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| Image Source - Pixabay |
IV Therapy Tips and Tricks
Intravenous (IV) insertion is a basic skill for every nurse and nursing student to learn, but it could be a difficult skill for most nurses. To be a master in IV insertion you need a lot of practice and perfect skills.
An intravenous insertion may be a painful procedure for patients. So, as a nurse, you have to perform this very accurately and skillfully. You should not make any mistakes during this procedure.
Here are the Tips and Tricks for nurses to hit the vein in one shot during the Intravenous (IV) Therapy procedure.
1. Gather confidence and be prepared -
You may feel nervous and also your patient may feel fear and anxiety. Before doing the procedure first prepare yourself, gather confidence, and believe that you can do it. Your confidence will encourage your patient too. He will start to believe that the nurse will do this procedure safely as she/he has enough confidence.
2. Explain the procedure -
Patients may have a lot of questions and confusion before the procedure which will increase fear and anxiety. So, before doing intravenous insertion explain the whole procedure and encourage him/her not to worry about it. Your explanation and encouragement will help to prevent excessive fear and anxiety of the patient.
3. Hide needles -
Before the intravenous insertion hide the needles to avoid needle phobia of the patient because by seeing needles patient may feel fear which increases blood pressure and pulse rate. So, give enough psychological support, educate the patient, and especially keep the needles out of sight until you use them.
4. Use topical anesthesia -
Intravenous insertion is a painful procedure. It is very important to control the children during the procedure. So, use topical anesthesia on the insertion area to reduce the pain.
5. Divert patient's attention -
During the insertion patient feels so much fear, anxiety, and pain. The fear of needles and blood makes them more nervous. To avoid it, talk with them about some topic which makes them think about your questions. By this method, the patient's attention will be diverted to another event.
6. Follow past history of patients -
Sometimes it is difficult to find a suitable vein. Ask the patient about his/her past IV history so that he/she can refer you to a suitable vein for intravenous insertion.
7. Assess the vein carefully -
Before the IV insertion, you must assess the vein carefully as you can not see the veins. So, try to feel the veins with your fingers, trust your fingers, and feel whether that vein is suitable or not. Palpate smoothly so that you can differentiate veins and tendons.
Along with this, you must check the fluid balance level of patients. If the patient is enough hydrated, the veins will be bouncy.
8. Choose appropriate cannula size -
It is most important to choose an appropriate cannula size according to patient size. If you select a vein that is smaller than the needle size, the vein may get injured as the needle is bigger than the vein. Choose the cannula size based on the gauge number.
Remember that a smaller gauge number means a larger diameter of the needle lumen and a larger gauge number means a smaller diameter of needle lumen.
To choose the appropriate gauge of cannula, follow the cannula color.
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Make the Vein More Visible
9. Apply warm compress -
If the vein is not visible properly, apply a warm and moist compress which will dilate the vein. Keep the compression for 10 to 15 minutes. Please remember that the compress should not be hot.
10. Keep the arms down -
Advise the patient to keep his/her arms down toward the earth to promote the venous filling. When the arms are toward the earth, gravity works to decrease the venous return which fills the veins with enough blood. It helps you to feel the veins easily.
11. Use nitroglycerin ointment -
Before the intravenous insertion, you have to dilate the vein. A dilated vein makes the insertion easy. Apply nitroglycerin ointment for two minutes to the site. Remove the ointment before IV insertion and disinfect the site.
12. Stop slapping the vein -
Most of the nurses are used to slap the veins or sites to make the veins. But stop this habit though this method is helpful to visible veins because veins ending have nerves which give painful stimuli to slapping and also contract veins. If veins contract, it is difficult to locate.
So, I request you to avoid slapping the sites, it makes the procedure even more painful for patients.
13. Gently flick the vein -
Dilated veins are more visible and easy to insert the needle. So, instead of slapping the sites, flick the vein with your thumb finger and index finger. This method releases the histamine and dilates the vein.
Vein Selection Tips
14. Place the tourniquet correctly -
Place the tourniquet tightly to obstruct the venous flow and make sure that the tourniquet is not too tight. Too tight a tourniquet may obstruct the arterial blood flow. Check the radial pulse after placing the tourniquet if you can not palpate the radial pulse, your tourniquet is too tight.
Place the tourniquet 25 cm above the IV insertion site.
15. Palpate the vein -
After placing the tourniquet correctly, palpate the vein gently by pressing up and down. Palpate the nearby veins also with the same finger so that you can feel the bouncy vein. Palpate and feel the veins but never slap the site, it contracts the veins.
16. Use a BP cuff instead of tourniquet -
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| Image Source - Pixabay |
Use this method when veins are too difficult to palpate especially for the older age patient. If the patient has low BP, it is difficult to feel the vein easily. In this situation use a BP cuff instead of a tourniquet. Inflate the cuff to the lowest pressure and check whether the veins are palpable easily or not. Adjust the exact pressure to dilate the veins. Using a BP cuff makes the patient more comfortable than the tourniquet.
Intravenous Catheter Insertion Tips
17. Support the vein -
Before inserting the needle support the vein by pulling the skin just below the needle entry site. It decreases the pain and gives support.
18. Hold the catheter at a 15-30 degree angle -
Hold the catheter between 15-30 degrees angle to the insertion site and also hold the bevel of the needle upward. The appropriate angle of the catheter helps to prevent vein injuries.
19. Twist the catheter -
Twist the catheter when you feel mild obstructions and frictional resistance. Make a slight rotating motion to overcome the resistance. Do it very carefully and don't hurry because a little mistake will make it painful.
20. Discontinue if painful resistance -
Don't insert the needle further if there is a painful resistance. This pain may be due to any obstruction or vein injury. Feel the condition carefully when you insert the needle and if there is no resistance, you continue the procedure further.
21. Check for Flashback -
During the catheter insertion check for the Flashback (backflow of blood from the vein to the catheter). It signifies that the needle is placed properly in the vein. When you see the Flashback, remove the tourniquet remove the needle also, and secure the catheter to the skin correctly.
Essential Consideration Tips for IV Therapy
22. Inside the ambulance -
Lock the patient's limbs in the ambulance as it moves. Moving the limbs makes it difficult to insert, blocks the IV fluids, and increases pain.
23. For old age and children -
Use a small diameter needle lumen as they have smaller and weak veins compared to adults. Before insertion, stabilize the children and hold the old-age patients as they are prone to falls.
24. For dark skin tone patients -
For dark skin tones, patients may find it a little difficult to visualize the vein. So use a BP cuff and adjust it until veins are visible and also wipe a cotton swab towards the vein direction.
