For nurses, phlebotomists, and other healthcare professionals, starting an intravenous (IV) line can be a stressful and embarrassing process. For the patient, it can be a painful and frustrating process. Even if you have decades of experience and a high rate of successful sticks, missing veins is an awful reality that all nurses and healthcare professionals face. These tips will help you improve your skills in starting an IV line.
Be Confident
Do not allow a missed vein encounter to undermine your confidence. It is true that a nurse can be reprimanded by a patient or colleague nurse. Especially if you are starting in the profession. Do not let a single mistake ruin your confidence. Always believe in yourself.
Consider The Institution’s Protocol
Certain facilities have policies in place that limit the number of times a nurse can start an IV. Some hospitals, for example, limit nurses to two attempts, after which they must find another nurse to try.
Assessment
Examine the vein. You must first check the condition of a patient's vein before placing a needle into it. Veins of a well-hydrated individual are firm, elastic, and simple to access. Veins that are well-hydrated are bouncy, making them ideal for insertion. Some patients require intravenous therapy yet are dehydrated, making it difficult to reach the vein all at once. Always make sure you're aiming for a vein that isn't fragile enough to blow up during the insertion to avoid damaging it. Please take your time
Use a needle that is the right size for the job.
There are different needle sizes. A vein can be blown by using a needle that is excessively big. Make the most of your available resources. But keep in mind that sometimes a 22g is all you have. Also, consider the age of the patient and the purpose of the IV line. It is always best to assess.
Finding The Location
The ideal site for your IV insertion is determined by the situation in which you are working, as well as the patient's primary complaint. Inpatient nurses frequently complain about AC lines, but the truth is that an AC line is likely an ER nurse's best buddy. If a patient arrives with anything that could lead to a CTA, it's best to go with the AC. The LAST thing anyone wants to do is poke someone again unnecessarily.
A CTA may be requested if the patient has a neurological complaint (stroke s/s), a cardiac complaint, or a pulmonary complaint, and most medical facilities/radiology professionals will not inject the high-pressured dye unless there is at least an 18g or 20g in a big vein (aka AC and above). Patients who are hemodynamically unstable should also be given a 16g–18g AC for substantial fluid resuscitation. If the patient is receiving continuous infusions and the patient occlusion warning continues to sound, ask the patient if another IV can be placed in the forearm or hand.
The Forearm
Because forearms do not kink with arm bending, they are ideal for continuous fluids. However, not everyone has a strong forearm. Furthermore, forearm veins do not always reliably provide good blood return for bloodwork, but this is more of a concern in the ED, where blood work is often performed after IV insertions.
The Hand
Hand IVs are sometimes the most visible veins. However, because they are usually thin veins, it may be difficult to place an 18g here. They're fantastic for a short time. Irritation is common in this area. Furthermore, they restrict the use of the hand and are more likely to cause harm to the patient - particularly with vasocaustic infusions like vancomycin or potassium.
Do The Right Angle For Insertion
You should try to get as close to parallel to the skin as possible (10-30 degrees). When you glide the needle into the vein at this angle, the needle is likely still within the vein when you see a flash, and the catheter can be advanced.
The only exception is if you want to go for a deeper vein, in which case you may need to increase the angle.
If you have a "good" flash of blood but can't get the catheter to float in after inserting the needle, pull the needle and catheter out a millimeter or two and attempt advancing just the plastic catheter again.
Comfort Of The Patient
This IV insertion tip is mostly for the benefit of the patient. Place the needle flush with the skin where you are going to poke after cleaning the IV site.
Before you poke, press the needle with the bevel up into the cleansed skin for 3-5 seconds. The longer you wait, the more their skin receptors will become desensitized, which should reduce pain. The patient is less likely to stiffen up as a result of reduced felt discomfort, which should lead to a more successful IV placement.
Veins aren't all the same; different persons with different diseases have veins that aren't all the same. Do not be harsh on yourself and always be confident.
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