Tips for starting IV's

[Handsome Robb]

It's been stated before but I want to reiterate it. There is no hard and fast rule about the angle you start at. Every stick is different, some veins are superficial and require a small angle while others are DEEP and require a steep angle.

In elderly patients I've heard of people starting the line bevel down and having more success, I tried it, couldn't figure it out and went back to what works for me.

Take bits and pieces of all the advice you get, try different ways and choose what you like and don't like to come up with your own style.

You know what? I have loved this forum for all the wealth of information and the advice. Not to be questioned on my skill or lack thereof. I'm not going to sit by and keep reading this garbage. I could care less how many patients you have and the "you do the math" bs. Move on. Just because you aren't as good at IV's leave me alone.

We called you on a BS claim. When you get all defensive and throw a fit it doesn't help.

Look at the numbers, if you really only missed one out of 832 sticks (4/day x 4 days/wk x 52 wks/yr) then you're the best person I've ever heard of starting IVs. That means you have a 99.88% success rating. I call BS.

Personal attacks aren't appreciated here. No one belittled you just said we don't believe your claim, there's no reason to point fingers.

I can pull my stats from my agency when it comes to skill successes/failures. I'd bet your QA/CQI would be able to provide something like that to substantiate your claims.

 

[teedubbyaw]

He's so pro. I'm so jelly. Maybe he should write a book.

 

[STXmedic]

He's so pro. I'm so jelly. Maybe he should write a book.

"Exaggerating Abilities for Dummies"

or

"Hyperbole: My Life as a Paramedic"

 

[chaz90]

I'll be honest. I'm not the world's greatest at IV starts. I'm probably hovering around ~85% on first attempt success, and I would bet my percentage drops for additional attempts on the same patient as they typically have more difficult vasculature from the beginning. I obtain access on probably 95% of my patients when deemed necessary however, and the EZ-IO remains my friend for the critical patients without immediately obtainable venous access. I'll continue to strive for the above mentioned 99.88% success rate though I suppose it's good to have a goal. Perhaps I'll start one IV this Jan. 1st and then avoid them for the rest of the year. 100% success rate for 2014!

 

[NomadicMedic]

Agreed. There are days when I can't miss and other days when I blow a line that looks like a "no miss". It's simply experience, as I realized over the last couple of years, the more I start, the fewer I miss. And the less I think about it, the better I do. I just looked at my stats (yeah, we track all that stuff) I'm good, but I ain't no 99.98% good.

 

[Akulahawk]

When I first started out, I was probably somewhere in the 70% range for first time stick success, and about 90% by 3rd attempt. Once I got the feel for it, I probably ended up in the low 90% for first, and about 98% second attempt overall. With two exceptions, I have a 100% success rate as of the last line I started, by a 3rd attempt. The first was a young male in DKA with extremely fragile veins (needed a central line, nobody got a PIV on him) and the other was an IVDU that I could only manage one attempt before a flight crew got their line started.

The point is that until I did get the feel for starting IV lines, I never had a 100% success rate. Because of those two calls, I will never have a 100% success rate. I had to start quite a few before I approached proficient... Nowdays, I'm probably rusty enough that while I could start the line, I might inadvertently cause a bit more iatrogenic blood loss than I would otherwise have.

 

[VFlutter]

Just because you aren't as good at IV's leave me alone.

Haters gonna hate. I would hit 99% if I threw 22s in everyone. Go big or go home, Brah. 16g or nothing.

But seriously, I doubt I am that good even with ultrasound. I guess I could never be a paramedic.

 

[Handsome Robb]

Haters gonna hate. I would hit 99% if I threw 22s in everyone. Go big or go home, Brah. 16g or nothing.

But seriously, I doubt I am that good even with ultrasound. I guess I could never be a paramedic.

I'm trying to decide if you're giving me :censored::censored::censored::censored: or him :censored::censored::censored::censored:. :lol:

Everyone here is all about 18s. I drop 20s all day long. I have been told that lab draws off 18s don't end up hemolyzed as often as smaller gauges but that's just hearsay.

 

[MasterIntubator]

So after years of studying and technique analyzing... I have grown to like the blood pressure cuff method.... learned in the 80's... rebirthed it in the late 90s when my success rate for critical patients and the elderly was not great.

Gotta take a BP anyway for med admin.... so why not save a step. Once you get the BP.... your target range for good vein stand up is between the systolic and diastolic. Elderly I will adjust to lower BP - more near the diastolic or less... this will help with the sudden 'blown' vein.

The perks for me:
- Adjustable pressure to get the best venous back pressure ---> nice plump vein
- Surface area to cover the upper arm....
- Time saving for VS taking
- Pt enjoys not having skin pinched

The Down falls:
- BP cuff leak ( user error on maintenance )
- Not proficient in manual BPs ( NIBP takes the back step for me )
- Need tactful positioning to keep the hoses out of the way

Play around... see how it works.

Also.... lighting has a great role... a dimmer light will cast shadows and tend to make the un-seeable seeable.

Someone mentioned 'feel'. mmMMMmm... yes, get in touch with your fingers. Feel the anatomical area and close your eyes or look away, let your fingers do some talking.... it does help.

Choose your IV cath size based off need, and not the size of your ego. Nothing wrong with a 22 if all you need is a something to give a med with and not fluid replacement. I figure we all do excellent assessments.

Hemolyzing serum is almost all the fault of technique, sample handling and excessive force/vacuum, not the size of the needle. Beautiful serum harvesting come from 24g/25g needles all day long. I agree with the hearsay on size. Yeah... its a factor, but not as common as technique

Be safe and make every experience a learning factor.

 

[Summit]

95% first stick success. Wow.

I feel inadequate at 75%. I guess most of my patiens are several of the following: very sick, vasculopaths, diabetic, over 60, obese, etc.

 

[NomadicMedic]

I was brainwashed with the "go big or go home" mantra in medic school. Now, it's a 20 or 22 in most cases. Trauma still gets a big cath, but most trauma I seem to stumble across is young guys with ropes.

I think our advice is all the same. Shallow angle, wait a moment after the flash before advancing and practice, practice, practice. The only way to get better is to do lots.

 

[Percomonline]

2 Quick IV Tips from PERCOMONLINE

Hi, my name is Jane Dinsmore, and I have starting IV's for 30 years and have been teaching people to start IV's for 20 years. Here are my 2 big tips....

1. Patience and a little time is your best friend. Don't rush. While you shouldn't leave the tourniquet on so long that the arm gets mottled and acids start to be retained down in the tissues in any significant quantity, try putting the tourniquet on and letting the arm drop and hang below the level of the heart for a moment before trying to find your vein. Let it fill up. I put the tourniquet on, let the arm hang down, and then tear my tape or get my IV dressing out and ready, check my catheter and loosen the cap, and ensure my IV tubing is filled with fluid. Then and only then do I bring the arm up to take a look. And in most cases, you can find a good vein quickly that way and maybe NOT the AC.

2. Insert the needle into the vein and when you get the flash, stop for just an instant and then gently push the needle forward again just a fraction - just enough to ensure you are in the lumen of the vein and not just in the vein layers of the wall. This is a common reason IV's "blow". Sometimes we forget to push the end of the needle a little bit farther to make sure you are in the lumen.

Hope these help, good luck!

Jane E. Dinsmore, Program Director
PERCOMOnline