IV Advice?

[EMSrush]

I didn't want to ask this question, but figured I have nothing to lose...

I consider myself to be pretty good at starting IV's... EXCEPT IV's in the hand. I have asked my preceptors and co-workers for feedback, and upon observing me, they have produced little in the way of suggestions. I have heard that hand IV's are the easiest, but for me, they're definitely not. :blush: I have no trouble finding the vein, but it almost always blows on me, which I find immensely frustrating. It's never a surprise; the catheter usually gets stuck before the blow.

Is there anything that anyone can think of that helped them or made IV insertion easier?

 

[mgr22]

Try having the patients flex their hands a bit, or close their fists to make veins more taut. Also, try starting a little to the side of the veins, or distal to the veins, instead of on top of the veins.

Are you getting flashback before the catheter "gets stuck?" If so, you might need to insert the needle a little further before trying to advance the catheter. If you get brief flashback, then it stops, it could mean you went through the other side of the vein, or you pulled the needle out of the vein before you advanced the catheter.

 

[8jimi8]

You don't need people to flex their hands or pump their fists. Put your nondominant fingers into their hand and grab their middle and index fingers with your thumb, pronate your thumb - flexing their hand for them. You can then use your thumb to make their skin more taut/ anchor the veins. As the above poster said, advance your needle furher before advancing the cath.

 

[mgr22]

You don't need people to flex their hands or pump their fists. Put your nondominant fingers into their hand and grab their middle and index fingers with your thumb, pronate your thumb - flexing their hand for them. You can then use your thumb to make their skin more taut/ anchor the veins. As the above poster said, advance your needle furher before advancing the cath.

I think you misunderstood. I'm not suggesting any repetitive motion of hands or fists. Just flexing the hand or closing the fist and leaving it that way is one way of making the skin more taut and stabilizing the vein. Your approach works, too.

 

[EMSrush]

Hey, anything is worth a shot. Yes, I will usually get a good flash, drop and advance, and after I've advanced the catheter about 1/3 of the way, it will get stuck. I hate it, because I know by then what will usually come next. :sad:

Maybe I'm releasing my traction early without realizing it..?

I have had people (co-workers) tell me that I've hit a valve, but really, how many "valves" can you hit before you start looking at the operator, instead of the vein...?

 

[8jimi8]

Ya, sorry misinterpreted your op

 

[8jimi8]

Hey, anything is worth a shot. Yes, I will usually get a good flash, drop and advance, and after I've advanced the catheter about 1/3 of the way, it will get stuck. I hate it, because I know by then what will usually come next. :sad:

Maybe I'm releasing my traction early without realizing it..?

I have had people (co-workers) tell me that I've hit a valve, but really, how many "valves" can you hit before you start looking at the operator, instead of the vein...?

What you are describing sounds like hitting a valve: back up your cath array, pull your needle. Attach a 10cc flush and advance the catheter as you gently flush. If you haven't buried the needle in the valve it should float right in. They called it "floating the cath," when they taught me. As a bonus, you'll REALLY be able to tell if you blew the vein!

 

[EMSrush]

What you are describing sounds like hitting a valve: back up your cath array, pull your needle. Attach a 10cc flush and advance the catheter as you gently flush. If you haven't buried the needle in the valve it should float right in. They called it "floating the cath," when they taught me. As a bonus, you'll REALLY be able to tell if you blew the vein!

Are you saying to attach the flush directly to the hub?

 

[8jimi8]

Are you saying to attach the flush directly to the hub?

It'll be easier to flush and advance if you attach your flush to a saline lock extension and then flush and advance. Don't forget you can also very easily see valves through the skin and also take note that a valve usually occurs close to bifurcations of the vessels

 

[EMSrush]

It'll be easier to flush and advance if you attach your flush to a saline lock extension and then flush and advance. Don't forget you can also very easily see valves through the skin and also take note that a valve usually occurs close to bifurcations of the vessels

I try to stay clear away from bifurcations for that very reason. How often would you say floating is successful in salvaging an IV for you?

 

[8jimi8]

I try to stay clear away from bifurcations for that very reason. How often would you say floating is successful in salvaging an IV for you?

I wouldn't try it on a critical patient. Prob less than 50% an as I implied, I only do that when I have plenty of time to go slow.

 

[EMSrush]

Noted. Thank you. I'll give it a whirl...