Are you ready to practice your venipuncture skills? Below is a list of the 20 most useful tips so you can avoid blowing a vein. 1. Feel the veins. You can’t easily see a good vein but you will definitely feel it by palpating the area. Feel for fullness and integrity. Choose the largest vein first as you will less likely blow it especially if you are using a large bore catheter. 2. Choose the right size of catheter and if not contraindicated, go for a small one. If you don’t need to infuse large volumes of fluid or if blood transfusion is not necessary, just use a small catheter. For adult patients, gauge 22 is usually recommended. On the other hand, gauge 22-26 IV catheters are commonly used for pediatric patients. 3. Make sure that the bevel is facing upwards so you will not blow the vein when advancing forward. You can control the angle of insertion more when the bevel is facing upwards. You will also have easier glided point of entry as the sharp end-tip of the needle enters the skin. Hold the syringe horizontally, and position the bevel of the needle so the point of the needle is facing up. Via Drugs.com 4. For geriatric patients, a deeper vein is less prone to blowing. Elderly patients usually have fragile veins like those thick veins that could be easily seen in the dorsal part of the hands. If you know that you are dealing with a fragile vein on an elderly patient, look for deeper veins that are more stabilized and less movable. 5. Always go for the straightest vein. Venous valves are often located between the intersection of two veins and you should avoid them for a smooth IV line insertion. If you encounter venous valves upon catheter insertion, it will stop the needle from advancing forward and you might puncture the vein wall sideways. 6. Use hot packs if your patient’s arms are cold. If your patient’s arms are cold, you need to warm them up to dilate the blood vessels. By doing this, you can make veins pop out quickly and avoid blowing them. You can use warm washcloths or blanket if you don’t have hot packs in your area. 7. Ask your patient to open and close his/her fist during vein assessment. This will improve venous refill especially if the arm is dangling downward. Also, when you are about to do venipuncture, make sure to ask the patient to keep his/her hands and arms relaxed. Improving venous refill will enable you to see the veins clearly and assess which vein is more prone to blowing. 8. Anchor the vein. You can do this by holding the skin and veins taut with your non-dominant hand. With this technique, you can keep a unstable vein from moving sideways as you puncture it. 9. When you are about to stick the needle, do it in a 15 to 30 degree angle. Adjust your angle of approach accordingly if your target vein is too shallow or too deep. The common cause of blown veins is too deep angle of approach when sticking the needle. Image shows the proper initial insertion angle for short peripheral IV catheters. Insert the catheter into the vein at a 15 to 30 angle. Source: spanamerica.com 10. Insert the catheter directly on top of the vein. Avoid side access as it can push the vein sideways even if it’s anchored by your non-dominant hand. Inserting the vein catheter on top of the vein will also reduce the chances of going through the two vein walls. 11. Go slowly with catheter insertion to avoid double penetration. Give yourself plenty of time in estimating the angle of approach so you can avoid jerky movements. Hit the vein slowly but steadily and make a short stroke through the skin to reach the vein quickly. Feel the catheter penetrate the vein. In some cases, you can even hear a small click-like sound and feel that you are getting a flashback. 12. Once you hit the vein and see flashback of blood in the flashback chamber, STOP advancing the catheter and drop your angle of approach. This is necessary in avoiding puncturing the vein wall again. Drop your angle of approach as you advance the catheter a little bit more. This will prevent puncturing through the vein. 13. Pull back the needle a little bit before advancing the whole catheter. The needle will serve as a guide wire as you push the catheter farther. You need to pull back the needle so there will be less chances of puncturing the vein again as you advance the catheter. 14. Try not to use a tourniquet in elderly patients. Their veins are so thick but very fragile so just a little pressure from the tourniquet can blow a punctured vein. If you suspect that there is poor vein integrity but you can easily see and feel the vein on an elderly patient, try anchoring the vein and do not use a tourniquet. However, if you can’t really palpate the vein, you can also try applying a tourniquet a little farther from your target vein. 15. Improve the vein’s fullness by using gravity. Ask the patient to let his or her arms dangle on the side of the bed. The gravity will improve the vein’s fullness so you can palpate it more easily for venipuncture. 16. If you are dealing with very fragile veins of elderly and chemo patients, try using a BP cuff as your tourniquet. With a BP cuff, you can control the pressure you want to apply. Start with the lowest pressure first and see if you can already make the veins appear. It is best to use the lowest pressure possible so you can prevent pressure-related venous blow. 17. Once you have a flashback, release the tourniquet first before advancing the catheter. This is important in reducing the chances of pressure-related blowing of fragile veins. This trick works for large but weak vein walls. You must be quick in releasing the tourniquet once you have ensured that the catheter is within the vein. 18. When you have successfully inserted the catheter, pull back the needle quickly to attach the IV fluid set and start the IV infusion with the first few drops running very slowly. Rushing into starting the IV fluid might blow the vein wall due to a sudden large volume of fluid being infused. Just let the IV infusion start slowly especially if you are working with fragile veins. 19. Don’t do “fishing”. If you don’t get a flashback, don’t make your needle go around digging for the vein. It’s very uncomfortable for the patient and you are also increasing the chances of blowing the vein. Whenever you don’t get a flashback, just pull back the needle a little bit and redirect it. If you still don’t get a flashback, pull the needle out and start again. 20. If available, use visualization devices. This is a great help for patients with difficult veins so you could not risk blowing a good venous access. There are many types of vein visualization devices around like transilluminator lights and pocket ultrasound machines. These devices will illuminate vein pathways so you can track the direction of where you should insert your IV catheter. source
