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Friday, June 05, 2020

20+ IV Therapy Tips and Tricks : Improve Cannulation Skills - Nurses Class

Intravenous therapy, iv catheter
Image Source - Pixabay 

IV Therapy Tips and Tricks

Intravenous (IV) insertion is the basic skill for every nurses and nursing students to learn, but it could be the difficult skill for most of the nurses. To be a master in IV insertion you need lot of practice and perfect skills.

A intravenous insertion may be a painful procedure for patients. So, as a nurse you have to perform this very accurately and skillfully. You should not perform any mistake during this procedure.

Here are the Tips and Tricks for nurses to hit the vein in one shot during the Intravenous (IV) Therapy procedure.

1. Gather confidence and be prepared -
You may feel nervous and also your patient may feel fear and anxiety. Before doing the procedure first prepare yourself, gather confidence and believe that you can do it. Your confidence will encourage your patient too. He will start to believe that nurse will do this procedure safely as she/he has enough confidence.

2. Explain the procedure -
Patient may have lot of questions and confusion before the procedure which will increase fear and anxiety. So, before doing intravenous insertion explain the whole procedure and encourage him/her not to worry about it. Your explanation and encouragement will help to prevent excessive fear and anxiety of patient.

3. Hide needles -
Before the intravenous insertion hide the needles to avoid needle phobia of patient because by seeing needles patient may feel fear which increases blood pressure and pulse rate. So, give enough psychological support, educate the patient and especially keep the needles out of sight until you use it.

4. Use topical anesthesia -
Intravenous insertion is a painful procedure. It is very to control the children during the procedure. So, use topical anesthesia on the insertion area to reduce the pain.

5. Divert patient's attention -
During the insertion patient feel so much of fear, anxiety and pain. The fear of needles and blood makes them more nervous. To avoid it, talk with them about some topic which makes them to think about your questions. By this method patient's attention will be diverted to another event.

6. Follow past history of patients -
Sometimes it is difficult to find out a suitable vein. Ask patient about his/her past IV history so that he/she can prefer you the suitable vein for intravenous insertion.

7. Assess the vein carefully -
Before the IV insertion you must assess the vein carefully as you can not see the veins. So, try to feel the veins by your fingers, trust your fingers and feel that vein is suitable or not. Palpate smoothly so that you can differentiate veins and tendons.
Along with this you must check the fluid balance level of patients. If the patient is enough hydrated, the veins will be bouncy.

8. Choose appropriate cannula size -
It is most important to choose a appropriate cannula size according to patient size. If you select a vein which is smaller than the needle size, the vein may get injured as the needle is bigger than vein. Choose the cannula size based on gauge number. 
Remember that smaller gauge number means larger diameter of needle lumen and larger gauge number means smaller diameter of needle lumen.
To choose the appropriate gauge of cannula, follow the cannula colour. 
Needle Gauge Size and colour

Make the Vein More Visible

9. Apply warm compress -
If vein is not visible properly, apply warm and moist compress which will dilate the vein. Keep the compression for 10 to 15 minutes. Please remember that compress should not be hot.

10. Keep the arms down -
Advise the patient to keep his/her arms down toward the earth to promote the venous filling. When the arms are toward the earth, gravity works to decrease the venous return which fills the veins with enough blood. It helps you to feel the veins easily.

11. Use nitroglycerin ointment -
Before the intravenous insertion you have to make the vein dilated. Dilated vein makes the insertion easy. Apply nitroglycerin ointment for two minutes to the site. Remove the ointment before IV insertion and disinfect site.

12. Stop slapping the vein -
Most of nurses are used to slap the veins or sites to make the veins. But stop this habit though this method helpful to visible veins because veins ending have nerves which give painful stimuli to slapping and also contract veins. If veins get contract, it difficult to locate.
So, I request you to avoid slapping the sites, it makes the procedure even more painful for patients.

13. Gently flick the vein -
Dilated veins are more visible and easy to insert the needle. So, instead of slapping the sites, flick  the vein with thumb finger and index finger. This method release the histamine and dilates the vein.

Vein Selection Tips

14. Place the tourniquet correctly -
Place the tourniquet tightly to obstruct the venous flow and make sure that tourniquet is not too tight. Too tight tourniquet may obstruct the arterial blood flow. Check the radial pulse after placing the tourniquet if you can not palpate radial pulse, your tourniquet is too tight.
Place the tourniquet 25 cm above from the IV insertion site.

15. Palpate the vein -
After placing the tourniquet correctly, palpate the vein gently by pressing up and down. Palpate the nearby veins also with the same finger so that you can feel the bouncy vein. Palpate and feel the veins but never slap the site, it contract the veins.

16. Use BP cuff instead of tourniquet -
BP cuff
Image Source - Pixabay

Use this method when veins are too difficult to palpate specially for the older age patient. If the patient has low BP, it is difficult to feel the vein easily. In this situation use a BP cuff instead of a tourniquet. Inflate the cuff to the lowest pressure and check the veins are palpable easily or not. Adjust the exact pressure to dilate the veins. Using a BP cuff makes the patient more comfortable than the tourniquet.

Intravenous Catheter Insertion Tips

17. Support the vein -
Before inserting the needle give support the vein by pulling the skin just below the needle entry site. It decrease the pain and give support.

18. Hold the catheter at 15-30 degree angle -
Hold the catheter between 15-30 degree angle to the insertion site and also hold the bevel of the needle upward. The appropriate angle of the catheter helps to prevent vein injuries.

19. Twist the catheter -
Twist the catheter when you feel mild obstructions and frictional resistance. Make a slight rotating motion to overcome the resistance. Do it very carefully and don't be hurry because a little mistake will make it painful.

20. Discontinue if painful resistance -
Don't insert the needle further if there is a painful resistance. This pain may be due to any obstruction or vein injury. Feel the condition carefully when you inserting the needle and if there is no resistance, you continue the procedure further. 

21. Check for Flashback -
During the catheter insertion check for the Flashback (backflow of blood from the vein to the catheter). It signify that needle is placed properly in the vein. When you will see the Flashback, remove the tourniquet and remove the needle also and secure the catheter to the skin correctly.

Essential Consideration Tips for IV Therapy

22. Inside the ambulance -

Lock the patient's limbs in the ambulance as it moves. By moving the limbs, it make difficult to insertion, block the IV fluids and increase pain.

23. For old age and children -
Use a small diameter needle lumen as they have smaller and weak veins compared to adults. Before insertion, stabilize the children and hold the old age patients as they prone to falls.

24. For dark skin tone patients -
For dark skin tone patients may be little difficult to visualise the vein. So use BP cuff and adjust it until veins are visible and also wipe a cotton swab towards vein direction.