4 Sloppy IV Mistakes You Should Avoid

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.



  1. administrator says:

    Sorry anonymous. While I appreciate your personal experience, it isn’t consistent with current medical thinking on the subject. While increased localized oxygen demand is a logical theory it doesn’t play out. Unless the patient is creating a systemic oxygen demand that elicits a cardiovascular response (think jumping jacks) it won’t do much of anything for localized circulation. While muscle movement might facilitate the operation of your machine, that doesn’t necessarily equate to increased vascular size pre needle insertion or improved needle stick success.

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  12. klynntx says:

    Hey Steve!
    Thank you for your blog about 4 Sloppy IV mistakes. I wish the nurses in this hospital would read it! I’ve watched as nurses have botched so many IV on my elderly father. The last one said, “oh it blew.” Other’s I’ve seen insert the needle and dig around until they could find the vein. Ouch! Thank you for posting your experience and for teaching others how to overcome the bad habits….It makes for interesting reading for us non-medical people.

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  14. joe carter says:

    i do my own dialysis needles and i went to have a stent put in my fistula and they scheduled 2-3hrs to put my iv in. isnt that insane considering like i told them i could have done it in a tiny fraction of that wait lol. i think veins in my hand would be easier than my arm, having an extremely shallow fistula in my forearm im used to using a very shallow angle.

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  17. I had a gastroscope done today. The young nurse threaded the IV and I thought it was OK. Now I have what looks like a colapsed vein and a huge blue bruise where the IV was. I put ice on it, but I was concerned and looked to the internet for answers. Did she make a mistake?… (forgot to mention, it is slightly swollen also).

    Thank you.

  18. Aw, this was an extremely good post. Finding the time and actual effort to
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  19. I have recently had so many IV sticks that I can’t even count. The two worst things are when the nurse says, “If I don’t get the vein the first time, I will get another nurse to do your IV!” Really??? Kiss of death! Those nurses ALWAYS miss my vein! The second thing I can’t stand is when the nurse sticks me and then moves the needle around before getting blood return!! OMG! That hurts like hell and gives me the worst bruising! I just had that happen today! UGH!

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  22. Barbara J. McCoy says:

    My son was hospitalized. When I came to see after work, I found a tourniquet on his arm thats been there for hours. His arm was indented from it.

  23. I recently was addmitted in hospital where I was given antibiotics intravenously. What I want to know is why did the nurse stick a needle into the base of the bottle while the drip was on. What I mean is that the drip was started and then she stuck another needle into the base of the bottle and a whole lot of bubbles came off the needle and it seemed to have increased the rate of flow of the iv and I became very dizzy and thought I was dying…I was so out of it. I could bearly make out what was happening but I do remember that I had to be defibulated and then I went blank for a couple of minutes and when I came around again the nurses acted as if nothing had happened…Could that have happened? Was I dreaming? Did that really happen?…Help me understand as I’m getting no help from the hospital or the nurses.

  24. when you are inserting an IV into the wrist area and you hit a valve can that cause blood clots and severe pain weeks later that feels like you are being stabbed in the arm????

  25. Awesome post!

  26. Hi Steve: thanks for the pet peeves. Mine is IV equipment or ANY equipment in your mouth. You don’t have to rip off the cap of an IV with your teeth. I have seen people stab their lip with the IV cath doing this. it is NOT cool. the other thing is opening the tegaderm and slapping the sterile side to the bedrail!!! i am starting to rethink my whole taping process as well after the tegaderm. rather than stick tape to dirty siderails or tables, i put on the tegaderm and then rip off the tape as i need it to secure the tubing!!

  27. Thank you very much I try appreciate this post especially since it happened to me today..smh
    Keep on being honest even if they hate it..

  28. Deep rolling veins ole lady says:

    After 7 sticks and all of the aforementioned mistakes you mentioned I will go back and try again 4 weeks later tomorrow and I’m nervous as hell ! I’ve drank 70 ounces of water today had no coffee or caffeine all day today and it will tomorrow , will dangle my arm , go in with warm compresses , eat salt and pray that they get a vein for my IV infusion that has been postponed because 2 RNs couldn’t get a vein !

  29. Devah Sofia Lucus says:

    Thank you for posting this. I had a lady blow my vein out today. I knew the instant it happened. She left the needle in and kept pulling blood (with difficulty because it wasn’t flowing properly any longer) and I endured it as it became more and more uncomfortable with that needle wiggling around in my arm. I am certain she was new at taking blood and I know she did her best but man is my arm sore tonight. The sight is swollen and hard and I was concerned because I have never had a blown vein look like this before. It’s good to know it’s no big deal.

  30. THANK YOU.

    But I would add one thing to your list: LISTEN to your patient

    I’ve been hospitalized many times for a chronic condition (now under proper treatment) and I’ve had 3 c-sections, two cyst lancings and one elective surgery. I’ve been stuck so many times its sad. One ER visit I actually counted: I’d been stuck over 14 times (count gets hazy once the pain med drip starts) So naturally, my veins have rebelled and lost their elasticity – or whatever it is that happens (I’m not a medical professional) and I cannot COUNT how many times since the last ER stay (five years now!) I’ve had to tell a phlebotomist “that vein does not work. Please use the other arm and use a children’s butterfly” and they just look at me amused as can be and proceed to NOT DO WHAT I TELL THEM. Then they are so surprised that the vein doesn’t work!

  31. Subduedjoy says:

    When doctors/nurses are finally able to get the vein and the blood trickles out extremely slow and then stops, I really can not blame them. I’ve been told that I have veins smaller than their needles and that they roll and constrict when an attempt is made to draw blood. I find that my health (as to how hydrated I am) affects how successful people are in drawing blood More than who draws the blood although some people are better than others.

    Plus, it is a lot easier to explain to people why you can’t give blood when you don’t blame the people trying to draw the blood and instead accept the fact that it is hard for people to draw blood out of you.

  32. Sahara Burns says:

    And please do not try more than 3 times. I have a permanent scar from a student who had absolutely no idea what she was doing, and didn’t want to admit it. So she tried 7 times in the same spot, leaving me with a scar I’ll have for the rest of my life, all because she wouldn’t swallow her pride and go ask for another persons guidance. May I mention I was 10 and this was my first blood work done? Not even an iv, just a blood work, should have been in and out in max 15 minutes. I remeber it so well, because I cried so hard, also ’cause the woman didn’t even use a alcohol wipe, talk about nasty. She was gonna go ahead and try for an 8th time, but my mom, a saint by this moment, personally took off the holder, grabbed my hand and we ran out. She had a first aid kit in the car, and she disinfected it and bandaged it. Let’s just say, that place was shut down 2 years later for multiple violations. I know I shouldn’t blame the student, but I do, if she could have just said,”Can you come look at this?” To any other staff member, maybe I wouldn’t have a scar, that I’ll have for the rest of my life. From then on, I ALWAYS go to the hospital, no matter what, no other lab, ONLY the hospital, where I KNOW they’ll stop by the third try. When I know, someone will get a second opinion. Where I know, they’ll listen to me, when I say, I have deep viens, as I have been told multiple times by doctors, nurses, and anestheologists alike. (hoping I spelled that right, probably didn’t) Where I also know, they’ll check my better arm, (right arm), before my left arm. Nobody in the history of ever, has been able to get blood/iv in my left arm. Always my right, and most times right hand for an iv. Also, If you are the 3rd or 4th person to look for a vien, and you sucessfully get it, without slapping my arm, and making a huge bruise, I’ll applaud you after it is removed. Because I ain’t moving a muscle, no way I’m risking moving and it coming out. One guy before an endoscopy, after 4 of his coworkers, 1 tried, 3 just didn’t even want to try because they couldn’t find one even worth trying, when he got it 2nd try in my right hand. It was like a holy grail moment, in my mind I said,”Don’t move a muscle.” But on the outside I was so happy that after an hour, someone got an iv in. His coworkers after that, called him,”The Vien Whisperer” a title in my opinion well earned.

  33. I know this nurse really messed my vein up last Friday . I even told her it was messed up and she just taped it down . Now a week later it’s so sore to the touch and its brewsing after a week to . Why would it just now get sore after a week ?

  34. I was asked more than once if I had drunk any water before getting the draw. We know now what *that *means, but how would have you handled the situation?

  35. just yesterday I got pricked 4 times in in my right hand left hand right arm and left arm all 4 times the excuse was the vein blown the iv out well how about the large needle pricks in my veins that mess really hurt and now im on day two my body is very sore from all those needle pricks im in a lot of pain and I went to the hospital for one thing but got treated for another is that fair to go and not receive no help for the problem you went in for

  36. Should an IV be inserted in the close proximity of a bloody anal discharge while the patient is having multiple seizures?

  37. Excellent points made in this blog article, however, it shouldn’t be taken as fodder for finger pointing. I saw one comment above saying several nurses botched his fathers IV starts. Without context who knows why, but after 4 years in ICU I can say there are many reasons. I think its uneccessary to “blame” the patient for bad veins, but lets be honest I’ve seen edema so bad an arm is more like a water balloon. Ive seen people so hypovolemic their veins are truly flat. And if someone is 80 and smoked 60 years they may indeed require multiple sticks. Nurses come in all shapes, experience and talents. We strive to improve with every stick. I want to be successful just as much as the patient wants me too. But don’t loose sight of reality some stick are not possible in the periphal veins…these patients need central lines/picc lines.


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