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5 surefire tips for IV cannulation success

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Nurses and intravenous catheters (IVs) seem to go hand in hand. Yes, yes, I know nurses are not the only health care professionals that place and start IVs, but we do the majority of it. My sincere apologies to all the out-of-hospital EMS personnel.

Oh, and as a side note to all the TV fanatics out there: Physicians RARELY start peripheral IVs. In fact, in my short tenure doing this job, I’ve seen ONE physician start one.

Anyway…

Even though my IV skills had a pretty rough start, I thought I’d share some tried and true tips to help increase your chances of success.

Know your anatomy

  • This is a simple yet vitally important rule. Don’t go rooting around for that “magic” vein. Know where to look and what you are looking for. Most cephalic forearm veins are overlooked, while the median anticubital vein is usually abused. Remember, the ventral side of the forearm is sometimes a gold mine!

Trust your gut

  • After your initial survey, if you know in your gut that you’re going into it blindly, stop what you are doing and ask for help. Ask for assistance or simply hand the task off to someone who is more experienced. There is no shame in knowing your limits, but don’t be afraid to fail, either.

Stick to your own routine

  • For some reason, every nurse thinks his or her way of prepping the vein, applying the tourniquet and exposing the vein is the best way. Ehhhh. Wrong answer! Once you develop your skill, be sure to follow your own routine. Your routine will ensure you do it the right way, each time, every time.

Hone your skills of palpation and touch

  • This seems to be a dying art these days. Just because you can’t see the vein doesn’t mean it’s not there. Be sure to practice your palpation skills. Practice and sharpen this skill by closing your eyes and palpating a known large exposed vein on a well-hydrated patient. When you see “that” patient with the good veins, be sure to palpate the veins with your eyes closed. Do it over and over again until you can recognize what the vein should feel like. Don’t ever rely on just your sight.

Don’t forget there’s a patient attached to that vein!

  • Once again, we nurses get so focused on the task that we forget there is a human being on the other side of that vein. Just because the dorsal hand veins are prominent does not mean you ignore the forearm! You are inevitably causing pain to your patient–be sure to empathize and make every attempt to increase their comfort level. I haven’t met a patient yet who actually likes being stuck with a needle!

Starting an IV is a skill like all others–practice makes perfect. It also follow our mantra, “If you don’t use it, you lose it.” Don’t handicap your practice as a nurse by letting your IV skills lapse. It’s better to try and fail than to never try at all!

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5 Responses to 5 surefire tips for IV cannulation success

  1. Molly Stokes RN

    One of the important comfort dos is wiping the wet alcohol off the site before sticking. Aneedle going through the alcohol stings more. As a patient, I can verify this.

    • ERnurse

      If you wipe the wet alcohol off of the site, you contaminate the area again. Allow the alcohol to dry, keeping the area free of contaminate, then stick the patient.

  2. Nurse Rene RN

    Excellent reminder on the ventral forearm veins. If one is starting an IV for a PreOp patient it is important to consider the POSTOP activities when deciding WHERE to place the IV. For example: a patient who is undergoing a hip or knee replacement will be using a Walker for the 3 or so days of inpatient stay. Therefore the hand and wrist area should be avoided if at all possible due to the high stress demand which will be placed on those areas.
    Also, in non-emergency situations it is the Humane thing to Anesthetize the site! There is no good reason to cause more pain while preparing to push what feels like the inside of a ball-point pen into someone’s arm! The hospital where I had all 4 knee surgeries had such a policy/procedure for all preop IV starts. It really DID ease the anxiety of being prepped for having ones’ leg cut in half!

  3. tsp RN

    Great information-One of the things I see many nurses do when preping the site is “rub” the blood back to the central circulation instead of distally-You also want the extremity as dependant as you can get it to get the best vascular distention. If the patient is stable-raise the head of the bed and lower their extremity.–Also study healthy people for vein location-Knowing vacular anatomy is key.

  4. Smithteamracing RN

    I have been a nurse for eons (20+ years) and am not a good IV starter. I work oncology and most of our pts have ports or PICCs. My advice–make friends with all the good IV starters!!! It definitely help if you know who to call for those hard sticks.

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