Worrying about an IV start...please help?

[blirajel]

Hello everyone,

I am a student nurse and the other day I was putting in an IV with a licensed nurse monitoring. The initial site I had chosen for the IV was somewhere along the forearm, but the nurse pointed out one of the hand veins instead (think it was the dorsal metacarpal between the bones to the ring and pinkie finger), so I went with that. Anyway, I found out later that the patient was experiencing some pain and compromised movement there; one of the other nurses thought I may have hit a nerve. Despite reassurances, I am still worried that my patient will have some kind of long-term pain from this; the hand is not my first choice for an IV start. Is this something I should be concerned about? I'm sorry if this is a silly question; I'm comfortable with IVs but this is really keeping me up tonight.

[jammin246RN]

Hey I have been in your shoes. lol. Most likely what has happened is you went through a valve. This isn't serious, but it can cause the patient some discomfort. Trust me if you had hit a nerve you would have known.... The pt would have been levitating lol. If the IV flushed and you got blood, you have a good iv, it just could be uncomfortable. Some tips on IVs for ya: Fore arm usually hurts less. Try putting a bp cuff on instead of a turniquet, and inflate it to 100. It covers more area and allows you to fine tune the pressure. The key is to get the pressure between their sbp and dbp. This way the blood can flow into the arm but can't flow out. It helps expand the veins. Also tack the vein down by holding a little pressure on the vein and pulling back toward the hand. This can help to avoid rolling veins. Remember a vein that you can feel is worth 2 you can see. And a vein you can see and feel is awesome! Sometimes it helps to scrub the area vigorously with an alcohol pad to help the vein pop up. Always bring 2 IV catheters into the room (its good luck... and if you miss the first time you have a back up), and place a chux or towel under their arm when starting an IV....sometimes it can get messy.

Best of luck!

[gettingbsn2msn, MSN, RN]

I have actually preferred the hand for iv's. I have great veins in both my hands and they are really easy to hit. When I was in the ER I had a brand new nurse. I could tell she was nervous and I told her to try my hand. She got the vein. However, if the patient is receiving meds that have a low ph the arm is a better choice. So it matters most what the patient will be receiving. Vancomycin is an absolute no no for the hands! Anyway, good luck, it does get easier.

[danh3190]

I don't think you caused any damage to the patient although hand veins can be uncomfortable.

I find hand IVs easier to start but I don't like them because they don't seem to last as long as the forearm veins. The important thing for me is to have a straight section of vein with no valves. The previous poster had good advice on starting IVs.

[MouseMichelle]

If you hit his nerve he would've jumped thru the roof, it's alright....

Mouse.

[herowneulogy, BSN, RN]

Wow, my school and the hospitals I preceptored at/or did my clinicals with, had a strict policy on procedures like this. Students were not allowed to do any sort of venipuncture, only setting up IVs/priming and actually starting the infusion.

Your school is fortunate. I would love a chance to know the feeling of a needle inserting into flesh!