A couple of days ago a reader asked me for some tips on IV insertion, unfortunately I was in the middle of a three day stretch and I wasn't able to get a post up in time. It got me thinking though and I began going over all the things that I have learned in the last few months that have made putting in an IV much easier for me.
So here is what I could think of, I hope it helps.
I know every instructor has said this and it makes about zero sense, but trust me, this is one time in nursing that your eyes can lie to you. It makes sense that every new nurse (and even some seasoned ones) will go for an easily visible vein, but often these veins are very close to the surface and will blow easily, deeper veins are often stronger, less fragile veins.
Palpate veins with your fingers tips and feel around for a springy feeling vein. It will feel vaguely like pressing down on an under inflated balloon, it will "bounce" a little under your fingers. Avoid "mushy" or soft feeling veins, these can be more delicate and blow easier. Select the largest vein you can find, they are way harder to miss, you can use a nice large catheter and they are less likely to "go bad". No point in putting in an IV that only lasts a few hours.
Once you have a found a nice big, bouncy vein follow it up about an inch or two and make sure it feels pretty much the same all the way up. A hardened area can indicate a valve or sclerotic area that will not allow the catheter to advance. If you find one of these area's be patient and follow the vein further up or down until you find a nice stretch of clean vein.
Now that you found that vein, anchor that sucker! You went through all the time to find it now make sure it doesn't run away when you try to poke it. I hear a lot of people say that a patient has veins that roll, all veins do roll to a certain extent so hold em down!
Everyone does it a little differently
For really roll-y veins try stabilizing
between two fingers.
Spread your fingers wide and hold the skin
Anchor the base of the vein close to your puncture site.
Apply pressure and pull your thumb towards yourself
pulling the skin taut
The key to anchoring a vein is to apply pressure, so don't be shy about pushing down on your patient and to pull their skin nice and tight. Apologize and let them know the discomfort will only be for a few seconds, it's a way better option than having to poke them a second time.
Don't go deep!
It's tempting to puncture the vein at a 30 to 45 degree angle, especially if you have drawn blood a lot, then drop your angle and attempt to advance the catheter, don't do it! Going in on a steeper angle than 15 or 20 degrees increases your chance of going straight through the vein, and I find that when I drop my angle after a flash I flub the insertion almost 50% of the time.
An IV nurse I work with gave me these tips, go in at an angle that is only slightly steeper than parallel with the vein and then check for your flash. If you don't have one advance slightly at a slightly steeper angle. As she put it veins aren't that deep and your aren't drilling for oil.
Don't be shy
OK so you got a great flash, but as you advanced the catheter you lose it. Sound familiar? It happened to me over an over again until my friend the IV Nurse commented that I am "bashful" in threading the catheter.
What she meant is that when I was advancing the catheter I would do so slowly because I was worried about losing my IV. Problem was that my caution was what was causing me to lose my IV sticks. She reminded me that advancing a catheter quickly would not cause any damage.
What I learned to do it insert the IV and check for a flash,
then wait and see how well the flash chamber is filling.
When I see that the chamber is nearly full,
I am sure the IV is in the vein.
Now in one smooth quick motion I advance the catheter.
I know it sounds way too simple but honestly it has worked like a charm every time. Oh yes and don't worry, if there is a valve or sclerotic area that you did not find prior to inserting the catheter won't advance, promise.
If you don't get it the first, second or even third time
Don't beat yourself up about it,
stop and think about what you learned from the experience.
Then let it go.
none of us were born with these skills.
We all have had to learn them
YOU WILL TOO!