tips on starting IV, drawing blood on obese patient

[Ms.RN]

I'm having a hard time finding veins then starting IV or drawing blood on obese patients. ARe there any tips on how to be more successful?

[Double-Helix, BSN, RN]

Spend a decent amount of time looking for good veins. Try tourniquets, hot packs, gravity, and ask the patient where they usually have luck with blood draws. If possible, look at areas that tend to have less subcutaneous fat, such as the back of the hand, the thumb, the wrist, and even the top of the foot.

[xtxrn, ASN, RN]

With the foot- some places require a specific order r/t other dx that can increase DVT risk :)

[studystudy]

A trick I use sometimes is putting a second tourniquet 2 inches above the first tourniquet. It can really make the veins pop. The other day I saw another nurse do a different variation of this, and she put one tourniquet above the AC (like usual), and another 2 inches below the AC. She hit the vein on the first try.

[RFRN]

Feel out all your possible options before you decide to go for it. Agree with other posters - ask them where they usually get stuck, heat packs, gravity, tie that tourniquet tight and give them a stress ball to squeeze. I had one not too long ago where I had to do a 1 hour glucose tolerance test and was having trouble finding a vein. Talk about pressure! Lab gives us an 8 minute window (+/- 4 minutes from exactly one hour from when they finish their glucose) to get the draw. Luckily, got it on the first stick. Would hate for the patient to have to come back and drink that Glucola again. I have to say, I started off doing venipuncture for lab draws prior to IVs and found that a good way to learn.

[bruali]

I was in a patients home a few days ago and had to call EMS, the patient was obese and her spouse said she had terrible veins. The paramedic immediately brought out a large flash light and pressed it to the patients arm. This illuminated the veins that he could not palpate. He got her first stick, and i will definately try this in the future if i have trouble.

[kgh31386, BSN, MSN, RN]

Big ppl are not bad to stick at all, especially the ones with edema. My trick is to press on their hand or arm with both of my thumbs. Put ur fingers on the bottom of their arm and press the tops with your thumbs. This will move their fluid and/or tissue out of the way so you can see a good vein. If you really can't see a vein they usually will have one on their hand just between the 4th and 5th finger on the top of the hand

[turnforthenurse, MSN, NP]

Ask the patient where they usually get stuck. I have had patients tell me nurses are more successful in one arm than the other, etc.

One thing that I find that helps is using two tourniquets - take them together and tie it. Putting some rolled towels underneath or a pillow helps, too (just make sure to put some chux on top of them in case you make a mess!). Using heat (such as a warm towel) or placing the extremity in a dependent position (to allow gravity to fill the veins) can help, too. Sometimes you won't be able to see the veins at all, but you will be able to palpate them. Sometimes the veins are deeper so therefore you will have to go deeper.

I once had a patient who was a VERY difficult stick - I brought in the best of the best IV starters that were working that night, but no luck. Finally, an ER tech came up and he used a venoscope, which is basically a fancy flashlight - basically the same thing that bruali described in their post. This allowed him to see the vein and was able to get the IV in.

[FlyMurse, BSN, RN]

It worries me to see so many people in this thread and others talk about seeing veins and palpating them only if you can't see one. Venous access should always be based on feel, not looks. Superficial veins often times can't handle an IV bolus or radiology contrast. Also, by palpation, you can sometimes feel valves in people and learn to avoid them. Those veinfinders are worthless. If I can't feel it then I let SWAT come in with the ultrasound. Every so often I'll go in an area where I'm not sure whether I feel anything or not, but know there's usually a vein there. Sometimes I get lucky, sometimes I get nothing.

Re: the 2 tourniquet trick (above and below)

I'm not sure I understand how this works, as the valves are already in place to prevent backflow. But lots of people swear by it, so there might be something to it!

I've been an RN for almost 3 years and an ED tech prior to that (which is where I learned my IV skills- nursing school sure didn't teach me much!). Just my opinion.