PJ's brain unfiltered. Now with more pulp!

Tips for starting IV’s

My suggestions:

  • For your patients that are scared of needles, let them know ahead of time that the IV site won’t have a needle in it once you’re done. It’s just a plastic tube and won’t hurt.
  • Don’t stop progressing the needle once you get blood flashback. Pause perhaps, but don’t stop. You need to advance the Jelco a TINY bit further and THEN you are in the vein. Remember that the needle tip sticks out from Jelco — just because the needle is in the vein doesn’t mean that the surrounding catheter is. So when you get flashback, progress a pinch further.
  • If you have a geriatric patient with paper-thin skin, don’t feel required to use a tourniquet (and use a 20–no reason to poke a giant hole if they’re not bleeding out).
  • Just before you use your Jelco, give the hub a little twist while it’s still fastened to the plastic; this will keep it from sticking when you attempt to retract the needle.
  • If you do want to use a tourniquet on a paper-grandma, tie it loosely. Also, you can use two (of the rubber variety). Two tourniquets overlapping each other tends to keep it flat instead of becoming thin & narrow — biting into the patient’s skin.
  • Look at your AC’s. Notice that on one arm, you have one “AC” in the dead center, while on the opposite arm, the vein bifurcates and forks around the center. 99.9% of the time, if the patient’s AC is in the center on one arm, it’ll bifurcate on the other one. You can use this to your advantage when blind sticking.
  • Stick fast. Don’t “try to be gentle” when breaking the skin; it makes it hurt so much more. If you’re concerned about accuracy, stick to the side of the vein and then enter it at an angle.
  • I find that sticking pediatrics & geriatrics is easier when done from the side, whereas late teens & adults are better right over the vein.
  • Your alcohol swab can help you find those veins, particularly on people with dark skin. Always grab at least 2 and start searching.
  • When you’re in the back and the truck is moving, sometimes it helps to put your butt on the floor, brace yourself against the stretcher & the bench with your legs, and cradle the pt’s arm with your hand. It cuts down on the vibrations.
  • When setting up a bag of NS for a pt you’re about to give D50 to, attach the IV line and then lower the bag to a point below the patient’s heart so that the blood can flow back up the IV line. This lets you know that the access point hasn’t blown and the D50 won’t necrotize the tissue around the site.
  • Since you’re just starting out with your IV sticks, try to focus on getting your actual movements down right before you concern yourself with finding veins. Try to start your IV’s on scene or with the truck not moving. If you’re lucky and get to do ER clinical time, go there ASAP and spend a few hours focusing on IV sticks.
  • Place a few two-by-two gauze beneath the jelco right before you occlude and extract the needle. If some blood oozes out, the gauze catches it and you avoid a stain on your new boots. Also, just sticking a D-sheet or a towel beneath the patient’s extremity can work just as well, but only if you expect massive amounts of blood.
  • Extremely high blood pressure = hard to occlude veins. Expect a mess. This is when you want that towel.

Suggestions from SomethingAwful members that I agree with:

  • If your patient is non-critical, as in you aren’t trying to get a 14-gauge trauma line in an AC, try to be nice to people and go for veins in places that hurt less/are not as inconvenient as others. For instance, go for the forearms and AC instead of the hands. Hands hurt… a LOT.
  • Don’t leave the patient’s arm a bloody mess. It takes two seconds to clean up and it looks much more professional.
  • When your patient is diaphoretic, be sure to use a few extra pieces of tape. You do not want that line popping out because your patient sweated the adhesive off.
  • If you don’t see or feel good veins, be patient. It’s far better to spend an extra minute or so with the tourniquet up where sometimes the good veins reveal themselves after some time. Once you have the basic skill, finding and choosing an appropriate vein is the most important step, particularly for patients who are a difficult stick. Let the arm dangle and let gravity help you. Smacking/flicking the vein with your hand or finger helps make it stand out, as do rubbing alcohol, warm towels, etc. Choose an appropriate vein and make sure the cannula is the appropriate size for the vein.
  • If you only have a short distance of vein before it branches/curves or whatever, don’t be rigid about trying to put the cannula all the way in. If it looks like you can only thread half of a 1 and 1/4 inch catheter in before it hits a branching or becomes really tortuous, then only thread half the cannula in and tape it in that way, rather than blowing the vein trying to be “perfect”. This is especially important with pedi IVs and anyone who is a difficult stick. If the vein is nice long straight and big though, put that cannula all the way in.
  • Start BELOW where you want to end up. Which is to say that you see a good, straight area on a vein, start below that area and advance up into it. The entire catheter does not have to be in the vein, just the end of it.
  • When occluding, occlude PAST the tip of the catheter. Many new people try to occlude ON the catheter. The catheter is rigid — it is designed not to collapse. You will not collapse the catheter and you will just end up making a mess as blood spills down the patients arm.
  • If you know you are in the vein, and the catheter suddenly stops advancing, you may be up against a valve. Valves are one-way. DO NOT PUSH THROUGH THEM. Not only does it hurt like hell, but you will lose your line. Instead, try to “float” it in by either flushing it a small bit with a saline flush or with fluid from the bag. This MAY open the valve and allow you to gently guide it in.

5 responses

  1. Chad

    GOD how I wish you were the one doing my IV’s when I was in the hospital! I am a really hard stick, and when I had my stroke I became very dehydrated and it was even harder for them to stick me. The people who did mine did exactly the OPPOSITE of what you have posted above!

    3 December, 2007 at 16:08

  2. Sue Sloan

    A marvelous invention was used on me today: Veonscope 11 Transilluminator. It looks like a carpenster’s ‘stud finder’ and it worked on the first scan. This is the most humane way to start IV’s I have ever experienced. I threatened to buy one & carry with me! Found it online for $164.00….Not too bad for saving ‘hard-stick’ people. All hospitals should have one!

    15 January, 2008 at 23:57

  3. Unfortunately those aren’t really viable options in the back of an ambulance. :) And mind you, when it comes to gadgets — you get what you pay for!

    16 January, 2008 at 08:02

  4. Clayton L. Coker

    very good. even had some things id never think of. but i must say a one on one tutorial in the actual back of unit is far better!!!!

    18 March, 2013 at 16:56

  5. GailA

    Lord, I wish you were the one doing my IV this last ER visit, usually I am not a hard stick unless dehydrated. They blew 4 almost 5 veins, by using to large catheters, 4 times the size of my small veins. I really need a child’s set up for IV’s. Now I have ruined veins and bruises for weeks to come. LEARN TO GAUGE THE SIZE of your patients veins, if they look small they usually are, go for the smallest catheter possible. Less trouble with insert and pain afterward. I’d had a Upper GI and a Facet block and neither one of those IV’s were a issue. ONE SIZE DOES NOT FIT ALL!

    25 October, 2013 at 04:38

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