Trouble advancing catheter

[ifindoubt2]

I've done many, many IV's over my career, but have recently begun infusing rhuematoid arthritis patients in an OPD. I have one patient whose peripheral veins (back of hands) seem particularly "tough". The first timeI did her IV, I felt a huge "pop" as I enered the vein, and had to use a surprising amount of force. No problem with the IV, once in. Next time, however, I got the point of the angiocath in, good blood flash, then couldn't get the 1/8 inch further in before trying to advance the silicone catheter. The vein zig-zagged as I tried, but I couldn't seem to get the plastic "sleeve" within the lumen of the vein. Her veins looked beautiful, and palpated with good resiliancy; I tried another site and had the same problem. Anyone with similar experience with "tough veins"?

[UM Review RN, ASN, RN]

Yes, in a couple of patients it depended on medications that they were taking. Prednisone and steroid use makes the veins easy to get into but with such fragile walls even the smallest cath can rip right through them.

One of my hardest sticks had had chelation therapy. Totally destroyed most of her veins.

Is it possible that the patient had a lot of sclerosing going on for one reason or another?

[ifindoubt2]

Thanks for the timely response. No sclerosis as I could tell--only on IVPB remecade and Benedryl IV previously. I even tried a steeper angle of entry on 2nd attempt, but same result. It felt like she had "rubberized" veins. I felt awful, and will attempt a simple butterfly if I have her again. Still need input, please...

[piccrn56]

I don't do many PIVs any more but when inserting PICCs with ultrasound guidance we do see lots of venospasm. If this is the case with your patient perhaps warm compress would help or nice cup of warm tea. If venospasm is the culprit and it is not contraindicated you could always try a touch of an anti-anxiety agent. (for the patient, not you!!!!):w00t: Karen:redpinkhe