veinipuncture tips ?

[HelpPleaseMD]

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Are there any tips on sticking veins you cannot see or feel or any tips in general? My success rate for the elderly / obese / chemo patients is in the 30%. I do have a crappy sense of appreciation of veins by touch.

 

[mimelim]

Ultrasound. Why you wouldn't use it, if it is available, on a hard stick is beyond my imagination.

 

[Vigil]

I can usually blind stick a 20G in between the middle and ring finger between the proximal phalanxes with good consistency and accuracy, even in dehydrated patients. Cephalic vein near the [edit] lateral wrist is good too. Try applying a warm/damp cloth for 5 minutes to help distend them.

 

[sylvanthus]

When in doubt, look at the feet.

 

[joeDO2]

all of the previous posters have good advice. ultrasound is a hugely valuable tool but since you're asking this question I'm guessing you do not have access to it. I like to hang the arm down off the side of the bed/stretcher for a few minutes to start. Its also important that you keep the patient warm since hospitals tend to be quite chilly. Some nice blankets from the warmer over the entire body and possibly a heat pack at the site you're looking at will do the trick. To maximize the appearance of the veins you can even have them squeeze a tension ball a few times. At this point you will at least be able to feel a vein on most people somewhere. Sometimes you have to look in atypical spots...back of the arm, all around the hand/thumb/wrist. The three most common locations I find a vein are top of the hand, lateral wrist, and AC space. The nurses like it if you start distally and work your way up. Some facilities discourage the use of foot veins but that can also be an alternative for a very difficult stick but at that point you should probably be finding someone with an ultrasound anyway.

 

[DrSnips]

I can usually blind stick a 20G in between the middle and ring finger between the proximal phalanxes with good consistency and accuracy, even in dehydrated patients. Cephalic vein near the medial wrist is good too. Try applying a warm/damp cloth for 5 minutes to help distend them.

The cephalic vein runs lateral, not medial. And yes, it is a fairly easy stick.
The main thing is getting good at feeling veins, which have a spongier feel than the surrounding tissue. This is hard to feel through gloves, so if you see a patient with no obvious veins, try feeling for a vein before putting your gloves on.

 

[joeDO2]

I can usually blind stick a 20G in between the middle and ring finger between the proximal phalanxes with good consistency and accuracy, even in dehydrated patients. Cephalic vein near the medial wrist is good too. Try applying a warm/damp cloth for 5 minutes to help distend them.

I also respectfully disagree with "blind sticking" a 20G in between the fingers. Sounds like an awfully painful and unnecessary technique.

 

[Vigil]

The cephalic vein runs lateral, not medial. And yes, it is a fairly easy stick.
The main thing is getting good at feeling veins, which have a spongier feel than the surrounding tissue. This is hard to feel through gloves, so if you see a patient with no obvious veins, try feeling for a vein before putting your gloves on.

oops! good catch.

 

[mmmcdowe]

Don't be afraid that you are hurting the patient. I've talked myself out of venipuncture sites because the patient was in pain and I wasn't confident, only to have the intern roll by and hit the exact vein that I thought I might be seeing.

 

[Bancrofti]

This might seem like simple advice or even common sense, but I found it extremely helpful to palpate for veins without a glove before I made my decision for the stick location. I would then sterilize afterwards of course. I believe when I had first learned I was instructed to do everything with gloves on so that definitely helped for me.

 

[alpinism]

Adding to everyone else's advice.

Some tips and tricks I learned as a flight medic:

1) When you clean the IV site w/ an alcohol prep try to push down abit harder than you think you should (rub the area vigorously) b/c this helps irritate the vein causing it to stand up more. It also causes less sensitivity in the area so you can insert your IV slower and increase your chance for success while causing less pain.
2) Inflate a BP cuff to the Pt's DBP or a tad above and let their arm dangle below the level of the heart while you prep your equipment. After about 30-60sec the veins will start to pop up.
3) Dim the lights and use a flashlight against the skin to help visualize veins.
4) The veins are there, they always are. Learn to feel for them every time you see a pt.
5) Start lower than a 45 degree angle because most peoples viens are very close to the surface. I usually go in at about 30 degrees or lower.
6) Always keep the skin taught.
7) Pierce the skin fast, then advance slowly.
8) Once you get a flash, drop your angle to near parallel so you don't poke through and blow the vein, then insert the needle just a bit more and thread the cath.
9) If you're not sure whether or not you're running fluid into the pts vein or into their arm you can occlude the vein several inches above the hub of the catheter. If the IV stops flowing you're in the vein.
10) Keep your cool even if you miss, don't let the pt see ya sweat. It happens to everyone all the time even after many years of practice.

Another Tip:
- Get a styrofoam coffee cup and tape pieces of cut up drinking straws around the inside wall to act as a makeshift arm and vein. Grab a 20g and practice sticking the straws through the outside of the cup. Great way to practice in between seeing pts.

Best advice is to practice, practice, practice every chance you get. Find as many hypotensive, dehydrated, skinny 80 y.o. grannies as you can and stick away!

 

[45408]

Ultrasound. Why you wouldn't use it, if it is available, on a hard stick is beyond my imagination.

This. The nurses pretty much always place IVs here, but I use an U/S for art lines all the time when a patient is hypotensive and edematous.

When in doubt, look at the feet.

Yep. Just go anterior to the medial malleolus for the GSV:

 

[HelpPleaseMD]

thanks! luv sdn