One of the nice perks I’ve found to blogging is that every now and then I get to rant. This piece might fit into that rant category. Not necessarily the full blown, foot stompin’, leave the caps lock key on, kind of rant, but a rant none the less.
I’ve started a bunch of IVs. Some were really good. Some were, I can’t believe I got that, there must have been some divine intervention involved, good. Of course I never say anything like that at the time. I tape it down nonchalantly and act like I get the hard ones all the time.
I’ve had my share of bad ones as well. I’ve missed IVs in veins so big that I should have been able to throw the needle dart style and still hit the vein. I’ve chased veins across peoples arms and left them with bruises to remember me by for weeks to come. I’m not proud of it, but I’ll take ownership of it. IVs aren’t my favorite thing to do. I didn’t become a caregiver because I liked causing people discomfort with needles. (Though some of my patients have seemed convinced otherwise.)
Along the way I’ve picked up some pet peeves about starting IVs and I’d like to share them with you. This is a list of my top four, please don’t do this, IV pet peeves.
When starting an IV please:
Don’t blame your missed IV on the patients veins.
This is an insidious habit. I don’t care what the patients veins look like. I don’t care if they are buried, if they roll of if they dance around like a hula girl. The patient didn’t miss the IV … you did. Don’t ever tell the patient, “You have brittle veins, deep veins, small veins, rolling veins.” (Whatever that means) or anything else to make it seem like the missed IV is the patients fault and not yours.
If you miss it, you miss it. Say sorry and move on. Those pitiful remarks about the patient being a hard stick will only make you look worse. Other popular versions of this bad habit are the medical history question asked right after the failed attempt, “Are you on blood thinners?” or looking aggravated at the drivers compartment as if to suggest that something in your partners driving cause your failure. Suck it up. Correctly document the failed attempt (hopefully on your free EMR) and move on.
Don’t clean the puncture site and then touch it again with your dirty glove or finger.
I know how it goes. You massage the vein. You poke the vein. Then you poke at it a little more. You feel it under there just waiting for your needle. You pick your angle and site of attack and then you dutifully swab the area to prep it before you stick. And then … you just have to touch it again.
I know. Believe me I know. Sometimes the urge is just irresistible. You want just one more feel of that vein to confirm it’s still there waiting for you. But don’t. You’re only recontaminating the site. Trust yourself. Trust the vein. It didn’t leave for vacation while you were picking up the needle. It’s waiting for you. Just stick.
Don’t ask the patient to open and close their hand
- It does nothing.
- No … really. It does nothing. (If you really want to, hang their arm down. That stands a much better chance of making a noticeable difference in vein size.)
Don’t blow the vein and then leave the tourniquet on while you look for a 4X4 etc.
We all blow veins. It’s never pretty when it happens. But when you see the vein blow, the very next move should be to pop that tourniquet. This will decrease the amount of bruising and swelling the patient experiences.
I see folks make this error all the time. The vein is blown. They know the vein is blown and the start looking around for the gauze 4X4. Then they do the one handed maneuver to tear open the package. Then they put pressure on the wound and remove the IV needle. Then at some point, while trying to stop the flow of blood they reach up and pop the tourniquet.
Pop the tourniquet first. Your patient might not thank you but I will.
I know all of these sloppy errors well. They are all bad IV habits that I had to break for myself at one time or another. Now I urge you to do the same.
I think I have my little problem with my comments box fixed. Give it a try. I’d love to hear what you think about sloppy errors or pet peeves with IV start technique or anything else.