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.

Steve

Comments

  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).

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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????

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