Q&A: Tips to improve IV insertion skills

Q: Do you have any tips on how to improve my IV insertion skills?

A: This is one of the FAQ and often comes from new blog readers. I have blogged about this many times before but I thought I’d post it again. To some of my long time readers, this may not be new but it’s always a good refresher.

Here are some tips I find helpful when peripheral veins are hard to find.

Palpation: Apply the tourniquet. Use your index finger to palpate the veins. Press directly on the vein with your index finger, assessing for vein softness and volume. Then release the pressure slowly without lifting your finger and feel the vein bounce back to your index finger. Repeat as often to ensure you found a suitable vein. Don’t stick without palpating the vein!

Tapping: Apply the tourniquet. Lightly tapping the skin or area where you see veins will help distend the vessel. Avoid “beating” the skin as it might cause venospasms.

Dry heat: Use dry heat to the proposed site. Application of dry heat increases blood flow allowing for good venous dilatation, thus improved vein visualization.  A study showed dry heat is 2.7 times more likely than moist heat to result in successful IV insertion on the first attempt, have significantly lower insertion times, and more comfortable.

Stroking: Stroking the vein toward the hand allow for venous refill.

Open/Close fist: Open and close fist during vein assessment but keep arm relaxed during venipuncture.Keep arm/hand in low (dangling) position.

Skin Anchoring: An important step to the success of venipuncture. Prevent the movement of veins during venipuncture.(especially for “rolling veins”). Pull skin downward below the point of insertion with the thumb of the non-dominant hand or pull skin above the point of insertion with forefingers or pull skin from underneath the extremity.

Insertion: Select the smallest gauge and shortest length catheter. Position catheter tip bevel up. Approach angle to skin at 10 –15 degree. Deeper veins need greater angle. Superficial require lesser angle. If parallel to the skin surface, will drag the skin as you puncture it. Lower angle once blood return is observed and advance the catheter.

Vein Viewer and Ultrasound: There are devices that can help you find veins. The equipment ranges from transillumination to ultrasound. These are expensive equipment and would require training prior to use. There is increasing evidence that the use of ultrasound for venous access is safe and successful.

Take a deep breath: Both you and the patient! Let the patient know when you are ready to stick and tell them to take a deep breath and blow it out slowly. This will distract them from the stick and help the tension in their arm.

Patience: Take the time to do a vein assessment and vein palpation prior to each attempt, don’t stick only because you can see a blue line. Some veins are located deep in the superficial fascia and the extra “fatty deposits” doesn’t help. Veins won’t change position just because you are in a hurry.

Oh, and do document your unsuccessful attempts at PIV insertion – many nurses don’t.

2 Comments

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2 responses to “Q&A: Tips to improve IV insertion skills

  1. Thanks for reposting this Cora. Those are all great tips. The only things that I could add is more emphasis on dangling the arm or having the patient sit up straight if possible. Gravity is a huge help. I also teach that the nurse should be in a comfortable position as well. Take the time to raise the bed or bring a chair to the bedside. I know when I compromise my own body mechanics things don’t go as well.
    A new state-of-the-art, near-infrared vein visualizer is on the market with excellent imaging and proving to be very impressive in finding those veins that are poorly seen with the naked eye. It’s from Evena Medical. I consult for the company and wish I had one for my day job. Maybe soon..
    Darilyn Cole, RN CRNI VA-BC