I Need Your Best IV Starting Advice

The EMT Spot needs your tips and tricks! I’m collecting the very best tips and techniques for nailing the IV every time. What have you got to add? What are your very best techniques for making sure you get the IV started when it counts? What’s the best IV starting advice you ever received? Now that you know, it’s time to help your fellow EMS brethren on their way to IV mastery.

Send me your contribution and, if  you make the final cut, you’ll see your advice immortalized right here in a future post. This is your chance to contribute to the ever-growing database of EMS knowledge that is The EMT Spot. I’d love to put your name right here, along side many of the industry’s top educators and EMS practitioners.

Send your IV starting advice to steve@theemtspot.com, send me a tweet @SteveWhitehead or click on the comments section and add your advice right here and now.

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  1. This might not be what you’re looking for, but know when to stop and transport. I’ve been on the scene for 20 minutes while medics are trying to start an IV on a pt in hypovolemic shock; just go. It is better to get them transported to a hospital with a ton of better resources than you have in your bag. Everybody wants to be the hero, but sometimes that entails knowing when to pass the torch.

  2. Steve Dahlin says:

    I couldn’t agree more, knowing the moment to make a decision isn’t giving up, nor giving in but its hard not to experience the sense of defeat when it happens. Ultimately getting the patient to the destination is best under these difficult sticks rather than camp out too long and risk further complications.

  3. My best advice is to not hesitate! Time and time again I’ve trained students that hesitate for too long. It’s scary when your learning, we have all been there, but you can’t hesitate. Once you find the vein, get it in, the longer you wait the more you shake and worse the patient is waiting scared (if they are awake anyway), which means they are afraid of the pain and the body reacts via constriction making it even more difficult. So feel that vein and get it in, fast and shallow:)

  4. -The vein you can feel is typically better than the vein you can see
    – get in quick, don’t hesitate, especially while transporting
    – advance just past the flash point before threading the cath.
    – for very mobile veins hold good traction and enter from the side of the vein
    – to much traction can flatten a vein, especial in the elderly or hypovolemic
    – larger bore IVs require a shallower insertion angle to prevent blowing the rear wall of the vein.
    – don’t forget to look under watches/bracelets

  5. – pulling the skin just a little tight to help stabilize the vein and also helps for patients that have veins that tens to roll, this will really help.
    – if a patient looks like they are going to be a tough stick, ask them. Moat of the time they are used to having multiple iv attempts and know where the most successful spots are. Listen to your patient ( this does not apply to patients that ask for ” butterfly” iv’s in the hand. Have to explain to them that we don’t use ” butterfly needles ” in the field.
    – don’t hesitate or fish too long. Use cause not to shear your catheter.

  6. Oops. Sorry for the bad spelling in the last post…. guess I should pay attention to auto fill before hitting send.

  7. The best advice I ever got was from my first partner. It was simple, it was basic, and it worked.

    *Stop thinking about it, and just do it.*

    Once I stopped thinking about if I was going to get it or not, I started hitting more and more. The more successful you are, the better the confidence, the less you worry, the less you think, the more you act, the more IVs are established.

  8. Agreed with Joe. Just do it.

    Don’t be afraid to look in “less obvious” places. The majority of classes and/or preceptors (personal observation) go for the classic locations, ie. A/C, hand, etc. I look at the forearm, both anterior and posterior, look at the anterior shoulder, and even the foot/shin area. These veins are the lesser used, have less vein wall trauma, and are in non-articulating areas (shoulder doesn’t diminish ROM). Don’t hesitate! It prolongs the patients anxiety, as well as your own. Pay attention to medications. While I have no concrete proof, I swear that every patient I stick that’s on Plavix have weak veins. Try inserting bevel down to prevent penetration of the opposite wall. If you hit a valve, attach a flush and “float” it in.

  9. Well it’s not too hard if you follow the process. First you select the proper equipment. The 24 year old male who just had a heat stroke on the job site would be a knock out candidate for a large bore in each arm. On the other hand the respiratory distress patient would probably be fine with a 20 in the hand. It all depends on the pt and what treatments need to be given. Will they likely receive blood? Are they just a medical pt? MOI/NOI every time.
    Second: Identify a site for venipuncture. I’ve learned to memorize the spots. Along the radius just distal to the wrist, between the tendons for the pinky and ring, are both good places. You know they’re there even if you cant see them. Start distal, move proximal.
    Third: If you fail, let your partner do it. If your partner can’t do it, let the hospital do it. It happens every day. Don’t let pride get the best of you and blow all the good sites, because that is just poor patient care.

  10. Talk to your patient! Especially the ones who are in every other week for some procedure or another. They generally have a good idea of what works/doesn’t work for them.
    I had this older guy one time, who had had Chrons for 20+ years. Terrible access sites. I mean, I tried everything and there was just not a vein on the guy. So I asked him if there were any tricks that the lab techs used on him when they were taking blood. And he told me the only thing that had ever worked was soaking a blue soaker pad in hot water, wrapping it around the arm, putting a heated blanket around that, and waiting 10 min. We weren’t in a rush, so I gave it a shot. And whadda ya know, a little vein came out of nowhere and I got it on the first shot.

  11. Charlie says:

    While advancing the cath and you feel resistance elevate the limb ( so the blood will flow back towards the heart) valves are one way, and if your against a valve this may give you the help you need.

  12. A little trick i picked up along they way if you are trying to get one on the top of the hand or really anywhere you are worried about the vein rolling. Find your vein and start to the side of the vein. Still hold distal traction and start at about the same angle you usually go over the vein but to the side. Then when you stick and the vein moves you will trap the vein. It will only move to the side so much and you will get it. Move the needle to the side more parallel to the vein just like you drop your angle over the vein and advance the catheter. Learned that trick from a nurse in th er, then another nurse saw me do it and said she had never seen that but liked it. Pretty helpfull sometimes.

  13. I was an intermediate for 4 years before I became a paramedic most of the tricks I learned where from trial and error. The best advise I give all my paramedic student riders is. SLOW IS SMOOTH, SMOOTH IS FAST! Basically if you take your time and I don’t mean minutes I mean when you stick make slow steady movement forward constantly watching for a flash or feeling for resistance and when you finally get the flash STOP check position and then advance the needle just enough to ensure the catheter is just inside the vein then advance it. Keep in mind this best used in little old people and small children with fragile veins. I for one hate sticking people more than once and this works really well. Ultimately you will save time by getting it right the first time. Also I found that is you have a vein that’s shorter than the iv cath you can start a short distance from the vein and work your way under then skin into the vein so that you don’t have a big peace of iv cath sticking out of the patient.