Starting IV

[krissieshull]

HELP!!! When starting my IV I will get a flash and then when I advance my catheter and try to flush it, it will not flush. What am I doing wrong and how do I get it to flush without having to start a new IV. I work in a chemotherapy office.

[JKL33]

You have either already gone through the vein, or do so in the process of trying to advance the catheter. My guess is your initial stick is too deep, or else when you're trying to advance the catheter you are inadvertently pushing the needle along with it rather than sliding the catheter off of the needle while keeping the needle stationary.

[Wuzzie]

Are you able to fully advance it and do you still have a good blood return once you do?

[rearviewmirror, BSN, RN]

It's hard to explain with words but here it is: as JKL33 explained, you probably went through the veins at that point. I worked in ER and on sonosites so I am pretty confident of my IV skills.... but I am a paperpusher now so take it or leave it....

when you hit the flash of blood, you do have to insert it in little more to make sure tip is in the vessel instead of "on the vessel." I would slightly push the needle upward (you can see it bend very little sometimes even) as I advance mine just little bit once I saw the flash. That's how I advanced my needles and never missed an IV most of the times. Sometimes you get people who have absolutely no veins since they came to hospital so often, then knowing how to use sonosite helps tremendously.

[cleback]

It's hard to explain with words but here it is: as JKL33 explained, you probably went through the veins at that point. I worked in ER and on sonosites so I am pretty confident of my IV skills.... but I am a paperpusher now so take it or leave it....

when you hit the flash of blood, you do have to insert it in little more to make sure tip is in the vessel instead of "on the vessel." I would slightly push the needle upward (you can see it bend very little sometimes even) as I advance mine just little bit once I saw the flash. That's how I advanced my needles and never missed an IV most of the times. Sometimes you get people who have absolutely no veins since they came to hospital so often, then knowing how to use sonosite helps tremendously.

Agree with this. Also after you advance the needle a bit further (just a smidge!) you can try floating the catheter in with the saline flush. This prevents me from poking through the vein wall when I advance.

[Kallie3006, ADN]

I third advancing the needle a tiny bit more after your official flash. Also if you have the cathlon resting on the vein wall or a valve it will not flush. In my experience if I have gone through the vein it will "flush" but you will see the NS pooling together similar to when the IV infiltrates.

To check for valves you can compress the vein, after compressing and the distal release the valves will "pop" back up but the vein will still remain compressed allowing you to gauge your entry point and avoiding valves.

To compress the vein to check: below the applied tourniquet (or with the arm dangled down) find the vein you are thinking about using and take a finger and place it over the distal part of the vein (like you do when occluding after insertion hooking up your pig tail) keep the part of the distal vein held down while you take different finger and run it up the vein. The vein should be collapsed at this point and remain flat. (Sometimes you can see a valley type indention) while keeping the distal end occluded remove the finger used for the proximal vein trace. The vein will remained collapsed and now the valves will show, if there are any in your selected area. This will assist with you trying to avoid hitting them. í ½í¸

Remember to take extra care with those getting chemo and the elderly population. Sometimes the pressure the tourniquet produces is to much for their veins and will produce a higher chance of blowing your vein.

[CloverPark, RN]

It's hard to explain with words but here it is: as JKL33 explained, you probably went through the veins at that point. I worked in ER and on sonosites so I am pretty confident of my IV skills.... but I am a paperpusher now so take it or leave it....

when you hit the flash of blood, you do have to insert it in little more to make sure tip is in the vessel instead of "on the vessel." I would slightly push the needle upward (you can see it bend very little sometimes even) as I advance mine just little bit once I saw the flash. That's how I advanced my needles and never missed an IV most of the times. Sometimes you get people who have absolutely no veins since they came to hospital so often, then knowing how to use sonosite helps tremendously.

YES! This! I had the same problem as OP... Mind you, I was the BEST at my facility at blood draws, but sucked horribly at IVs.... Finally, I decided to observe one of the best IV starters and saw her do that little upward motion. I took a mental note and then tried that technique once I had the chance... And I got it!!! Been using this method ever since, and now I'm up there with the best of them at my facility.

[peachtreednurse, RN]

I'm sure you're probably doing this already, and not even thinking about it...but insert the needle at the narrowest level to the skin with the bevel up, and once flash is visible advance just about a cm more before retracting the hardware and hooking to the flush to insure placement and integrity of the vein before fluids initiated.

[Wuzzie]

I'm sure you're probably doing this already, and not even thinking about it...but insert the needle at the narrowest level to the skin with the bevel up, and once flash is visible advance just about a cm more before retracting the hardware and hooking to the flush to insure placement and integrity of the vein before fluids initiated.

Did you mean 1mm instead of 1cm?

[peachtreednurse, RN]

Did you mean 1mm instead of 1cm?

OMG yes THX

[Wuzzie]

OMG yes THX

Kinda thought so!