As a new nurse, I struggled with the more hands on type of nursing. IVs were one of those struggles. Over the years, I learned tricks from more experienced nurses than myself. By the time I left the floor, I loved to start IVs. It's one of the things I miss about the bedside.
1. Use your Hands, Not your Eyes
This was the very first trick I learned. Your hands are much more adept at finding a good vein than your eyes. Sometimes veins that look juicy under the skin, aren't palpable with your fingers. These tend to be easy to blow or miss entirely. Veins should feel spongy. Sometimes you will not be able to see the best veins. It takes time, patience, and practice to learn which ones are the best to try.
2. Tag Team
Get you a nursing "mom", a more experienced nurse than you who can help you to learn good technique. If you are struggling with your IV game, watch other people who are "good sticks" and implement some of their technique. A fellow nurse could also watch and give constructive criticism after you've attempted, hand you supplies, or help calm an anxious or confused patient.
3. Go in almost flush to the skin
One of the most common mistakes is going in at a steep angle. You should barely have any angle at all when you're placing an IV. Deeper veins will require deeper angles, but still do not require any deep diving.
4. Warm it up
It's tougher to find a vein when your patient is cold. If you're luck enough to have warming blankets, then by all means use a heated blanket. I did not have that luxury, but hot water in a glove for a few minutes does the trick if you have a vein that is not quite popping enough to stick.
5. Gravity, Make a Fist, Flicking
Having the patient to hang his or her arm off the bed will help to improve blood flow to the area. Another similar technique is to have the patient make a fist or open and close their hand. Flicking the vein releases histamine causing vein dilation, butno need to flick super hard!
6. Minimize Distractions
It's not easy to do your job when people are crowding around you especially in high stress situations. It's not rude to turn off the TV and ask for family to step out so that you can concentrate. Every now and then you will have Aunt Carol who takes offense, but most people will understand if you explain why you are asking them to step out. After a while, it won't matter what's going on in the room. You'll be able to do it in your sleep.
7. Choose the Right Catheter Size
In general, for Med-Surg nursing we worked with 20g, 22g, and 24g needles. Every now and then, we would see, but rarely place an 18g. You would think a smaller catheter would be easy to place. However, I find that 24g are so flimsy it makes insertion difficult. Reserve those for the toughest sticks. 22g needles may be your best bet when you are starting out. They can withstand PRN meds and fluids. However, 20g or bigger, is best as these are required for certain tests and are more stable, but they also require a vein big enough to hold them.
8. Stretch Out the Wiggly Ones
If I suspect rolling veins, I ask the patient if that was an issue in the past. You should always stabilize the vein with your opposite hand, but be especially firm with veins that you suspect may roll.
9. Stop when you see flashback and advanced the catheter
When you see flashback in the chamber, stop, and pull back the needle while you thread the catheter. It takes time to learn the technique and this is the most frustrating time to mess up!
10 Placement
For inpatient nursing, forearms are your best friends unless you suspect you'll need an AC vein for a CTA. Look at the non-dominant arm first (this is strictly for the patient). If you've never had an IV personally, let me tell you they're annoying. Make sure there are no restrictions on which arm to use. Some patients will have an AV fistula placed in one arm, lymphoedema, or have various other reasons that make one extremity unsuitable. Wrist, hands, and even thumbs sometimes have suitable veins, but the placement is awkward, the insertion can be more uncomfortable for the patient, and they don't tend to last long. Nurses tend to overlook the upper arms, but frequently there are good veins here and these do tend to last. If you need to place an IV somewhere other than the upper extremities, make sure your policy allows this without an order.
It's important to stay calm, have confidence in yourself, take your time, and get plenty of practice. It's best to do your practicing in non-emergent situations, of course. The more you stick, the better you'll get. No one hits every single vein they go for. If you can't successfully get an IV placement, call on an experienced nurse, the IV team, or inform the doctor. Some patients end up needing alternate access because they are such hard sticks. Eventually, you'll become the experienced nurse the others call on!
1. Use your Hands, Not your Eyes
This was the very first trick I learned. Your hands are much more adept at finding a good vein than your eyes. Sometimes veins that look juicy under the skin, aren't palpable with your fingers. These tend to be easy to blow or miss entirely. Veins should feel spongy. Sometimes you will not be able to see the best veins. It takes time, patience, and practice to learn which ones are the best to try.
2. Tag Team
Get you a nursing "mom", a more experienced nurse than you who can help you to learn good technique. If you are struggling with your IV game, watch other people who are "good sticks" and implement some of their technique. A fellow nurse could also watch and give constructive criticism after you've attempted, hand you supplies, or help calm an anxious or confused patient.
3. Go in almost flush to the skin
One of the most common mistakes is going in at a steep angle. You should barely have any angle at all when you're placing an IV. Deeper veins will require deeper angles, but still do not require any deep diving.
4. Warm it up
It's tougher to find a vein when your patient is cold. If you're luck enough to have warming blankets, then by all means use a heated blanket. I did not have that luxury, but hot water in a glove for a few minutes does the trick if you have a vein that is not quite popping enough to stick.
5. Gravity, Make a Fist, Flicking
Having the patient to hang his or her arm off the bed will help to improve blood flow to the area. Another similar technique is to have the patient make a fist or open and close their hand. Flicking the vein releases histamine causing vein dilation, butno need to flick super hard!
6. Minimize Distractions
It's not easy to do your job when people are crowding around you especially in high stress situations. It's not rude to turn off the TV and ask for family to step out so that you can concentrate. Every now and then you will have Aunt Carol who takes offense, but most people will understand if you explain why you are asking them to step out. After a while, it won't matter what's going on in the room. You'll be able to do it in your sleep.
7. Choose the Right Catheter Size
In general, for Med-Surg nursing we worked with 20g, 22g, and 24g needles. Every now and then, we would see, but rarely place an 18g. You would think a smaller catheter would be easy to place. However, I find that 24g are so flimsy it makes insertion difficult. Reserve those for the toughest sticks. 22g needles may be your best bet when you are starting out. They can withstand PRN meds and fluids. However, 20g or bigger, is best as these are required for certain tests and are more stable, but they also require a vein big enough to hold them.
8. Stretch Out the Wiggly Ones
If I suspect rolling veins, I ask the patient if that was an issue in the past. You should always stabilize the vein with your opposite hand, but be especially firm with veins that you suspect may roll.
9. Stop when you see flashback and advanced the catheter
When you see flashback in the chamber, stop, and pull back the needle while you thread the catheter. It takes time to learn the technique and this is the most frustrating time to mess up!
10 Placement
For inpatient nursing, forearms are your best friends unless you suspect you'll need an AC vein for a CTA. Look at the non-dominant arm first (this is strictly for the patient). If you've never had an IV personally, let me tell you they're annoying. Make sure there are no restrictions on which arm to use. Some patients will have an AV fistula placed in one arm, lymphoedema, or have various other reasons that make one extremity unsuitable. Wrist, hands, and even thumbs sometimes have suitable veins, but the placement is awkward, the insertion can be more uncomfortable for the patient, and they don't tend to last long. Nurses tend to overlook the upper arms, but frequently there are good veins here and these do tend to last. If you need to place an IV somewhere other than the upper extremities, make sure your policy allows this without an order.
It's important to stay calm, have confidence in yourself, take your time, and get plenty of practice. It's best to do your practicing in non-emergent situations, of course. The more you stick, the better you'll get. No one hits every single vein they go for. If you can't successfully get an IV placement, call on an experienced nurse, the IV team, or inform the doctor. Some patients end up needing alternate access because they are such hard sticks. Eventually, you'll become the experienced nurse the others call on!
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