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Trouble threading IV catheter

Emergency   (934 Views | 7 Replies)
by Junior Junior (New) New Nurse

Junior specializes in Emergency RN.

104 Profile Views; 3 Posts

Hello :)

I have no problem finding flash... but recently ran into the issue of once it's threaded. I will obtain the flash, drop my angle, advance slightly, then advance the catheter -- and then the cannula stops filling up with blood after I remove the needle (we have the BD autoguard) 

I found sometimes I can pull the catheter back slightly and it will fill with blood and I can flush it in.  But it is now just not filling with blood or able to be flushed? I feel like I am constantly doing it now, and am overthinking it.. wasting good veins and then left in a pickle. Has anyone else had this problem?

Thank you!

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brownbook has 35 years experience.

1 Follower; 3,390 Posts; 46,051 Profile Views

Yes, and only 100 variations of it. It's so hard for anyone to say with 100% certainty what you're doing wrong. It's like describing how to ride, balance, on a bike!

My guess/advice is to not do anything when you get the flash. STOP all movement of BD autoguard. Take a deep breath. If you're really in the vein it should fill up more than just a flash.

Personally I don't think I consciously drop my angle. Maybe I do it unconsciously?

An IVDA patient taught me the trick of when you get the flash but it stops. Gently, lightly, tap one finger on the skin  right over where the catheter tip is. This gentle vibration helps direct the catheter into the vein. 

Have you watched YouTube videos on starting IVS? They're great.

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13 Followers; 4,056 Posts; 31,524 Profile Views

Is this a new issue that has cropped up long after reliable proficiency was obtained, or are you still kind of learning? Sometimes very proficient IV starters go through a little streak of weird misses.

Anyway, if it isn't working when you thought it was in, you just most likely don't have it where you think you do (that is, in the vein).

People get a "flash" all the time as they're nicking the vein or sailing right on through it.

I don't start at much of an angle at all. I see people starting at something like a 30-40++* angle and I never do that; it seems like a great way to puncture all the way through the vein. I don't know what my angle is, but ?10* maybe? If you laid the catheter set flat on the skin I would only tip it down enough to have the needle make skin contact (that isn't the process I use, but it's where I end up). The whole idea of starting at an angle isn't meant to be a big angle, "start at an angle" are just words to convey that the tip of the needle needs to make contact with the skin.

So start an a relatively flat angle. Make sure the vein is anchored. Keep your own non-dominant thumb out of the way. If you are going over your own thumb, good luck, it's probably too high an angle of approach. Anchor the skin/vein at a site distal enough to your insertion site so that your own hand/thumb isn't in your way.

You should puncture the skin and vein almost simultaneously. See your chamber filling up, not just a "flash." If your chamber is actively being filled, you only need to advance the needle a mm or so....or not at all. (This part depends on personal technique and how far you went in with your initial puncture). Then...make sure you're flat and slide the cateter without pushing the needle at the same time (many people don't realize they are doing this).

I think the overall problem is people have been misinstructed or else never really understood what is meant by "flash." It isn't a little speck of blood. If your chamber isn't filling up you aren't in your final position yet.

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CKPM2RN has 3 years experience as a ASN, EMT-P and specializes in Emergency/Med-Tele.

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There are many slightly different methods and everyone has a favorite. And like someone said, everyone goes through a bad streak once in a while. I have seen a few people who hadn't been instructed correctly on what a "flash" is and when they should stop advancing the needle and only advance the catheter. 

JKL33 put it great. But I think it was mentioned that it's like trying to describe riding a bike. Closely observe another nurse starting and IV, then have that nurse coach you through one. You'll get it right then. 

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amoLucia specializes in LTC.

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To OP - I see you're a newbie here. There's a whole other room that focuses on IV questions? Very informative. 

Just in case you're still trying.

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Junior specializes in Emergency RN.

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On 2/3/2020 at 4:03 PM, brownbook said:

Yes, and only 100 variations of it. It's so hard for anyone to say with 100% certainty what you're doing wrong. It's like describing how to ride, balance, on a bike!

My guess/advice is to not do anything when you get the flash. STOP all movement of BD autoguard. Take a deep breath. If you're really in the vein it should fill up more than just a flash.

Personally I don't think I consciously drop my angle. Maybe I do it unconsciously?

An IVDA patient taught me the trick of when you get the flash but it stops. Gently, lightly, tap one finger on the skin  right over where the catheter tip is. This gentle vibration helps direct the catheter into the vein. 

Have you watched YouTube videos on starting IVS? They're great.

Thank you for your response! I am going to try the tap, I have never seen that done. I have been an ER nurse for almost a year and have done many IVs but I think I just ran into a rough spell.  I have watched a ton of videos, but I definitely won't stop!! Thank you for your time

On 2/8/2020 at 3:13 PM, amoLucia said:

To OP - I see you're a newbie here. There's a whole other room that focuses on IV questions? Very informative. 

Just in case you're still trying.

Thank you! Yes, solely made my account to ask this question...no shame. Have a good day

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Junior specializes in Emergency RN.

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On 2/4/2020 at 5:18 AM, JKL33 said:

Is this a new issue that has cropped up long after reliable proficiency was obtained, or are you still kind of learning? Sometimes very proficient IV starters go through a little streak of weird misses.

Anyway, if it isn't working when you thought it was in, you just most likely don't have it where you think you do (that is, in the vein).

People get a "flash" all the time as they're nicking the vein or sailing right on through it.

I don't start at much of an angle at all. I see people starting at something like a 30-40++* angle and I never do that; it seems like a great way to puncture all the way through the vein. I don't know what my angle is, but ?10* maybe? If you laid the catheter set flat on the skin I would only tip it down enough to have the needle make skin contact (that isn't the process I use, but it's where I end up). The whole idea of starting at an angle isn't meant to be a big angle, "start at an angle" are just words to convey that the tip of the needle needs to make contact with the skin.

So start an a relatively flat angle. Make sure the vein is anchored. Keep your own non-dominant thumb out of the way. If you are going over your own thumb, good luck, it's probably too high an angle of approach. Anchor the skin/vein at a site distal enough to your insertion site so that your own hand/thumb isn't in your way.

You should puncture the skin and vein almost simultaneously. See your chamber filling up, not just a "flash." If your chamber is actively being filled, you only need to advance the needle a mm or so....or not at all. (This part depends on personal technique and how far you went in with your initial puncture). Then...make sure you're flat and slide the cateter without pushing the needle at the same time (many people don't realize they are doing this).

I think the overall problem is people have been misinstructed or else never really understood what is meant by "flash." It isn't a little speck of blood. If your chamber isn't filling up you aren't in your final position yet.

I consider this a new issue after reliable proficiency. I was doing fine, just going about my days as an ER RN and then "bam," now I think I am on a weird streak. I also am trying not to overthink it,or become timid because I know that a lot of medical professionals go through streaks.  I will try and take into consideration everything you said! Thank you. I have been taking more time to make sure the chamber is filling and not rushing, that has helped. I will make myself more aware of my angle and see if I have been going in too steep. Thank you so much!! 

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TeeJaazi84 has 9 years experience as a BSN and specializes in Trauma/ER.

20 Posts; 1,248 Profile Views

Arghhhhh...I HATE the BD Autoguard catheters! I bet it’s not just you. I’ve worked with the Smith catheters and am very proficient and experienced when it comes to IVs( on the IV specialty team throughout the hospital). We just switched to these and I’ve never struggled to thread and maneuver so much with an IV ever. I absolutely hate them. I suppose it’s just going to take a minute to change/perfect time technique with the new catheters. It’s prob just going to take some getting used to on your end! 

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