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Discussion

starting IV's

just started a position in a Chemo Tx center a few days ago. One of the priorities I have been given is to start IV's. in my previous position, an IV team started IV's & occasionally I would start one. Easy because sitting up in bed with an arm hanging down, well the arm is the only place for a lot of blood pooling, and we could use a big arm vein, so no problems.

In the chemo office I must use the hand or wrist.

I always used to release the tourniquet once I saw the flash, here they don't, and they stand behind me so they can "check off this skill" I keep being told NOT to release the tourniquet, HOWEVER, after the flash, advance, and trying to flush, I NEVER get blood return. "they" are getting frustrated with me.

help :)

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    • Featured Replies

    All roads lead to Rome.

    As long as you get a good blood return then it doesn't matter, be comfortable with the way you used to it.

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    Why don't these patients have central lines?

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    • Experts

    Hand and wrist veins are not ideal for chemo due to their small size and proximity to nerves. In addition, if the chemo were to infiltrate, the patient could be at high risk for losing his/her hand. Hand and wrist veins are also more painful.

    Use the forearm veins if at all possible. With practice, you'll get used to seeing these sites, and your patients will thank you.

    I don't understand why they want you to keep the tourniquet on; you have a greater chance of blowing the vein that way.

    There's no "one" right way to start an IV, but you may find some helpful information through Intravenous Nurses Society (INS).

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    • Author

    thx ONCRN, they said w/the smaller veins we can see sooner if they will have a bad reaction? if that works then NEXT tx is higher up. only 1/2 the pt's have ports :(. i can see leaving the tourniquet on if doing labs, but i was taught b4, to pull the tourniquet off for a few, ck blood return, then put tourniquet back on for blood samples. i guess there are diff methods. i really dont like doing hands for the reasons u mentioned, but when you are new, you can't be spouting off.

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    • Experts
    thx ONCRN, they said w/the smaller veins we can see sooner if they will have a bad reaction? if that works then NEXT tx is higher up. only 1/2 the pt's have ports :(. i can see leaving the tourniquet on if doing labs, but i was taught b4, to pull the tourniquet off for a few, ck blood return, then put tourniquet back on for blood samples. i guess there are diff methods. i really dont like doing hands for the reasons u mentioned, but when you are new, you can't be spouting off.

    The whole point is to prevent having problems with your site, which is why using smaller veins is frowned upon.. You could look up some literature on site selection for chemo.

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    I worked in a very busy chemotherapy infusion center at one of the most renowned hospitals in the US. We tried to stay away from using the hand/wrist veins with chemo, especially when planning to infuse irritants or vessicants.

    It seems very strange to me that they want you to start with the hand.

    As far as the tourniquet goes I was under the impression that they are good for finding and accessing a vein but the shorter time you have them on the less stress is put on the vein that is already getting punctured and could blow with prolonged pressure and stress at the puncture site.

    It doesn't hurt to ask politely what their rational is. Maybe it was something specific to the patient you were accessing?

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    • Guides

    I think the tourniquet should be kept on until the catheter is threaded into the vein that way the vein stays as dilated as possible making it easier to insert the IV catheter. Once the IV catheter is in then you should let the tourniquet down prior to flushing the IV site.

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