Special questions about putting in IVs?

[Luvbuble]

I am wondering why putting IV's in pts is such a "easy" job for the ER staff?

I have been doing this for a little while and I still don't understand why I cannot get the technique down.

My main question is :

When I insert the needles, most of the time, I don't get flash back. I know I have not "hit" the veins. I always, almost 99% of the time, I will have to fish for the veins and finally get a flash back.

Do you insert your needle on the top and middle of the vein? Or do you go from the side? or do you do it like you are hooking the vein up from the skin? I have seen some people did that and it looks like a good technique. What have I done wrong? how come I can never get a flash back right away after I insert the needle?

[purplemania, BSN, RN]

I recommend you contact Education for a manikin to practice on. Then do it over and over. An experienced nurse should be able to help you in a matter of minutes. Ask to go to Same Day Surgery, or Labor and Delivery where they have lots of IVs to start on semi-healthy people. Watch and learn.

[Luvbuble]

Sometimes I use my left index finger to pull the skin taut from above the vein and maybe at the same time pull down with my left thumb--but not right below the vein, I kind of pull to the left. Either that or I just use my left thumb to pull it taut from below the vein, I just put my thumb down low enough so it is not in the way of my angio angle. When I do a hand (which I usually avoid, I hate all those tendons in there it just grosses me out) I hold their hand with my left hand, bend their fingers toward their palm and put my left thumb on the knucle below where I am sticking and pull the skin taut from there. You will not be able to see the vein as well after pulling the skin taut sometimes but it anchors the vein so you can hit it easier. You just have to know where you are going to stick before you pull the skin--sometimes I make an imprint with my finger nail right along the vein, this works especially well when you have to do blood cultures and you can't touch your site.

I have heard other people talked about making an imprint on the vein too.

I have never tried it b/c I am not exactly sure how you did it.

My questions are:

1. When you do an imprint with the finger nail, do you do it on the site where your needle will go only or do you mark the entire vein?

2. Do you mark the top & middle of the vein? or you do mark the side?

3. After making the imprint, you put alcohol on it. Then you pull the skin taut and insert your needle. When you pull the skin, wouldn't it move the marked imprint to the side or down which might shift the actual insertion site?

It is not that I don't believe this will work but I just want to know exactly how you do it so that I can do it the right way.

Thanks a thousand!

[PANurseRN1]

You could always get a surgical marking pen and put a tiny dot on the spot you want to stick.

As far as holding the skin taut, if I am starting in a hand, I use my L hand to kind of grasp the pt's fingers. My thumb is right at the knuckles, and I pull traction there. I sometimes joke with elderly male pts., "I'm going to hold your hand now, dear!" It always gets me a chuckle.

I make sure the pt's arm is hanging to gravity as I am setting up my equipment. That helps to get the veins more distended.

When I start looking, I survey the area. Take my time looking around. I don't just go for the first thing I see. I'll gently tap on some veins (no slapping), stroke them with my nail, take the alcohol pad and lightly scrub.

One of the biggest mistakes I see newbies make is rushing. SLOW DOWN. Take your time. When you see a vein, make sure the cathlon is bevel up, and go in on a low angle. You have to stick "briskly but smoothly." If you get a flash, advance the needle a little further, then try to thread.

Preparation is key. Make sure you have everything ready: tape, transparent dressing, IV tubing, 2x2s. If you get a successful stick, it's a good idea to put a 2x2 under the catheter. That way, when you disconnect the retracted needle, the blood from the angio will go on the 2x2, not make a mess all over the pt hand. You can also lightly press at the insertion site to temporarily occlude the site while you are connecting the IV tubing.

One comment about going for antecubs: If the pt. is going to be needing surgery, this is not the greatest site, as it interferes with what anesthesia has to do (BP cuff inflation interferes with IV flow and giving meds). If it's the only thing you can get and it's a trauma situation, that's another deal.

And don't be fooled by big fat juicy veins. They can be notoriously uncooperative.