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. I was hospitalized for 5days for pneumonia and had to get antibiotics in iv form. They said I was a hard stick etc. The plebotomists had to do the nurses’ job…I hated it. Anyway one of the iv sites, one in the vein in my left wrist is itchy now (I’ve been out the joint since the 10th), and I can feel and move the vein. Like I pick at it and can push it left to right…is that normal or am I going to die???

  2. I was to have a cat scan with the dye put in an IV I had in my hand. The nurse kept flushing to make sure the dye would go in without any problems but I remember it kept getting stuck or would not push through correctly or enough. So another nurse took over and flushed it but still was having problems with it flowing easily. So I layed down and was told to raise bot hands above my head, so I did. Apparently the one nurse was going to push the dye through once the procedure was starting. All of a sudden I felt this excruciating, burning pain! It felt like my hand would explode! I screamed and screamed and screamed until a young Indian doctor ran in to see what happened. He was freaking out because there was this women in complete horror and terror, screaming and crying at the top of her lungs. I mean I have never felt pain like that my whole life It was very traumatic, I was shaking severely from the trauma and it would not stop hurting! I was transferred to ICU to have my hand watched every 15 minutes because it was almost too full that it might not be able to contain. The hand surgeon on duty said , “It looks like we are going to surgery,” He said he was going to have to slice my hand in a couple of places on top and on the inside as well as down my inner arm which would leave a nasty scar. We were getting ready to go when he was called to emergency where a three year old had sliced their main artery and needed it repaired immediately. He said. “I’ll be back in about an hour and we will go from there.” So I called everyone that was of concern and told them I’d be having surgery and the end result would be some very nasty scars. I cried and cried because I knew this was going to happen to me. After 2 hours, the surgeon came back and looked at my hand and said he thought there was some improvement and that he wanted me to begin being monitered every 15 minutes again in the ICU. So that made me feel a bit better. The next morning my hand had gone down completely, with the exception of the heartbeat of pain it was giving me. I had always though horrible things about narcotic pain meds but I know could see why they were used in the medical field. This was definitely a time for their use. The next day all I had left from the ordeal was a few blisters on my hand and wrist, and some bruising, however, I still have that heartbeat of pain that won’t go away. I believe I may have some nerve damage due to some numbness and cramping that won’t go away. I hope no one ever has to go through what I did as it was a most traumatic experience!

  3. My Aunt, had to have some blood drawing from her right arm, and the Tech said that her veins blew. Meaning she couldn’t find one but soon after that her arm started blistering up what is that? Now her right arm has a tear the whole middle section you can see the raw meat where the skin has come off. so said. Today I come in and it’s not covered at all the Tech that was seeing her, got called away so what do you do then

  4. I was at the doctor on Friday and was told that my veins and small and they roam. I am returning on Monday for another attempt and was told to start drinking water about three hours prior to my appointment, will that make it easier for them to draw the blood.

  5. I’ve been a CNA for 6 years and in that time I’ve seen a lot of nurses do a lot of questionable things. Touching clean Iv sites is one I see all to often. Especially when they think they lost the vein. I just had my appendix removed at 32 weeks pregnant. While not totally uncommon it’s not something you see a whole lot. I was shipped from my small town hospital to a beautiful respected teaching hospital two hours from my home where they had doctors and surgeons available to handle my case. Upon arrival my iv needed changed. I know I am a hard stick. My veins literally run from people. I was in so much pain I really didn’t care that I had over 20 attempts from 6 people to get not one but two Iv sites started. 20 gauge needles are not fun but I needed surgery and my baby and I were in serious trouble if we didn’t have the surgery that night. I allowed the attempts. An airvac medic tried one time And went right thru the vine on my right forearm and several nurses blew both hands and left forearm. Finally an anestisiologist was able to barely get one in my upper right forearm and I had the second one started during surgery in my left wrist. Immediately when I woke up I had the one in my wrist removed. I have bruises up and down both arms. I am a hard stick. Surgery went well and my son and I are perfectly fine. We are due for a c section any time now and I’m not looking forward to having an Iv started again. I’m the one every nurse dreads. I’ve never had anyone start an Iv on the first try. Even simple lab draws lead to collapsed veins and multiple sticks. I am a healthy person. Never sick or hospitalized except for the birth of my children and now the appendectomy. But I have terrible veins.

  6. I have to open and close my had A LOT when I go donate at biolife otherwise the machine doesnt work. And personally my veins do fill up a a lot faster if I do movement and it makes sense. The more you use your hand muscles to move the more those muscles will demand oxygen increasing blood flow to the areas.

  7. 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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