If you lack practice and experience, IV therapy and finding a vein for an intravenous catheter, can understandably be stressful.
It is an essential skill for a nurse to master, and you are always aware that in situations where a vein is difficult to find, your patient will suffer from discomfort if you hit the wrong spot.
What follows are my best intravenous or IV therapy tips and tricks on how to hit a vein every time.
How to hit a vein every time
Palpation
First, you should palpate the patient’s skin in search of a viable vein.
The majority of veins are not visible to even the trained eye of a nurse, so touching the flesh will help locate the vein line beneath the skin.
With experience, palpation will help you detect viable veins. Ensure that you are being gentle of course, and do not use any arteries for insertion.
Use a vein Finder
If you still feel a little nervous locating veins through palpation, a vein finder light is a very good method.
I have reviewed a number of vein finders here. Whether you are a nurse, home carer, or need to find your own veins for treatment, a vein finder can really help.
Simply shine the vein finder light over the skin to detect a viable vein for the situation at hand.
Assess the vein
The next step after finding a vein is to assess its condition and suitability.
If the patient is well hydrated, the veins in their arms and hands will be firmer making them a better candidate for insertion.
However, in cases where the patient is dehydrated, IV therapy and finding a suitable vein can be more problematic. It may take more than one try.
You must also ensure that the vein you plan to insert into, is robust enough to take the insertion.
Again, skill and practice will help here, as will making the vein more visible. Let’s look at some ways you can do this.
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Making the vein more visible
Gravity
Simply asking the patient to relax their arm downwards by their side can help make veins more visible
Gravity acts to slow venous return and will distend the veins making them more prominent for palpation.
Fist clenching
While the patient dangles their arm, you could also instruct them to clench and unclench their fist.
This acts to compress and distend distal veins which increase venous filling.
Gently flick the vein
If you have located a vein and wish to assess it as mentioned above, gently flicking or tapping the flesh above the vein can often help make it more visible.
The slight pressure of the tap releases histamines beneath the skin and causes vein dilation.
Do not be too hard with this method, and avoid slapping the vein. Veins have nerve endings that react to painful stimuli. The result is counter-productive as the vein may actually contract under the pressure and actually be less visible.
You also might hurt your patient, which is clearly bad news.
Use a warm compress
A warm, moist compress left over the area you plan to insert for 10 minutes will also help venous filling for IV therapy.
The increased temperature dilates the vein making it more visible.
Tourniquets
I have left one major method of increasing the visibility of veins until last; the reliable tourniquet.
Wrapping a tourniquet above the site of insertion will increase the vein dilation considerably. This will then allow you to palpate far more effectively, due to the prominence of the vein.
Again, you should assess the vein as mentioned above, in order to choose a viable entry point for insertion.
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Inserting the catheter
Now that you’ve found the vein, made it more visible, and assessed it, it is finally time to insert the catheter.
Let’s take a look at the steps involved with this so that you can ensure you hit the vein successfully the first time.
Clean the area
So that the tape and dressing adhere tightly after insertion, you should clean the area on and around the insertion point before you begin.
You can actually assist venous flow while doing this by rubbing the alcohol pad in the direction of the flow. This will help to fill the vein further, before insertion.
- Related Content: How to Clean an Injection Site – Step by Step Guide
Prepare skin for insertion
Once the alcohol has dried on the skin you should pull the skin taut just below the insertion point.
The tighter area of the skin will help to ensure that the needle is able to pierce the vein more effectively.
It also helps reduce the pain felt by the patient.
Insert the catheter
Now it is finally time to insert the catheter. This should be done vertically above the vein. Mistakes occur if you end up inserting at the wrong angle or too much to the side.
You may end up pushing the needle through the vein rather than into it if you initiate venipuncture at the wrong angle.
Another helpful method as you insert is to gently rotate the catheter hub. This can assist successful venipuncture where tortuosity of the vessel, vessel fragility, and/or frictional resistance is present.
Halt procedure if you feel undue resistance
If you feel resistance from the vein or the pain shows signs of real pain, halt the process and withdraw the needle.
Take your time and ensure that the patient is okay. Then reassess the vein to see what the problem might have been, or if there is any damage.
After that, start the process again to find a different vein for insertion.
Don’t insert too far
If the insertion looks to be going well, ensure that you do not go too far.
Once you hit the vein and see a small flash backflow of blood, finish advancing the catheter and remove the needle.
Well done, you’ve done it!
With the needle removed, you can now secure the catheter to the patient’s skin and remove the tourniquet if you used one.
The patient is now ready for the infusion line. Give yourself a pat on the back, you’ve successfully completed the procedure.
References
- “Comparison of four skin preparation strategies to prevent catheter-related infection in intensive care unit (CLEAN trial): a study protocol for a randomized controlled trial.” Goudet V, Timsit JF, Lucet JC, et al. Trials. 2013;14:114. Published 2013 Apr 27. doi:10.1186/1745-6215-14-114
- “Comparison of the effectiveness of the virtual simulator and video-assisted teaching on intravenous catheter insertion skills and self-confidence: A quasi-experimental study,” Elif Günay İsmailoğlu, Nilay Orkun, İsmet Eşer, Ayten Zaybak. Nurse Education Today, Volume 95, 2020, 104596, ISSN 0260-6917, https://doi.org/10.1016/j.nedt.2020.104596.
