Starting IV's


What do you do if someone has HORRIBLE veins that you can not see. You can, mabey, feel them but can not see them for the life of you?

Dixielee, BSN, RN

1,222 Posts

Specializes in ER. Has 38 years experience.

Practice, practice, practice is the only way. Your patients may not like it, but there is no magic formula. Most patients you will not really be able to see the veins. You have to develp that magic touch. If not for my right index finger" "good sensation", I could not be a nurse! Find someone, a friend, family member, etc. and have them let you practice finding veins on them. NOT with a needle, but your finger. Put a tourniquet on them and "feel" for the hidden veins. First feel the ones you can see, the close your eyes and feel them again and again. The "look" with your fingers for some others. Start with the obvious ones in the antecubital, then go to the hand, the wrist, then the forearm. Older folks a lot of time have veins in the upper arms that are forgotten. Don't forget the foot, look there as well, although in some places you have to have a special order for that.

Once you know what a vein feels like, big and small, you will be better off. Also, some veins "look" good, but are hard and tortuous and are not worth the try. Many elderly have large but fragile veins and skin. I don't use a tourniquet on many of them, or put it on very lightly.

Drag out your old anatomy book and look at where the veins are "suppose" to be and start trying to locate them on yourself or another guinea pig. Once you get a few by the Braille method, you will build confidence.

On darker skinned people, a lot of times if you wipe with alcohol swab you can see them better. The wet skin sometimes will show you something you did not see before. On people with really bad veins, warm towels wrapped around the area sometimes will make them more evident. Same with hanigng the arm off the side of the bed for a while.

There are lots of tricks to try and you will develop your own as you go along as well. Good luck.

We are not allowed to use ac, foot, or scalp w/o docs orders, so be sure to know policy. Dixie gave really good tips. Like she said practice is what helps, but some days we all have problems. It takes time to be a good sticker, just be patient and one day you will be doing it without thought.


17 Posts

Maybe I'm too new at this stuff to be posting, but I don't have too much of a problem with IVs. It's prob my fave nursing procedure! I've put in quite a few IVs and after a while, I got the hang of it. Either way, I'm just trying to help!!! :)

When I start an IV, I put the tourniquet as close to the IV site as possible. I've read that you put it 8 or 9 inches above the site... Well, to get them to REALLY distend, put it as close as possible. I always aim for teh back of teh hand. I think they show the best here. Also, if you follow the thumb down, it seems that that vein is almost always possible to get. I never try to hit before a bifurcation; it seems to always go the wrong way, and also, I don't hit before those vein bumps. I don't know what they are, but they don't seem to let you flush. On dark skinned people, I put alcohol over the vein, then I rub the vein distally with the swab. That gets them to begin to show, and if you flick at them, they really start to show. Also, I hang the patient's arm down a little and have them make fists a few times... If you can't see anything by now, you can at least feel them, so you can try a shallow blind stab. When it's in, you can just feel the needle want to go a certain way. And if you felt like you went through the vein, sometimes you can save it by pulling it slowly backwards. Also, if you had flashback and you advanced the catheter in, and all the sudden you can't flush, maybe the tip of the cath is against the vein wall, so back it out a little, you should be okay. For rolled veins, it might be easier to pull them down and enter from the side, that way, they have very little place to roll... Hope this helps!!! :D Oh yeah, and watch how deep you go in a blind stab!

Specializes in Med/Surg, Ortho.

Go for the blanket warmer,, wrap the arm in a warm blanket for about 5 min.. Dilated veins are always pretty easy to see.

simao pt

48 Posts

Both Dixielee and Heymickey gave excelent tips!

Many times the best veins are actually the ones you can´t see. I'm lucky because I have terrible veins :chuckle , so I could practise on myself (just searching!).

Even now I look at a person, look at their hands and harm and think about how difficult they would be if they had to be puncioned. :rolleyes:

Once I was with my boyfriend watching TV and suddenly he asked "WHAT are you DOING?". I then realized I wasn´t caressing his arm but feeling is veins! :uhoh3: :uhoh3:


223 Posts

I don't go by veins I can see, and even if I can see them, I still feel them. Good veins have a lovely spongy sort of feel. It just takes a lot of practice, you'll get the hang of it sooner or later! I nsg school, I got my first IV on a classmate. I missed the next nine times I tried :smackingf . I was convinced I could never be a good sticker - but now I get called to other floors for hard sticks. PRACTICE PRACTICE PRACTICE! Be positive!

Barefootlady, can I ask why you have to have a Dr's order for an AC? I try to stay away from the AC but sometimes it is the easiest to stick and the only thing I can find.


88 Posts

I know this is going to sound strange but until you get good at where the veins are or if you have a person that you just can't find a good one for the life of you just try this. Get a flashlight, turn the light off and shine the light on their arm, actually put the flashlight on their skin. Suddenly you can see a slew of them. At least then you'll have a clue where to stick.

Don't assume they are all good because you can see them, but after you have an idea of where they are feel again and you might see a difference.


30 Posts

I vein basically feels like a rubber band flattened out, its usually spongy with some give, of course before you stick palpate and make sure there is no pulse esp. in the AC area. Some veins do feel hard but if thats all you got you can usually pass through it. Also the alcohol pad waorks well also the thumping , (although the books say not to do this), if you rub briskly with an alcohol pad, it will not only help the vein be more visible but it also numbs the skin a little and the stick is more tolerable for the pt. Before the stick always use a fresh alcohol wipe and go over the site just one time. Being in the ER we get a lot of low BPs, and dehydrated people that the veins arent visible, you will get the knack for feeling them, one day it will all just click for you. Also I do a lot of sticks in the AC because its much more comforatable for the pt, and since we draw all the blood , its usually a bigger vein that makes redraws from the heplock much more reliable so that we dont have to stick them again. I know the floors complain about it but they dont do the blood draws and dont have to stick everyone that comes in through the door. I do however, if I think they will be admitted always start out distally at the hand. Good luck in all you do.

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