One of the major functions of a nurse is to insert IV lines on patients. This should be done perfectly but experienced nurses may still encounter or face problems like a blown vein. In order to minimize patient discomfort and overall productivity of a nurse, here are some useful tips to lessen or eliminate those errors.
Assess the veins – Look for a good vein by palpating the arm or area with your fingers. Choose the larger and straight vein as this will be able to accommodate large bore catheters.
Go for the correct size of the catheter – To be safe and avoid a blown small vein otherwise, use a small one. Gauge 22 is ideal for adult patients while gauges 22-26 catheters for pediatric patients.
Check application of tourniquet – Sometimes the blood flow is being affected by how the tourniquet was applied. BP cuffs can also be used on chemo or elderly patients wherein their veins are very fragile.
Bevel position – Make sure that the bevel of the needle is facing upwards as this is much easier to see where the tip enters the skin. Plus you can control on the angle of insertion when you see the bevel.
Anchoring a vein – This is to keep an unstable vein from moving. With your non-dominant hand, hold the skin and vein tautly as you insert the needle slowly.
Check your angle – Adjusting the angle of the needle’s approach will definitely make an impact on the vein. Ideal angle is 15 to 30 degrees. To reduce puncturing the two vein walls, vein catheter should be inserted on top of the target vein.
Learn when to stop – Do not advance the catheter once you hit a vein and the backflow starts so as not to puncture the vein wall. This is also a good time to drop the angle of approach when you advance.
Pull back – Before fully advancing the whole catheter, pull back a little to make a successful insertion. Quickly but carefully release the tourniquet so as to reduce blowing of veins due to too much pressure.
Catheter inserted – Once done, pull back the needle carefully then attach the IV fluid set prepared. Remember to start the first few drops to run very slowly before adjusting to the required drops.
Avoid fishing – If you missed a flashback, never dig for the vein or look for another angle. It’s like fishing for a successful try. This will make the patient jerk their arm thus losing or blowing the vein. It will also make the patient feel uncomfortable with what you are doing.
Visualization devices also help, like transilluminator lights or pocket ultrasound machines. These devices aid in clearly showing the vein pathway for a nurse to track the insertion direction for a successful insertion.