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4 Sloppy IV Mistakes You Should Avoid

Discussion in 'Nursing' started by Egyptian Doctor, Jul 29, 2015.

  1. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

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    One of the nice perks I’ve found to blogging is that every now and then I get to rant. This piece might fit into that rant category. Not necessarily the full blown, foot stompin’, leave the caps lock key on, kind of rant, but a rant none the less.

    I’ve started a bunch of IVs. Some were really good. Some were, I can’t believe I got that, there must have been some divine intervention involved, good. Of course I never say anything like that at the time. I tape it down nonchalantly and act like I get the hard ones all the time.

    I’ve had my share of bad ones as well. I’ve missed IVs in veins so big that I should have been able to throw the needle dart style and still hit the vein. I’ve chased veins across peoples arms and left them with bruises to remember me by for weeks to come. I’m not proud of it, but I’ll take ownership of it. IVs aren’t my favorite thing to do. I didn’t become a caregiver because I liked causing people discomfort with needles. (Though some of my patients have seemed convinced otherwise.)

    Along the way I’ve picked up some pet peeves about starting IVs and I’d like to share them with you. This is a list of my top four, please don’t do this, IV pet peeves.

    When starting an IV please:

    Don’t blame your missed IV on the patients veins.

    This is an insidious habit. I don’t care what the patients veins look like. I don’t care if they are buried, if they roll of if they dance around like a hula girl. The patient didn’t miss the IV … you did. Don’t ever tell the patient, “You have brittle veins, deep veins, small veins, rolling veins.” (Whatever that means) or anything else to make it seem like the missed IV is the patients fault and not yours.

    If you miss it, you miss it. Say sorry and move on. Those pitiful remarks about the patient being a hard stick will only make you look worse. Other popular versions of this bad habit are the medical history question asked right after the failed attempt, “Are you on blood thinners?” or looking aggravated at the drivers compartment as if to suggest that something in your partners driving cause your failure. Suck it up. Correctly document the failed attempt and move on.

    Don’t clean the puncture site and then touch it again with your dirty glove or finger.

    I know how it goes. You massage the vein. You poke the vein. Then you poke at it a little more. You feel it under there just waiting for your needle. You pick your angle and site of attack and then you dutifully swab the area to prep it before you stick. And then … you just have to touch it again.

    I know. Believe me I know. Sometimes the urge is just irresistible. You want just one more feel of that vein to confirm it’s still there waiting for you. But don’t. You’re only recontaminating the site. Trust yourself. Trust the vein. It didn’t leave for vacation while you were picking up the needle. It’s waiting for you. Just stick.

    Don’t ask the patient to open and close their hand

    • It does nothing.
    • No … really. It does nothing. (If you really want to, hang their arm down. That stands a much better chance of making a noticeable difference in vein size.)
    Don’t blow the vein and then leave the tourniquet on while you look for a 4X4 etc.

    We all blow veins. It’s never pretty when it happens. But when you see the vein blow, the very next move should be to pop that tourniquet. This will decrease the amount of bruising and swelling the patient experiences.

    I see folks make this error all the time. The vein is blown. They know the vein is blown and the start looking around for the gauze 4X4. Then they do the one handed maneuver to tear open the package. Then they put pressure on the wound and remove the IV needle. Then at some point, while trying to stop the flow of blood they reach up and pop the tourniquet.

    Pop the tourniquet first. Your patient might not thank you but I will.

    I know all of these sloppy errors well. They are all bad IV habits that I had to break for myself at one time or another. Now I urge you to do the same.

    I think I have my little problem with my comments box fixed. Give it a try. I’d love to hear what you think about sloppy errors or pet peeves with IV start technique or anything else.

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  2. Viv_vuvu

    Viv_vuvu Young Member

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    Hello. I was a Nurse Educator for our IV Department at the hospital I worked at. Then, transferred to the ER. I have seen patients that had been stuck over and over again. Each time hearing the patient blamed for it. Most frequently the cause "You have rolling veins". When I taught I always told the individual that I was training to not always rely upon their eyes to visualize a vein. Particularly in toddlers. I always taught to feel for rebound of the vein. I also thought that it was extremely important that they knew the Anatomy of the veins that are commonly used. One big issue for me was improper application of the tourniquet. All too often the patients complained more about how bad the tourniquet hurt them. I have seen them twisted and turned and so very tight. Keep in mind that with our elderly patients, often times the tourniquet does not need to be tight at all. I have actually started IV's on the elderly without the use of a tourniquet. Another common mistake is to start an IV directly over the radial artery near the wrist, or in the hand near the bend of the wrist. Try to avoid the hand all together. Keep in mind that the hand has very little tissue and if the IV infiltrates, the fluid can damage the tissue depending on what is infusing through it. This is very painful for the patient and also requires that the area be secured to prevent movement of the wrist. Always approach your patients with a cheerful , positive attitude. Make your patient feel comfortable with you. Learn how to "Pin down the vein". It's simple. Once you have located the vein and prepped the site, place your thumb over the vein and gently slide your thumb down the vein applying pressure as you do so. Always remember to use an alcohol swab to prep your finger if you must retouch the area. Remember that starting an IV is an invasive procedure. You are entering the venous system .Then enter the vein with a smooth fast stick. Immediately drop and thread once you have seen your flash. Do NOT move the catheter around in an attempt to "Chase the Vein". If you do not enter the vein immediately, you are done with that attempt. Never stick more than twice. Once you have failed on your second attempt, not only are you frustrated, but so is your patient. Your patient will certainly appreciate you much more. This does not mean you are a failure. We all have good days and bad days. NEVER BLAME your patient. And please, if you are starting and IV, always start low on the arm. If you start high on the arm, you can lose the opportunity to go back down the arm and start again. Another rule of thumb is to always immobilize the hand if you have started the IV in the hand. Especially a child. And importantly as starting an IV is finding out what is going to be infusing through the line. Many medications are very irritating to the veins and a large vein is preferred to allow for more blood circulating with the infusion. Be passionate about what you are doing. Stay positive. And always secure the IV for that it is as comfortable as it can be for the patient. Ask if they are left or right handed. Try to avoid their dominant arm. Here is a tip on starting an IV on a severely burned patient. Find where your vein is, then place a fairly large piece of Tegaderm over the area to give you a way to secure the IV once it is in. Simply stick through the Tegaderm and then you will be able to apply tape to the tegaderm and not the burned flesh. Believe me, I have started IV's on Neonates , Toddlers or all sizes, Severely burned patients and patients with very fragile skin or skin disorders . And remember when you are dealing with a child, you are also dealing with parents. Always try and make the parents feel like they are apart of the process by explaining that their child is going to cry no matter what. Let them feel like the rescuer when you are done. Gosh, I could go on and on. For now, just learn as much as possible and then apply your skills with confidence.
     

    Last edited: Aug 16, 2015

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