Bevel up or Bevel down?

A week ago, a colleague @nerdymedic posted this question posted this on Twitter.

“Can you shed some light on the “bevel down” technique that some profess for peds?”

It was an interesting question, to which I replied:

Bevel down vs. bevel up when inserting IV catheters. I have always inserted peripheral IV catheters bevel up because entering with the bevel up allows the sharp tip to pierce the skin first, paving the way for the rest of the needle. I noticed that entering the vein with the bevel down causes painful tearing of the skin. I work with adult patients and have only inserted IVs in a few peds patient mostly school age kids, and use bevel up. However, when accessing a dialysis fistula, I use bevel down as it causes less damage and less bleeding.

I think most nurses were taught to insert bevel up. There are a few who insert bevel down and have found it very helpful resulting in a successful insertion.  What do you think? Do you insert bevel up or bevel down? If you work with peds, do you use the bevel down insertion?  Take our poll:

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5 thoughts on “Bevel up or Bevel down?

  1. Interesting question here Cora and I hadn’t thought about a bevel down technique for specific applications like dialysis fistulas. I wonder what the people who chose “Neither” do? Sideways?

    Keep the great articles and questions coming. Love the Infusion Nurse blog!

  2. Pingback: Best In Nurse Blogs: Thanksgiving Edition | The Millionaire Nurse Blog

  3. Another question might be, why bevel-up?

    Is it tradition and dogma, or science? As you probably know, there are many things we do based on tradition that are ill-supported by science.

    Not retracting and re-inserting a needle when starting an IV is one example. The rationale for it was to avoid the potential for catheter shear…

    … but that was only true for the older, through-the-needle catheters. Modern, over-the-needle catheters work differently. While you might indeed bugger one up by retracting and then re-inserting the needle, it is nigh impossible to actually shear off a piece.

    Yet still we teach people to fear that consequence, when it no longer applies to the equipment we use today.

    • Bevel up is recommended because entering with the bevel up allows the sharp tip to pierce the skin first, paving the way for the rest of the needle. This is also supported by evidence based books published by the Infusion Nurses Society and Nursing interventions & clinical skills by Elkins, Perry and Potter 2007 edition, to name a few.

      Reinserting a needle when starting an IV is definitely not recommended for the reason you shearing of catheter.

      Thank you for your comment.

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