Hey all! I’m a nursing student about to graduate in May. One skill that I still don’t feel 100% on is my IV starts. I usually always get flash back and know that I hit the vein. My problem comes when I try to advance the catheter into the vein I always seem to blow the vein. What advise, tips or tricks do you guys have with IV starts? Any advise is appreciated!
Look at your IV needle/cath. The needle sticks out a little bit (mm) past the start of the plastic cath. You will get a “flash” when the metal needle enters the vein, but that does not mean that the plastic cath is in the vein yet, so once you get the flash, advance it a little bit more to make sure the cath is in the vein also.
You could also be coming at the vein at too steep of an angle. If you are coming straight down on it, when you try to advance the cath off of the needle, it will just hit the back wall and will not be able to bend enough to go up the vein. You may try to come at the vein at a more shallow angle.
If you KNOW you are in the vein because it is bleeding out of the cath when you remove the needle, but you can’t advance the cath, you can try “floating it in.” Put a saline flush help locked syringe on the cath and gently push in the saline as you push the cath into the vein. This will increase the space of the vein and will also push open valves which you may be hitting. Some people take the tourniquet off to float the cath in, but I usually try it with the tourniquet still in place, just being careful not to push to hard or fast.
If you think you have a better chance of getting it if you use a little needle, try using a bigger needle. The “flash” while using a 24 is delayed and those are made for superficial veins on babies, not real vein on adults, and the short cath length comes out easier. The smaller ones are also more flexible and harder to get through the skin without bending and then snapping straight. On adults I hardly ever go smaller than a 20g and usually stick an 18g in them if I can. I only drop to a 22g if there are no veins big enough for a 20.
You can also look at this video provided by MN: http://www.mightynurse.com/venipuncture-skill-learning-how-to-start-an-iv-video/#comment-6674
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