Need some IV tips

[han14tra]

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I'm a 4th year going into EM. I've been going over to the ED with the techs and practicing IVs/blood draws. I want to get 50 successful ones before I graduate. It is not going so well. I go into the right spot, but I can't get a flash with the 22 g butterfly in the antecubital. So, they take over. They just re-direct it a bit, and they get a flash. I can see the vein just fine and enter at the right spot. I just think my problem is that I have no depth perception. I either go too deep or not deep enough. Any tips?

 

[illegallysmooth]

If you can see and feel a good vein, and you are sticking in the right spot but not getting a flash, check your angle. You should be going in pretty shallow, then you know you hit the right depth when you see the flash.

http://theemtspot.com/2009/08/04/six-techniques-to-nail-the-iv-every-time/

This has some tips.

 

[Rendar5]

don't go by look, go by feel. other than seeing the flash, your eyes should be doing absolutely nothing

 

[deleted109597]

"Get better nurses"
"Don't do residency in NYC"


Also, keep practicing. However, barring going to some likely hellhole residency, you'll put far fewer than 50 IVs in during residency.

 

[EM2BE]

"Get better nurses"
"Don't do residency in NYC"


Also, keep practicing. However, barring going to some likely hellhole residency, you'll put far fewer than 50 IVs in during residency.

And usually under ultrasound if the nurses can't get it.

 

[pianoman511]

My general flow chart:

Nurse can't get it -> U/S guided peripheral -> EJ -> Do I really need a line ? -> Central line

 

[WildMed16]

Do an anesthesia month.

Try hand veins. Look at veins that com together like an upside down Y. Shoot for the junction point. Those are the easiest to hit.

Once you get the feel for the depth, start trying the ACs again.

 

[Dr Terrier MD]

Rendar5 is exactly right, you should always rely on feeling the vein, not seeing it. Just because you see a vein, doesn't mean it's the best one to stick. Your angle should be about 10 degrees, like illegallysmooth pointed out. If you don't get the flash, just pull back a little and feel where the vein is in relation to the needle, then readjust. Honestly, it just takes practice to get good. And I think getting good at doing IVs is probably more helpful than just plain blood draws, but it's good to know how to do both. Good luck!

 

[Birdstrike]

I'm a 4th year going into EM. I've been going over to the ED with the techs and practicing IVs/blood draws. I want to get 50 successful ones before I graduate. It is not going so well. I go into the right spot, but I can't get a flash with the 22 g butterfly in the antecubital. So, they take over. They just re-direct it a bit, and they get a flash. I can see the vein just fine and enter at the right spot. I just think my problem is that I have no depth perception. I either go too deep or not deep enough. Any tips?

The key to any procedure, from IVs up to surgery, is the same.

Numbers. After so many, it just clicks, like riding a bike.

Don't get frustrated. Just keep doing them.

 

[Colbert]

My general flow chart:

Nurse can't get it -> U/S guided peripheral -> EJ -> Do I really need a line ? -> Central line

I also throw in the IO before central line if I really need the access. They're more comfortable than a central line in the awake patient (from what they tell me), you just really need to prepare the patient for you pulling out a power tool.

 

[han14tra]

Thanks for all the advice. I went back to the ED tonight. They had 10 patients who needed IVs. I did 9 successfully. I even placed one on an attending surgeon (talk about working under pressure.)

 

[Birdstrike]

Thanks for all the advice. I went back to the ED tonight. They had 10 patients who needed IVs. I did 9 successfully. I even placed one on an attending surgeon (talk about working under pressure.)

Good job, man.

 

[KeyzerSoze]

My general flow chart:

Nurse can't get it -> U/S guided peripheral -> EJ -> Do I really need a line ? -> Central line

I interviewed at a program where the nurses do U/S guided peripheral IVs, but from what they said it sounded like that's pretty uncommon.

 

[Dane07MD]

Some of our nurses are trained to do U/S lines. They are only allowed to go after peripheral superficial veins with it. Can't be deep brachs or EJs without the hands of an MD. It's definitely handy when I'm busy and don't have much time for a US line.

 

[combatwombat]

I'm a 4th year going into EM. I've been going over to the ED with the techs and practicing IVs/blood draws. I want to get 50 successful ones before I graduate. It is not going so well. I go into the right spot, but I can't get a flash with the 22 g butterfly in the antecubital. So, they take over. They just re-direct it a bit, and they get a flash. I can see the vein just fine and enter at the right spot. I just think my problem is that I have no depth perception. I either go too deep or not deep enough. Any tips?

Easy. On your way home from work tomorrow, grab a handful of 1 cc syringes and a tourniquet. Then, go down to your local drug dealer and buy a few bundles of sweet lady H. Spend the next few months smacking your bitch up, and before you know it you'll be a zen master of finding veins.

Either that or just keep practicing 🙂

 

[AlmostJesus]

A few things that I have always used (many covered in the 6 tips posts)
1. A well anchored IV attempt will have a much higher chance of success.
2. If you are starting a line in the AC, aim low, feel where the vein tracks below where you see it in the fossa and poke about a fingerwidth below it.
3. IV catheter bending - I learned it from anesthesia - if you have the BD Insyte catheters, when you remove the cap, use the inside of the cap to bend the needle slightly. This allows a more shallow angle and a more direct approach, especially on AC and EJ IVs.
http://www.youtube.com/watch?feature=player_embedded&v=0LT47_R5r_M
This video shows what I am talking about, for regular veins, I bend it only slightly, but I feel like it makes a difference.
4. If you are having trouble finding veins in fat people, grab a blood pressure cuff, inflate it to half way between their diastolic and systolic blood pressure and use that as the tourniquet. Oftentimes the regular tourniquets just dont work well on fat people.
5. Find your sweet spot - Over time, you find a spot that works really well for you when you start IVs, that is always the first place I look. I always look at the top of the hand first, then the forearms, radial, then the AC (selection varies based on ease of placement and timeframe the line is needed in).
6. Practice makes perfect. Go to a place like ambulatory surgery where they are doing a ton of IVs every day and get some practice there. Otherwise talk to some paramedics, paramedics are IV fanatics and oftentimes have very good skills due to the volume that they place in the field.