Intravenous therapy (IV Therapy), 30 Nursing tips & Tricks

Intravenous therapy ( IV therapy):   90-95% of patients admitted  in the hospital receive of intravenous therapy for the  treatment. Every Nurse Therapist must be remember the skill of intravenous catheter insertion by heart. To avoid these complaints and giving undue pain to your patients, take a look at these tips on how to become a sharpshooter in every intravenous insertion that you make.

Purposes of IV Therapy

• To provide parenteral nutrition

• To provide avenue for dialysis/apheresis

• To transfuse blood products

• To provide avenue for hemodynamic monitoring

• To provide avenue for diagnostic testing

• To administer fluids and medications with the ability to rapidly/accurately change blood concentration levels by either continuous, intermittent or IV push method.

Preliminary intravenous insertion tips and tricks.

1. Stay calm and be prepared. Hitting the bullseye on one try will depend on the nurse’s preparation and skill. You and your patient should be composed as a nervous, and rushed procedure will likely result in failure. Allay anxiety by explaining the procedure to the patient and determine the patient’s history with IV therapy. Ensure the patient is comfortable and sufficiently warm to prevent vasoconstriction.

2. Exude confidence. Believe in yourself and reassure the patient you know what you’re doing. The patient will be encouraged by your confidence and you too, of course.

3. Assess for needle phobia. Needle phobia is a response as a result of previous IV insertions. Symptoms include tachycardia and hypertension before insertion. On insertion bradycardia and a drop in blood pressure occurs with signs and symptoms of pallor, diaphoresis, and syncope. Reassure the patient with a comforting tone, educating the patient, keeping needles out of sight until the last minute before use, and use of topical anesthetics can help manage needle phobia.

4. Observe Infection control measures. Use gloves in inserting a cannula into the patient. Intravenous insertion is an invasive procedure and requires aseptic technique and proper infection control measures. Wipe a cotton swab or alcohol pad on the insertion site to minimize microorganisms in the area and also to visualize the chosen vein more clearly.

5. Assess the vein. Before inserting a needle into a patient’s vein, you have to assess its condition first. A well-hydrated person has firm, supple, and easy-to-reach veins. Well-hydrated veins are bouncy, making them the right fit for insertion. Some patients need intravenous therapy but are dehydrated, so it is a challenge to hit the vein in one go. To avoid injuring the vein, always assess first that you are aiming for a vein that is not frail enough to blow up during the insertion. The following tips can help you with that.

6. Feel rather than look. If you can’t see a suitable vein, trust your fingers even more than your eyes. It’s also an excellent opportunity to familiarize yourself with a suitable vein. A tendon may feel like a vein but palpating it through a range of motion may prove that it is not.

7. Ask your patient. The patient may know more which veins are suitable basing on his previous IV history.

30 IV Therapy Nursing tips and tricks
8. Use appropriate cannula size. Match the needle and the gauge of the cannula to the size of the patient. You can hit a vein that is smaller than your needle, but it would be injured and would blow up because the needle is bigger than it is.
9. Consider the use. Put into consideration the type of infusion that is needed when you choose your cannula. Needles with smaller gauges could not accommodate blood transfusion and parenteral feeding. Needleless equipment is now widely used to minimize injury to the vein during and after insertion.
10. Insert at the non-dominant hand first. Consider inserting on non-dominant hand first so the patient can still perform simple functions using the dominant hand. However, if you cannot locate an appropriate site or vein for insertion in the non-dominant hand, proceed with the dominant hand.
11. Start with distal veins and work proximally. Start choosing from the lowest veins first then work upward. Starting at the most proximal point can potentially lose several sites you could have below it.
12. Use a BP cuff rather than a tourniquet. If the patient has low BP, it would be best to use a BP cuff inflated to appropriate pressure to make the veins dilate. This technique can also be useful for older patients and those with veins that are too difficult to access. For patients with hypovolemia, use a larger vein as small veins collapse quicker. Inflate the cuff to the lowest pressure first and see if the veins appear.
13. In using a BP cuff as a tourniquet. When using one as a tourniquet, invert it, so the tubings are away from the limb giving you a clear view of the site and removing possibilities of the tubings contaminating the site. The BP cuff lets your patient have a wider, more comfortable tourniquet that compresses evenly and efficiently and can be adjusted to the exact pressure needed to dilate the veins.
14. Puncture without a tourniquet. If the patient has adequately filled but fragile veins, proceed with the insertion without using a tourniquet. Pressure from the placement of the tourniquet may cause the client’s delicate vein blow out upon puncture. Now that we’ve found a suitable vein, how do we make it more visible? Here are some tips and tricks on how to do so.
15. Gravity is your friend. Let the patient’s arm dangle down on the side of the bed if no veins are observed to promote venous filling. Gravity slows venous return and distends the veins. Full and distended veins are easier to palpate and are always an excellent option for insertion.
16. Use warm compress. Apply warm compress or warm towels over the area for several minutes before you insert. A warmer temperature would enable the vein to dilate and make it more visible to the surface.
17. Do not slap the vein. Some nurses have a bad habit of slapping the site of insertion so that the vein be more visible. Though the practice is helpful at times, veins have nerve endings that react to painful stimuli causing them to contract, therefore, making it harder to locate the vein. Please don’t make an already painful procedure even more painful.
18. Flick or tap the vein. Rather than slapping, use your thumb and second finger to flick the vein; this releases histamines beneath the skin and causes vein dilation.
19. Feel the vein. Wrap a tourniquet above the site of insertion to dilate the veins and gently palpate the vein by pressing it up and down. Use the same fingers in palpation so you would be able to familiarize the feeling of a bouncy vein. Tap the vein gently; do not slap it to avoid contraction of the vein.
20. Fist clenching. Instruct the patient to clench and unclench his or her fist to compress distal veins and distend them; this helps in venous filling.
21. Use the multiple tourniquet technique. By using two or three latex tourniquets, apply one high on the arm and leave for 2 minutes, apply the second at mid arm below antecubital fossa. Collateral veins should appear. Use the third one if needed.
22. Vein dilation using nitroglycerine. To help dilate a small vein, apply nitroglycerine ointment to the site for one to two minutes. Remove the ointment as you make your final disinfection of the site with alcohol.
23. Flow where you want it to go. When disinfecting the insertion site, rub the alcohol pad in the direction of the venous flow as to improve the filling of the vein by pushing the blood past the valves.
24. Clean vigorously and widely. To have the tape and dressing adhere tightly to clean dry skin. Disinfect a wider area to in case another vein shows up.
25. Use a vein locator. Veins can be very hard to find in infants or small children, equipment like transilluminator lights and pocket ultrasound machines can illuminate vein pathways so you can have a visual direction of where you should insert your catheter. Be wary of burning skin and limit the duration of contact.
26. Stabilize the vein. Pull the skin taut just below the entry site to support the vein for needle entry and this also lessens the pain the patient may feel upon insertion. Make sure that the alcohol has already dried on the skin before inserting because this may become more painful for the patient.
27. Insert the IV catheter directly atop the vein. Initiating it from the side of the vein can push it sideways even if it’s anchored by your hand.
28. Prevent kinking. Sometimes, if the vein is hardened or scarred, there is a risk of kinking the cannula. Otherwise, one can get through the scar to a usable portion of the vein by using the following technique:
29. Twirl the catheter hub. Mild obstructions, tortuosity of the vessel, vessel fragility, and frictional resistance can be overcome by “twirling” the catheter hub. To do this insert the IV with a slight rotating motion to help glide over some parts of the vein.
30. Bevel up. Make sure the bevel of the needle faces upwards as this is the sharpest part of the needle. Believe me, the needle will glide easily if inserted this way.
31. Make the shot at a 15-30 degree angle over the skin. Hold the catheter in a 15-30 degree angle over the skin with the bevel up and inform the patient that you are going to insert the needle.