ago--they are so happy to see a flash, that they hurry up and try to thread the catheter--and it buckles. It won't thread. They are confused, as there is blood in the flash chamber---what happened is that blood entered the flash chamber when the STYLET entered the vein--but the tip of the catheter itself was not yet in the vein.

Stevierare, you are right on the money. I use Insyte where I work and agree 100% w/ you. To the OP, don't feel bad. You will get it. I go through dry spells once in awhile w/ iv's too!

HyperRNRachel · May 18, 2005

Another FYI: One of the most common reasons for the complaint of "I got a flash, but the catheter won't thread" is failure to advance the entire unit another 1/8" into the vein before threading the catheter off the stylet--it means that only the tip of the stylet is in the vein, and not the tip of catheter itself.

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I have done this! I get a flash and then I cannot advance the catheter. I asked everyone in the department I work in and nobody had an explanation for me. I thought I was hitting a valve, after a few times of doing this I started thinking I had some kind of gift for finding valves! :rolleyes: Now I know I am not a valve detector; I am just a premature advancer! :chuckle

A big thanks to all who pointed out this mistake. :kiss

This article is also a nice refresher. http://www.nursingcenter.com/prodev/cearticleprint.asp?CE_ID=582125