Tips for IV starts

I read through some of the "old threads"....they are great! Most facilities now use IV catheters with retractable needles. Insight Autoguard, "IAG" is a fairly popular product in the field. BEWARE! You MUST go in SLOWLY with this type of catheter and come in at a lesser angle to avoid puncturing the back of the vein wall. Once you see the "flash", go almost parallel to the vein and advance VERY slowly. It was a very difficult transition to IAG's for myself and other coworkers who had learned with "jelcos". As for size: I work Urgent Care and routinely use a 20 gauge for rehydration. When the patients condition does not appear very stable, I use a 16 or 18.

I read through some of the "old threads"....they are great! Most facilities now use IV catheters with retractable needles. Insight Autoguard, "IAG" is a fairly popular product in the field. BEWARE! You MUST go in SLOWLY with this type of catheter and come in at a lesser angle to avoid puncturing the back of the vein wall. Once you see the "flash", go almost parallel to the vein and advance VERY slowly. It was a very difficult transition to IAG's for myself and other coworkers who had learned with "jelcos". As for size: I work Urgent Care and routinely use a 20 gauge for rehydration. When the patients condition does not appear very stable, I use a 16 or 18.

Going to endo, to start iv's, for the next two days. I hope I get at least a few sticks. I will let you guys know. Yes, I think the older threads were very helpful. I will do my first one on a real person tomorrow.(hopefully) I am crossing my fingers.

The problem I had to overcome when starting IV's [i start mainly on 24-34week preemies] is that I would get all excited when I saw a flashback and instantly advance the catheter. You have to drop the angle of the needle and insert it a smidge further. Also make sure your catheter hasn't slipped over the end of the needle before you insert it, or it'll snag. I tend to go by sight, but then I always stick babies who have tiny veins to begin with. Stretching the skin helps, and keeping it wet with alcohol helps too. I am now convinced that a 24 gauge IV can fit into any vein no matter how small! I've stuck a baby's thumb vein with a 24g before! Also remember that we all have our lucky and unlucky streaks. I can get 5 in a row, and then miss 5. IV's are weird like that!

Good LUck!!

:bowingpur

Steve, you rock! I don't think I could hit those little premie veins. Anyway, you give good advice, that is why most new folks can't start their IV's. Must drop the angle! Also, I use a couple of techniques that I think help you score. (Like the carpenter's rule), it pays to look twice - stick once. In other words, don't feel bad about spending a little extra time finding the best vein their is to offer. Then the other thing I do was taught to me by a CRNA; first, get that arm dependent, milk it a few times and then slap on the tourniquet. Alcohol is great to help show you those veins too. good luck! SG

biggest thing is take your TIME! If the patient is right handed, try to place in left arm...if patient is possibly going to need a CT with contrast, the bigger the better...

a straight vein is easier to hit than a crooked vein

linda

Hope I'm not repeating someone but I've always found on a difficult stick using a blood pressure cuff as a tourniquet inflated enough to prevent venous return but not to inhibit arterial blood flow, also using a heat pack helps a lot by relaxing the vein causing it to dilate...I have found with these tricks, taught to me by a 30yr IV therapy nurse, I haved been able to hit veins that have been missed by numerous nurses.

I would also add to start with the bigger veins in the AC to practice. These veins are usually popping out and are easier to hit. As you get better and you get your technique down, then start moving down the arm to smaller veins.

Practice Practice Practice! Search out all IV starts and try. Rely on feel, not look. With hard sticks some of their best veins are not visable to the eye, yet are like pipelines. The best veins are bouncy, if visible you dont want to stick in a y. You will probably hit a valve. Confidece is also key. If you think you can do it you will more often. After prepping site find the right angle that works for you for insertion, stabalize the vein. Once needle is in and you see flash advance just a little more before retracting needle. Apply pressure to site just above insertion site(this should prevent blood flow all over until you can attach flush) Hope this helped a little- let me know. Good luck

In addition to Daytonite's response:

I particularly like Post #50 by teeituptom on this thread. It is "Vision the Vein, Be the needle" After 30 years of starting IV's I gotta say that this is so very, very true.

Try a venoscope, http://www.venoscope.com

seeing is believing.