Six Techniques To Nail The IV Every Time

Did you get the IV?

Sometimes it seems like your performance on the whole call can be reduced to the success or failure of the IV start. Rarely does the successful treatment of the patient hinge on a successful IV placement but sometimes it can certainly feel that way.

The best way to ensure that you’re ready when that make or break it IV start does come your way is to start a lot of them when the pressure is not on. If you wait until game day to practice, you’re a whole lot more likely to fail.

The single biggest factor that separates the IV virtuoso from the weekend hacker is practice and experience, so when the patient could use an IV, jump in there. The patient’s a kid. … Get in there. The patient is a frail, elderly woman on Coumadin. … Get in there. IVs are nothing to fear. Start practicing these six IV start tips. Before you know it, you’ll be an IV starting superstar.

1.) Pick your IV site in 12 seconds or less.

Sometimes we’re really looking for the best spot and sometimes we’re just stalling, but we tend to take to long to find the IV attempt site. It’s rare that the success or failure of an IV attempt hinges on finding just the right vein. It’s annoying for the patient and everyone else involved to watch you endlessly search for your IV site.

It’s not a halloween pumpkin.  You don’t need to search until you find the perfect one that speaks to you just right. Put your flashlight away. When 12 seconds has passed, pick the best site you saw, swab it up and go.

2.) Don’t just look, feel.

Sometimes the very best veins the patient has to offer aren’t visible to the eye. If you get in the habit of simply looking for veins your going to miss some great pickins’. Start by getting in the habit of feeling the good veins that you can see. With a little time, you’ll learn to feel the ones that aren’t visible as well.

Another trick for developing this skill is to learn to find all the veins in your own arm by feel. You can practice this while watching TV or sitting through Keanu Reeves movies. (Yes, he’s playing the same character in this one too.)

In case you were thinking it, no, feeling for veins doesn’t give you an extra twelve seconds. Feeling for veins isn’t an excuse to spend even more time massaging the patient’s arm when you should be making the IV attempt. Once you feel something that’s acceptable, grab that needle and go for it.

3.) Use solid traction.

A huge percentage of missed IVs are poor traction issues. Once you’ve decided on the exact point of entry, get in the habit of placing a thumb a few inches distal to the site and pulling traction. Pull harder than you think is necessary. The patient should feel a firm pressure. You’re trying to anchor down all that flesh and eliminate the possibility of movement.

We neglect traction because it makes advancing the catheter more difficult. Finding a spare digit to help advance the catheter off the needle can be hard with one hand busy pulling back on the skin. This isn’t an excuse to let go of traction at the moment of advance. Maintain that traction till the catheter is fully advanced.

One telltale sign that someone is guilty of chronic traction neglect is that they complain about patients “rolly veins”. “All my patients today have rolly veins”. No they don’t. You’re just not holding proper traction. All veins roll. (They’re round and suspended in tissue.) It’s your job to hold them still before you insert the needle.

4.) Use a shallow angle.

If you’re getting a brief flash in the chamber that stops before you have a chance to advance the catheter, you’re probably inserting the needle at an improperly steep angle. Some folks get the idea that they need to insert the IV needle at a 30 degree or even 45 degree angle. You’re not trying to dive bomb the vein there Red Barron. You’re trying to insert the needle tip within the vein.

Shallow out that angle. The closer the needle approximates the actual angle of the vein, the easier it will be to land the tip inside the vein where you want it.

5.) The catheter goes forward. The needle does not go back.

I see this one A BUNCH. (Sorry for shouting in here.) It’s even more common with the newer safety-glide type needle sheths. If you feel like you have good needle placement and you get a great flash but you just can’t advance the catheter without blowing the IV, this is probably your problem.

Once you’ve achieved proper needle placement and you’re ready to advance the catheter remember that the hand holding the needle does not move. Not an inch. Not a millimeter. The catheter needs to advance forward off the needle. The needle does not move backward out of the catheter.

The difference is subtle. From outside the vein (Where we happen to be sitting) the two moves look almost exactly the same. We try to advance the catheter but that first little push off the needle hub can be difficult. So, to help the catheter along, we move the needle hand back ever so slightly to get the catheter moving. As a result we pull the needle out of the vein before the catheter has a chance to find its home.

6.) Let the bad ones go.

Give yourself permission to fail sometimes. It’s not the end of the world if you miss an IV. Dispite what your partner tells you, nobody out there gets em’ all the time … nobody. And nobody learns good IV technique without blowing a few veins.

Pop off the tournequet. Pull out the needle and apologize to the patient. “I’m sorry, that one didn’t go where we needed it.” Then start looking for the next site.

IVs are uncomfortable for the patient. We didn’t get into this business to cause people pain and discomfort. That can make the sting of a missed IV even more difficult. Ultimately the patients pay for our failures. And some of them aren’t terribly gracious about it.

Learn what you can from the failed IV attempt, but once you drop that failed needle in the sharps box, forget about it. The previous failure has no bearing on your next attempt. Don’t let it haunt you. Document it. Include it in your hand-off report and own it, but don’t let it affect the next attempt.

Your last IV attempt is already in the history books. The next one is still a question mark. That makes the next one immeasurably more important. Go get the next one.

What other IV tips do you have? Why not type in a comment and let us know before you move on.


Related Articles:

Four Sloppy Iv Mistakes That You Should Avoid

Glucometer Errors

Five Assessment Findings That Should Concern You

Describing Pain



  1. the yager bomb says:

    I like to put my anchor tape on the Iv cannula wings before I even poke the patient, that way I’m not fiddling with it after it’s in. I don’t miss often and it helps to practice on those patients that are dehydrated, or not alert and oriented. I love putting in an iv in the combative patients, talk about a hard stick.
    I never go for a 22, give me a 20 or an 18, they last longer, go in more smoothly, and you can use them for more varied purposes. My first question to the nurses who come and ask for my help to get an iv site is did you already try? And then did you feel anything? So many of the newer nurses look at the tiny spider veins that some of these elderly patients have without ever touching them. The patients have pipes you’ve just got to feel for them. And alot of nurses who aren’t comfortable with placing ivs or it off so that a more experienced nurse can take “a stab” at it, but one of these days, wham! You’re gonna need a good site because the patient is coding. Don’t put it off! Just poke them! Take some deep breaths and tell yourself you can do it, being negative only breeds hesitancy and mistakes. Be confident. And seriously? People it’s just a needle, just be glad they’re not putting you in 4 point leathers for stupidity. I swear most health issues are self induced, here’s your gold star for killing yourself with cheeseburgers and fries.

  2. I’m not an EMT, but I’m a nurse! I understand the “find it in 12 seconds” for the EMT, but on the floor (where I work) the patient has already had 1 or 2 IV’s already and now on the 3rd one! So I’m presented with a bruised up arm, sagging skin, edematous, thick skinned or dialysis patient arms… sometimes the person will be “Right arm precaution” or “Left arm precaution” and all I got is one arm… (all bruised and beaten up). So… it is unrealistic for a floor nurse to find a vein in 12 seconds. It depends how the patient presents to me. Here come the EMT turned into nurses finding ALL the veins and I’m over here like, “Gimme a break!” But, this was inspirational because I am in a IV starting slump myself.

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  6. I have a problem performing iv line. Which veins can i use so that i dont hurt patient

  7. Please DO TAKE an extra 12 seconds, minutes, whatever it takes! As a patient with “poor veins”, I’d rather be “poked” once well, rather than end up with two bruised arms. And I really, really appreciate a nurse who’s good at this stuff! My (apparently self inflicted, according to one of the commenters) type 1 diabetes (so I’m not shy about needles) takes me to the hospital often, so I’ve grown to idolize nurses who respect their patients and professions enough to become brilliant at these little things.

  8. thank u it’s amazing how these words touches u .

  9. I’m a nurse and work since many years in a vascular surgery ward.
    I DO search a lot for veins in some cases, and the sensible words of Patient X should teach something to us all.
    Obviously there are the big ones (veins/arteries) you use in emergency situations, right?
    But if you have the patient described by Irma, or want to prevent infection in an immunosuppressed subject, then size matters and it’s the patient’s safety, not the satisfaction given by stabbing him with the biggest pole you have on hand that matters, too (imho).

  10. I want to thank you for this post. I work in the lab at a hospital but I don’t do blood draws but feel sometimes I could put in an IV or draw my own labs than those trying. I have a illness that has required a lot of IVs, and lab draws. I appreciate the looking to try and find a vein, but I also see the EMTs perspective as some of us with poor pickings to start with you might never find what your looking for. My veins are so tiny I have to have the infant size IVs and I’m 33. If a larger one is needed they call in the big docs with the ultrasound. And lately they have even been having a hard time. today I was stuck by home health nurse 5 times and not one was successful for my IV as I have needed fluids for rehydration. We tried even in the shoulder area. But I did see the ineffective traction from this nurse and this nurse also did not do like you said to in the advance the catheter and not the needle. In all 5 times though there was never a flash. But in 2 attempts it was appearant it was in the vein but it blew. So thank you in now I can be a more responsible patient and offer some suggestions since everyone is scared to attempt me. it’s a good thing I’m not afraid of needles, so I would make an excellent practice target for honing someone’s skills.

  11. Sarah Gehrke says:

    As a nurse in a position with 100% conscious people, I have found asking the patient which veins they have had IVs in the past, what worked, and what didn’t. I am extremely proficient with drawing blood and have not had the opportunity to work with catheters very much. I bet I have done 300 or less IV insertion using catheters over a 10 year period and uncountable blood draws. Even though I am skilled in vein anatomy the fear for me is getting the catheter sheath inserted without making a mess while trying to hook of the line (yes, tourniquet off asap). The last few I did were not such a mess:) Thank you for sharing this and providing encouragement!!

  12. Rad Tech Student says:

    I am an XRay Student in my final semester. We are allowed to start iv’s with direct supervision. I have had some of the best techs teaching me but I still fumble at the catheter slide. My hands are small and I can’t figure out how to hold the needle and slide at the same time. After reading this I think I have been doing a few things wrong like not holding tension at all times to the skin and I also think my angle is off. I love attempting sticks because there are times when my sticks are flawless! Most of my patients are elderly so I can’t always see the veins. I have learned how to feel for these veins but I am still anxious on sticking them. Any tips?

  13. I am not a nurse; but, when I receive an I.V., It is much less painfull to have the outer vein used; than to use the inner arm vein.

  14. I’m the patient that demands that you do it right the first time. I don’t want anyone practicing on me. If you don’t know what you’re doing tell me so I can get up and go to a different facility. I pay big bucks not to be an experiment. I have had two failures in my life and will never have anyone but the best. If I tell you about the problem ahead of time and you’re not the right person for the job, back out. Reschedule, find some one else that can do it, or refer me else where.

  15. What I will take away most from this is the importance of anchoring that vein as well as not moving the need back while attempting to advance the catheter.

    Thanks for taking the time to write this and share it with us!

  16. Russ Anderson says:

    Make sure you know where your turniquet release is. I always pop the turniquet as fast as possible once I get a sniff of blood return. It allows for blood flow to guide the catheter up the vein as well as decreases the amount of blown veins. Poke, flash, release, advance.

  17. I’m an RN and recently switched hospitals and units- we are only able to insert 18gage IV’s, and have to use lidocaine for each stick. I’m on the losing end of the battle, and feeling terrible over it. I had become proficient in butterfly IV’s, now we only use angiocaths. Does anyone have any suggestions for insertion post lidocaine? So far it’s not my friend.

  18. Anonymous says:

    Barry your an asshole.

  19. There is nothing wrong with Barry’s thinking. I am a RN. I have been on the patient side more than I would have liked to. I don’t care for needles pointing in my direction. So, yeah, you stick me once. I learned to stick well because I don’t like being stuck. Sometimes your first encounter with your patient involves you starting an IV. If you can’t do that well, they may question whether you know what you’re doing in other areas and you could very well be brilliant. But as for the 12secs…I will look as long as I need to find a decent vein to stick, because 98% of the time, that’s the only stick I need… but hey, I’m an IV/ER/ICU RN. I did work the floor too and I believed in teaching my nurses how to “up their game” in the IV lane.

  20. Ah Barry, I’d love to send you to another facility but that’s not the way it works dickhead.

  21. Look, we all have good stick days and bad ones. Of course patients only want to be stuck once. Who wants to be stuck more than that? But who knows, the patient could be dehydrated, it’s an emergency, etc… I really enjoyed this article. For those of you who are just starting out, have a professional do it on you, just so you can understand how it feels (empathy for your patient). The hands tend to hurt more than antecubital. Try your best and be professional. You’ll be fine.

  22. Mikey ^_^ says:

    I utilize both hands when advancing the catheter. I agree I see it all the time too where people inadvertently pull the needle out while trying to advance the catheter in.

    So what I do, I pull the traction distally, poke, get a flash, lower it and advance it juuuuust a tad, at that point, my needle is where it needs to be, I don’t need to continue puling traction, so look at that, that hand is free!
    Here’s the key moment, next I drop my needle hand down so that it is anchored down on their arm, that needle is going nowhere now. If you don’t anchor it, then you have a big chance of accidentally pulling the needle back out, and you needle that needle there to guide the catheter in. And now my free hand is free to just slip that catheter right in there. Also, once you get that catheter all the way in there, look at that, your fingers are already right where they need to be to occlude the vein for pulling the needle out mess free!


  23. Tracey S. says:

    I am a new medic and IV insertion has been my nemisis. I am usually terrified especially when a room full of spectators are watching just to see if you are going to get it. Love the article. I am definitely going to use the tips given.

  24. Cristina says:

    How about in pediatrics?! No only do you have a tiny, Moving, screaming, crying, wiggling target, that Alston dehydrated 90% of the time,but you also have their hovering parents watching your every move and offen also crying. Lots of fun. buffered lidocaine is a wonder drug when you can use it.

  25. Thank you for your article, it,s been very informative. I am pretty sure I will use your tips while inserting an IV insertion.

  26. OMG! The best lesson I just learned is – never tell the tech you’ve done lab work. I did lab work for yrs. on infants and obese individuals. Recently had minor surgery, I mentioned to the tech that I’d done what she was doing…don’t ask! She hit an artery! So, good advice, never instruct. If anything simply ask them to hold the vain down while inserting the needle.

  27. I just printed out these tips out and will give them to my surgeon next wk. on my post op appointment. Very helpful.

  28. Anonymous says:

    I am a nurse and practicing for about 7 years. I have done Thousands and thousands of successful IVs with different kinds of catheter and brands. For every brand of IV catheter, I uses different techniques. (Maybe some of you guys cannot distinguish the difference of the catheter.). For successful IV insertion, I don’t believe in 12 seconds IV site assessment. EMT usually starts IV at the field where fresh veins are shouting at your face and saying “PICK ME”! While on real world where you are dealing with CHF patient, with +4 edema on x4 extremities. ESRD, hemodialysis patient with AV shunt on the other arm. Chemo patient with infected porta cath, and so on and so on… 12 seconds is not enough!. I am old school, I don’t use vein finder or ultrasound. I patiently take my time to make it sure that I won’t make my patient a pin cushion: I always feel bad if if stick my patient 2X. Here’s my basic input for successful IV insertion and the rest is just experience. (1) GOOD LIGHTING. Before you start the IV procedure, make it sure that you have adequate lighting. Open the curtains or blinds of the window. Natural lights is better than lamps. At night, turn on all lights, or bring yourself a flashlight. (2) POSITION. You have to be on the most comfortable position. If there’s no extremity mobility precaution, try to move the extremity according to the most comfortable position you’re at. (3) ARM ELEVATION. If there’s no arm mobility limitation, tuck some pillow under the arm higher than the heart. Rationale: veins are less muscular than the arteries, with valves and more distal to the heart. For these reasons, the pressure at the vein is lesser than the arteries. Therefore blood return is also lesser. So if you try to elevate the arm higher than the heart level, you are promoting more blood return and the vein will be more visible for IV use. (3) STRETCH the skin. Often times we are hearing that “OOpps your vein rolls”, every time we missed?! Lol. Do me a favor, stretch the skin please. (4) ADVANCE a tiny bit. As I mention above, not all catheter are the same. Some catheter are pliable and they bend when you push the plastic catheter in. The reason is because of the tiny gap on the tip of the needle bevel and the tip of the plastic catheter. Sometimes the tip of the plastic catheter was just on the outer layer of the vein. So if your catheter is soft and pliable, the catheter will sure just gonna bend. To make it sure that you are 100% in, Advance the needle and catheter together a tiny bit but very slowly before pushing the plastic in alone. (4) Practice, practice and more practice.

  29. Everyone has to learn sometime on someone. Barry is living in a dream world. I would love to pick and choose patients the way he wants to pick and choose medical staff. Unrealistic people like him are part of the burnout problem in healthcare.

  30. Anonymous says:

    Barry and Mimi, it must be nice to be so perfect. Let me just say that it doesn’t help matters when you’re a dick to the nurse or tech starting an IV or drawing your blood. It only makes them nervous, and a nervous nurse/tech doesn’t always perform to the best of their ability. People aren’t born knowing how to perform venipuncture, it takes practice and experience. So yeah, we have to practice on patients to become good. That being said, when one is in training, you have to know when to quit and get someone else. For me, it was after the second failed attempt. I’m a PETCT tech and all my patients are oncology patients. Most of my patient’s veins are shot due to chemo therapy. Obviously, the “12 second” is not feasible when dealing with oncology patients. I’ve had patients thank me for not rushing in, and taking the time to place warm towels on their arms. I have my technique down and everything, but whatever, what do I know right? I’m only successful 99% of the time not 100%

  31. Excellent info!!! Thank you, keep it up, Im listening =)

  32. What about in cases where you manged to slide the whole cannula in and managed to draw blood from that cannula before flushing and that subsequently have problems running fluids through? Being able to draw 2 tubes of blood from it should mean I’m definitely in the vein right.. Why would it still not allow fluids to run through just 1h later??! This happened to me today and I’m totally gutted and puzzled

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