I’ve heard nurses and patients state they have “rolling veins”. This is a MYTH! It is failure of the RN to anchor the vein while inserting the IV. This is true of very superficial big veins one sees with the elderly population and commonly with men. Anchoring the vein using your free hand in the “C” position (forefinger at top of vein and thumb at bottom allows the insertion to go smoothly. I recommend practicing on the iv sticks that are straightforward rather than multiple veins that converge where you may hit a valve. This is painful for the patient and can cause infiltration and phlebitis. Also, it is ok to place the tourniquet on pretty tight if the patient has deeper veins, non-obvious superficial veins or “skinny” thin veins. In a pinch, if the patient isn’t allergic to iodine, swipe the iodine over the antiseptic area of the vein and this will most times highlight the vein. Works well with patients of darker skin tones.
1. Calm yourself (you are educated)
2. Have all your supplies handy so you are not flustered by needing anything once you start.
3. Based on procedure, reason for IV, patients history determine location., no AC for laboring mom, no right hand IV fir right elbow surgery, ask your long term IV drug user the best one, I’m not kidding).
4. Anchor anchor anchor
5. I allow myself two pokes if I did not then we were not a good fit and I grab a coworker, your patient will respect you for that.
6. Brush it aside and try the next one.
Practice really does make perfect
Search “the IV guy” on Instagram! He has courses that also give you ceu’s!
I’ve watched you tube videos that have pointers on how to improve your skills that have helped me.
Unfortunately the skill is practice,practice,practice
Practice practice practice
1. Most important is to practice. Rarely should you pass on an opportunity to start an IV. Use good judgment.
2. Ask those who are known to be the best at your hospital. This can also include IV resource nurses if you have those as well as house supervisors or administrators on duty, charge nurses, those with a lot of experience.
3. Watch videos on YouTube. The ABCs of Anesthesia is a good one.
4. Read "The Art of the IV Start"
5. Remember to take your time. Don't rush starting an IV. Look on both arms and hands. Make sure they're warmed up to promote vasodilation. Hang the arms over the side of the bed. Place the tourniquet closer to the site you plan to go, so not above the elbow if you're going on the wrist or hand. Watch your angle, you don't want to go at too sharp an angle and risk going right through the vein.
6. Like others have said, anchoring the vein is key.
7. Know what you're using the IV for. Pick the size of the cannula based on this. 16-18 for large volume infusion, CT contrast, surgeries. 20-22 for infusions at lower flow rates, intermittent antibiotics.
IV team rotation!! I have been a nurse since 2009 and never learned the mechanics until I trained with BD and learned techniques and how to use a catheter correctly! Take every opportunity to learn!
I read all the answers so far, and there's a LOT of Great info! Especially the anchoring of the vein! The trick for me though was in not going too deep and ending up going through the vein, thus 'blowing' it. Especially if someone had 'tough' skin. Another nurse showed me a trick that took that risk away, at least for me. When making your initial stick, go just right NEXT to the vein .. not directly into it. Then, once in the skin, still anchoring the vein, 'sneak' the needle Into the vein. Haven't blown a vein since learning that trick some 20+ years ago!
40 year nurse here and I have excellent IV start skills...WHY? Hot pack the arm first then apply the tourniquet REALLY tight. My patients complain how tight it is but I tell them they only want one poke with an 18guage...
I agree with all the responses I have read. Follow someone who is an expert and ask for their assistance and mentoring. The more u do this the better you will be. Their are tricks of the trade;
Tourniquet, let arm hang but support kit , use heat
(Protect skin). Listen to your patient. They can help you.
The more you try, the better you’ll get. Offer to do other nurses patients as well. They’re grateful for the help, even if you’re unsuccessful. I also recommend floating to the ER for a few shifts.
All answers were good one thing don't be afraid to stick the patient, you must enter the vein and timid half pokes only hurt the patient. Not too hard to go the whole way through the vein but with confidence. I had a patient who would not let me use a tourniquet, a smooth confident stick worked every time.
If someone is unable to have a tourniquet on, use an inflated BP cuff above IV insertion area. Pt can pinch tubing once inflated. This way you still have both if your hands free to insert IV. I myself am unable to have tourniquets as I have Factor V Leiden. I have gotten a superficial clot from a tourniquet. Surprising how many nurses/paleontologists do know this trick.
Ask to help and shadow in the ER or pre surgery. And start every IV you have the opportunity for. Let your colleagues know you want to learn. It take a ton of repetitions to become proficient.
