IV Help

Panacea Financial Contract Review
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Iso4ane

Iso4ane

Full Member
Verified Member
15+ Year Member
Joined
Nov 30, 2009
Messages
1,962
Reaction score
2,122
To put it mildly, I currently suck at placing IVs. Getting a flash is rarely an issue, it's everything after that, either I have trouble threading the catheter, back wall the needle and blow the vein, or even the times I do get it in, it looks like a blood bath. I figure repetition is key, but any advice so I can get competent, and keep things clean, a little faster? Thanks
Members don't see this ad.
 
0kazak1 said:
To put it mildly, I currently suck at placing IVs. Getting a flash is rarely an issue, it's everything after that, either I have trouble threading the catheter, back wall the needle and blow the vein, or even the times I do get it in, it looks like a blood bath. I figure repetition is key, but any advice so I can get competent, and keep things clean, a little faster? Thanks
Click to expand...

Over the years, I recall seeing some people that would advance the entire apparatus (to the hub) into the vein before withdrawing the needle. I would not recommend doing such, but only use this to illustrate the point that even upon getting a flash you can safely advance a fair amount before threading the catheter. More often than not, the IV is missed due to "premature catheter advancement." Just something to visualize.
 
Members don't see this ad :)
Go in as flat as possible and stay as flat as possible when you advance after getting flash. Often times I will even lift up (while keeping the needle pretty flat) so that the needle is riding right under the anterior vessel wall to prevent back-walling. Try to place an IV where the vein "Y's" and go in flat straight through the crotch of the Y. Pretty hard to back-wall it that way.
 
The same way you get to Carnegie Hall: practice.
 
Consigliere said:
The same way you get to Carnegie Hall: practice.
Click to expand...

1470174.png
 
This thread is an innuendo gold mine.

Advance the entire apparatus (to the hub)
Premature catheter advancement
Go in as flat as possible
Often times I will even lift up
Go in flat straight through the crotch

A lot of good advice here that is applicable in other areas outside of just IV placement.
 
Most people I teach miss due to lack of stability. They get in fine, then either go too deep, or back out before finishing.
You sound like one of those people.
Once you get in, stop. Anchor yourself with your ring and pinky finger, dont move and breath. Then, and only once anchored, slip it in just a hair further. Then use your index finger to advance until it is fully in.
When you withdraw, first use your other thumb to block the very tip, not in the middle, or it will spurt all over because it is too hard to compress the middle of the shaft.

You should achieve satisfaction doing these things.


Sent from my iPad using SDN mobile app
 
pjl said:
Most people I teach miss due to lack of stability. They get in fine, then either go too deep, or back out before finishing.
You sound like one of those people.
Once you get in, stop. Anchor yourself with your ring and pinky finger, dont move and breath. Then, and only once anchored, slip it in just a hair further. Then use your index finger to advance until it is fully in.
When you withdraw, first use your other thumb to block the very tip, not in the middle, or it will spurt all over because it is too hard to compress the middle of the shaft.

You should achieve satisfaction doing doing these things.


Sent from my iPad using SDN mobile app
Click to expand...


well said

you should write a book or perhaps create a series of adult videos with these tips
 
pjl said:
Most people I teach miss due to lack of stability. They get in fine, then either go too deep, or back out before finishing.
You sound like one of those people.
Once you get in, stop. Anchor yourself with your ring and pinky finger, dont move and breath. Then, and only once anchored, slip it in just a hair further. Then use your index finger to advance until it is fully in.
When you withdraw, first use your other thumb to block the very tip, not in the middle, or it will spurt all over because it is too hard to compress the middle of the shaft.

You should achieve satisfaction doing these things.


Sent from my iPad using SDN mobile app
Click to expand...

That was hot.

You forgot to mention the cigarette at the end.
 
I agree that most missed IVs are due to premature catheter advancement. If the needle is in the vein but the catheter is not (which is the case when you immediately get the flash of blood) attempts to advance the catheter will only push the vein off of the needle, and you will have a blown vein. The bigger the IV gauge, the more you have to advance the full apparatus into the vein before you push the catheter off of the needle.

Another trick I learned was to make skin puncture just lateral to where you want to enter the vein. I do this because when I was learning to put IVs in, I would often get a blown vein when I tried to go straight into the vein by entering the skin directly on top of the vein because that is when the patient is most likely to move. If you enter the vein and the patient moves due to the pain of skin puncture, you really have to be seasoned at stabilizing everything to not blow it. Might not be a big deal for most, but i had issues with that so I made an adjustment. By entering the skin just lateral to the vein, if your patient moves their hand or arm, you are highly unlikely to blow the vein. You can just wait for them to chill out, then angle your IV towards the vein and do your thing. Once I get flash, i straighten the apparatus out to be more parallel with the vein, advance, then thread the catheter. It works for me and it give you a chance to gather yourself after puncturing the skin if your patient is jumpy and or has elephant skin. Good luck!


Sent from my iPhone using SDN mobile
 
I think subconciously a lot of people use the tenting technique. You basically break skin and keep tenting your way as close to the surface as possible. Then when you're above the vein and in a spot you like you can push in a little bit and get your flash. Then you advance a little more and thread off the catheter.

Two other important things I learned:

1) Don't just poke blindly, either feel a good target or see a good target.

2) Go for it as if you're going to get it. Being timid tends to make you more jittery.
 
Members don't see this ad :)
Have everything you need with you. It's your first impression and having to walk back for stuff you forgot makes patients jumpier and more difficult. Act like you've been there before. Have them hold their hand off the bed below their heart. If they look at you funny, tell them "your veins get bigger the further below your heart they are and I don't want to poke you twice." Demonstrate this with your veins so they'll see you know what's up.

Flick it harder and more times than you think you should.

If you blow it, blame it on valves or scoliosis.
 
0kazak1 said:
To put it mildly, I currently suck at placing IVs. Getting a flash is rarely an issue, it's everything after that, either I have trouble threading the catheter, back wall the needle and blow the vein, or even the times I do get it in, it looks like a blood bath. I figure repetition is key, but any advice so I can get competent, and keep things clean, a little faster? Thanks
Click to expand...

Flash, ensure you're parallel with the course of the vein (this may require dropping your angle) advance 2mm, advance catheter. Great success. 60% of the time it works every time.
 
Practice in plane ultrasound guided IVs on asleep patients too. It can be very educational.
 
I have seen IVs placed a zillion different ways from all types of very experienced nurses and doctors. I don't know many who have started few IVs who are good. Repetition, repetition, and tweaking technique time after time will make you better. Don't stop poking.
 
My 2 cents, drop the patients bed and pull a chair up. Your brain can better focus on the fine motor movements of your hands when your back and legs are relaxed.
 
Its all about the vein you choose mate!

slap the tourniquet on early, hang their hand down and get em to fist pump,

Go putter around the room for 30 seconds until this has an affect...

Then chose the best vein. If theres nothing good on the back of one hand, look at other sites. Dont just take any crappy old vein. Take the easiset mate! insist on it

And best tip of all, is to puncture the skin at a Y point on a vein. Most people have one or two veins on the back of their hands that is long and stragght and then diverges on into digital veins like a Y shape. Go at the very top of the Y. There is some fibrotic tissue or something at the Y that holds that area of the vein in place so it doesnt move away from you.
Sit your ass down too.

But the most important thing is practice! ive done 5000 and just yersterday butchered an easy one 5 times!!

Also tell the patient that their veins look a bit flat today from fasting so it might be tricky. That way they are not so upset if it takes you a go or two. And delighted when you nail it first time!

Good luck
 
I agree in that the easiest ones are where the vein bifurcates. I always use the acronym FLAT when teaching people to do IV's. Fist, Lower arm and hand, Alcohol pad or Apply warm compress and Tap. These help expose and let you better visualize the vein. Enter as close to the skin as possible, basically tenting and when you get flash advance just a touch more and lower the IV and thread the catheter.

Hold the skin taut!! I've seen so many people blow it because they don't hold it taut enough. I do a lateral approach for veins that may roll as well. Get good at using an US after you nail your technique. Very helpful for the hefty patients.

Oh and if you missed pull the needle but leave the catheter in place so you don't have to worry about about bleeding and a hematoma and you can just go a bit more proximal. Then when you get a working one in you can remove it and put a dressing on it.


Sent from my iPhone using SDN mobile
 
Everybody under general could use a second iv so for a month toss in a second line on asleep patients. This will let you work on your technique while eliminating the other factors with an awake pt. Use lidocaine on awake patients....yeah it is two sticks but a tb needle is nothing.
 
My favorite trick is after I get my flash to lift the superficial wall of the vein with a little upward traction, then flatten and advance a relative amount depending on the size of IV. This opens veins more and gives you a longer traverse time while in the lumen. You will get less through and through misses and will feel more comfortable advancing before threading.
 
pgg said:
Hah, reminds me of an attending I had who was teaching me how to do art lines.

"Just feel the pulse ... and stick the needle ... right ... there. Where it's pulsing."
Click to expand...
I remember the one peds attending who wants you to mask and put the iv in with no help...."just stick it in the blue" and "you don't need a tourn-na-key" !!
 
a lot of times when I have to get an IV after someone failed, I find they don't spend enough time looking for a good vein. Drop the hand, flick the vein good, and if needed use a double tourniquet or the BP cuff. Engorge the vein as much as possible before attempting. I find it helpful in difficult patients.
 
Tee Cell said:
a lot of times when I have to get an IV after someone failed, I find they don't spend enough time looking for a good vein. Drop the hand, flick the vein good, and if needed use a double tourniquet or the BP cuff. Engorge the vein as much as possible before attempting. I find it helpful in difficult patients.
Click to expand...


Ultrasound makes vein finding a no brainer. It's so easy....
 
It's been touched on above, but preparation really goes far when doing PIVs. Make sure you're getting the fattest, straightest segment of vein you can find. Bifurcations are generally a good option, but you do need to (the only time this is probably legit) make sure you don't get stuck in a valve because they tend to be abundant proximal to bifurcations.

As far as traction goes, I like to just pull the skin (and vein) a bit taut with one to two fingers of my non dominant hand. Then when I'm ready to advance the catheter I can use those two fingers of the offhand to slide the catheter down, leaving my needle hand to keep everything steady.

One habit I got into was finding one spot that I really like, usually anterior forearm or posterior hand and I always start looking there. It gives a little consistency, but I try not to force it if there's nothing happening in those spots.

Lastly, just figure out what works best for you and do it that way every time. The specific technique isn't nearly as important, as long as you refine it and consistently use it. Good luck!
 
You must log in or register to reply here.

Similar threads

C
IV tylenol
Replies
42
Views
3K
ToKingdomCome
T
C
US IV question
2
Replies
63
Views
3K
medicine2wallstreet
M
I
Scalp IV for adults?
Replies
42
Views
4K
PpfSuxTube
P
K
Job Help
Replies
42
Views
2K
Dynamis
D
epidural man
IV start service
2
Replies
77
Views
5K
lunaire
lunaire
Top