How to be the “BEST” IV line starter
March 31, 2011 Leave a comment
In the Emergency Room, one of the most important nursing skill you must have is being good in starting an IV line for patients. An “IV” fluid or “Intravenous” fluid is important for patients admitted in a hospital whether it is for hydration purposes or a site for administering drugs or whatever purpose it may serve. Most emergency nurses find this task to be the most difficult one due to a number of factors: maybe because of relatives who anxiously observe you as you do the cannulation and you can’t concentrate, maybe because you are too stressed and you can’t focus on what you are doing, or maybe because the resident doctors keep on giving orders even if you are not yet done with your work. I know these because of the long years of experience i had in the emergency room and i tell you, it was not easy. The hospital I worked for has a daily average of at least a hundred out patient consults and at least 30 in patient admissions and would you believe if i tell you there are only three of us nurses to attend to all of them in a 12 hour shift??!But because of this, i have learned some tricks to make me, if not the best in our hospital,a good IV starter!I am not bragging about this but because of what i do everyday, it makes cannulation as easy as like taking a patient’s vital signs.
Now, I will teach you a few tricks to make IV cannulation easy for you!
1)I will assume that you already know how to “prime” the line, just make sure there are no bubbles in the line because patients or even relatives will argue with you about this.
2)Always do a sterile technique when doing this.It is our habit to “feel” the patient’s vein so we know where to prick but make sure you do not touch the insertion site AFTER sterilizing it.
3)Choose your needle carefully!The size will depend on the patient’s age and case. For example, if the patient will undergo surgery, it is best that you choose a needle with a large burrow or hole because most anesthesiologists prefer this for them to administer their drugs more efficiently. The Smaller the gauge, the larger the hole remember that!
4)In our country, it is our practice to start the line on the dorsal part or the hand.If so, try to estimate the needle’s size with the length of the vein.Make sure that if you start inserting the needle, it will not go through the other end if the vein is not straight.if so, start pricking a few cm before the actual vein then puncture it from inside so that the end of the cannula will not bend or puncture through the vein.
5)There are veins that are hard to prick like those of old people.Their veins move freely if you feel them.The trick here is to puncture the skin from the side of your targeted vein.Then on your other hand, try to secure the vein by gently pressing it so it will not move and prick the vein from the side.By doing this, you are sure to hit the vein because it will only move sideways.If you will try to puncture it from the top,it will only slide.
6)For pedia patients, it is so irritating because they constantly move and cry.Try to get some help with your co-staff to hold the patient or if they are too busy, ask for the relative’s help.Now, the catchy part here is that even if you have a visible vein, it will be hard to keep your needle in place because they will surelystruggle. The trick here is this: have the kid secured by your helper,have them firmly hold the kid’s hand,prick the site and then let go of the needle for a few seconds,but not completely.The rationale for this is the kid will surely move even if they are firmly secured because of the pain.Then after, try to immediately hit the vein because you will only have a few seconds chance that the kid will not move again.
7)This is the trick that i love!I don’t know how you will react to this technique but i believe it is effective and useful.If you miss your target,never admit that it was your mistake!.Now why did i advise you this?Because once you admit this, it is like telling your patient that you are incompetent.Your patient will lose faith in you and might even argue with you.You can tell them that sometimes it is normal for veins to collapse due to dehydration, or tell them that their veins are really hard to find.Also,this can keep your focus and composure if you still have your patient’s cooperatin and trust.But remember that this will not always work on all patients.Be careful and try to be polite when telling them this.But if you really are having a hard time, it is better to ask for help from a more experienced one.
8)If all alse fails and you really cannot find a visible vein, you may try a blind shot.It means you will try your luck hitting a vein even if you can’t see it.But before you do this,explain first to your patient on what you are about to do and ask for their consent.If they agree,prick the sites with the highest probability that you will hit one.The site where your thumb is on the side of the hand,the back of the hand near the pinkie finger,the brachial vein,for babies the site on the ankle,or even on the head.
All of these are the techniques that i learned during my duties.Do these on your own risk and according to your hospital policy!Also these are just suggestions to make your life easier n the hospital.Some of you will disagree on my methods and some of you i think will find these useful.