Starting IVs on old sick people

[zacarias]

Hey,

I've read tons of info on starting IVs and used to start them quite frequently a fews ago but now am having problems. Am working at a new job where we do our own IVs and not having good success. I have only tried on a few patients but the patients have been severely sick, old, with bad skin, and possibly in renal failure.

Two of the people have been sick old women, one with COPD. I tried to get the vein but the flash is none. I think i'm rolling it but I'm not sure. After I take the catheter out (a failed attempt) I look at the puncture whole is right over the vein, like I was in the right spot. I'm wondering....am I going to deep, are these veings in skinny old people a lot more superficial than I'm anticipating?

Any advice would be appreciated as I refuse to be one of those nurses who isn't good with IVs!!!

Z

[zacarias, ASN, RN]

Thanks for all the tips. What do you mean "cause the vein to go flat?" Also, One more question. I notice when I apply a lot of tension under where I'm going to poke, the vein suddenly becomes flat and I lose my feeling of how deep to go etc or where exactly it is because it's flat. How do I keep it there to not roll yet still have a vein that's not obscured or flattened by my tension? THANKS!!!

[crawlyberry]

Hi...student nurse here...I have read others sites where nurses were talking about using a penlight and/or venoscope when starting IV's. Can someone give me some insight on this. We are learning IV's this week and and tricks would be greatly appreciated. Thanks.

[kaedawn]

Really helpful information on venous access. Just what i needed. Many thanks! ~ kathy

[vamedic4, EMT-P]

Thanks for all the tips. What do you mean "cause the vein to go flat?" Also, One more question. I notice when I apply a lot of tension under where I'm going to poke, the vein suddenly becomes flat and I lose my feeling of how deep to go etc or where exactly it is because it's flat. How do I keep it there to not roll yet still have a vein that's not obscured or flattened by my tension? THANKS!!!

To answer your question about the tension you apply - if the vein goes "flat" or you can't see it anymore, release some tension until you can see/palpate the vein again. In my experience, it's usually the "deep" veins that tend to roll anyway - not the superficial ones. If you release tension and still can't see/feel the vein, release the tourniquet and reapply after a minute or two - let the vein fill up with blood again.

Hope that helps.

vamedic4

Couldn't go outside today.

[Alternator81]

I am a nursing student but work as a phelbotomist in blood donation. I usually do over 30 sticks per day. We haven't started IVs in school yet, so I don't know how they train nurses. But-- I can tell you what I do.

Tie tourniquet *close* (not way up) to VP site and I ask the pt to clinch their fist to get the muscles to push the vein up. then feel the anticubital. If I don't get anything, sometimes I will try a BP cuff. Then I usually firmly rub from the wrist to the antecubital once or twice to help push blood up. If it's really being fussy, the warm compact trick works wonders!

Once I clean the area, retie the tourniquet, I ask them to make a fist again, and wait for it to come up. Secure the vein by tightening down the skin 2 inches distal of the antecubital-- stretch it down and hold it. This will help to keep it from rolling. "And a stick" bevel up. I usually go in from the top because I don't usually have problems, but sometimes I go from the side. Once you go in, if the hub inst flashing, stop and feel for the vein right above the VP site and use it as a guide, pull the needle back and use the vein as a guide and push back in. Sometime it wont flash, or it will flash and then disappear-- this doesnt mean that you arent in the vein! I would take the advice to flush with saline to see how it flows. Watch for infiltration in the area, which is a sure sign that you were unsuccessful.

I think that a problem that I had when I first started was that I didn't want to hurt anyone or I was nervous, so I would stick fast. Going in slowly is ok! It helps to keep you from going through the vein! When I first started I was having some problems, but I asked a coworker to watch me and give me some advice. It realy helped! If someone you work with a good stick, ask them if you can watch them or if they can give you any tips.

Good luck!

[suanna]

Just a couple of tricks from an old nurse:

-never use a tourniquet! a BP cuff inflated to just above diastole will engorge the vein much better, and for difficult sticks when you have to hunt for a while, it is more comfortable for the patient;

- if the vein "blows" when you attempt the stick, or you get a flash but can't advance the catheter into the vein, invert your bevel before you stick. That way you won't get a blood flash until the catheter is in the lumen of the vein. It hurts a little more but you only have to stick once.

[m0m2boys]

Tons of great new tricks for me to try out!