Whenever a patient tells me, “I’ll warn you, I’m a hard stick”, I take their word for it. After all, my patients know their bodies best. I approach every IV insertion with caution, care, and according to our Standard Operating Procedure (SOP), however, I am extra attentive when patients warn me or appear anxious. This heightened awareness helps with successful placement and positive rapport.
Today, starting IVs is one of my favorite skills, but it wasn’t always that way.
Like many new nurses, I struggled inserting IVs with about a 50% success rate on most days. (I sincerely apologize to the other 50% 🫣) While IV insertion is taught in nursing school, to become an expert, one must practice. A lot. And as a new graduate in the cardiac unit, most patients already had their IV placed when they were transferred to us. This meant I rarely had the opportunity to start a new IV. This soon changed however when I joined a surgery center where I was placing a minimum of 7 IVs a day.
At first, this higher number of patients only exposed my weakness. I was embarrassed and frustrated for my lack of efficiency. I was unaware of what I was doing wrong. Soon, I set my ego aside and asked my trustworthy coworker for advice. This quickly turned my failures into successes. I was thrilled and obviously so were my patients.
Along the way and many veins later, I practiced the following methods which have helped build proficiency in venipuncture. Whether you are a student or experienced medical provider, I hope these provide some reassurance for a successful poke.
Note: What follows is neither comprehensive nor a step-by-step guide. Rather, these are tips for medical professionals who have already been trained and licensed to start IVs and administer IV medicine. My opinion below assumes that you are familiar with patient care as well as IV sterilization, components, gauges, and proper insertion steps.
The correct position and angle of the catheter has been the most helpful for me and would ultimately make or break the probability of a successful IV.
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Tip #2: Seeing > Feeling
You don’t need to actually see the vein; feeling the vein is just as promising. I start with the antecubital fossa, the hand, then forearm.
Tip #3: Tap Tap Tap
Lightly tapping or flicking the vein can be extremely effective for dilation of the veins. This is especially helpful when you are unable to see or feel the veins because they will usually perk right up.
Tip #4: Heat It Up
Wrap a heating pad or warm washcloth or blanket around the area to cause vasodilation, especially in combination with Tip #3 above.
Tip #5: Gravity
Having the arm dangle can cause extra blood flow to the lower extremity. This can be especially helpful starting IVs in the hand. Asking the patient to make a fist can further assist as well.
Tip #6: The Ultrasound
If your practice has the resources, enlist technology. At Innerbloom Ketamine Therapy, we may use a small portable ultrasound called the Butterfly. This helps to find veins that are not visible to the eye and is especially useful for patients that have swelling in the tissues or have had long term venipuncture treatments.
Tip #7: H20
Remind your patients to stay hydrated before their visit. When the body is properly hydrated, veins are more dilated, and therefore easier to access.
Tip #8: Keep Breathing
Although it can be frustrating, it will be key to stay calm during this process. Chances are the patient is just as stressed out, if not more so than we are so do your best to stay mindful of your emotions and most importantly don't forget to breathe. You got this.
I always revert to these methods whenever I face a difficult stick, as they tend to work most of the time. Remember, practice may not make perfect, but it surely helps! If you struggle with IV insertion like I did, I encourage you to try my tips, or ask a coworker who has a high success rate for their strategies. We are always learning together.
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