Expert Insights
Intravenous Access
You're so Vein
If you’re working in direct patient care, you will more than likely find that you will be working with someone’s veins. Mastering the art of locating the target (vein), devising a plan for point of entry, and stabilizing the delicate tissue can be difficult even for seasoned nurses. As an Emergency Department nurse, intravenous access is something that is obtained numerous times during a shift. We draw blood from the newly inserted intravenous catheter (IV) and then administer fluids or medications. Oftentimes, people are very ill when they seek care in the Emergency Department and their veins are literally hiding, which can be frustrating for both the nurse and the patient. There are, however, some tips and tricks that can be done to help ease this process and tension between the patient and the one holding the needle.
- Be confident! Explain to the patient what you are going to do and ask permission. Almost always they will be agreeable, but there are some instances that the patient will refuse all needle sticks.
- Hand hygiene: In the ER, things can be a bit hectic and hand hygiene seems to be pushed out the window when critical situations arise. It is always best to use some hand sanitizer and to let your patients and/families see that you are using it.
- Use a stool or chair: Save your back! You will be thankful in a few years that you did.
- Open all of your packages onto a clean bedside table or stand. This makes the process quick and smooth.
- Apply a tourniquet to the patient's arm above the antecubital area.
- Dangle the patient's arm with their hand off of the bed nearly level with their shoulder. This helps those stubborn veins to make their appearance to the surface.
- Always prepare for blood culture collection. Even when you don’t think you will need it, it will more than likely be ordered. Confirm with your ordering physician if blood cultures are needed. Scrub, scrub, and scrub some more, let the skin dry completely, and do NOT touch the skin after it has been scrubbed. When the skin is touched after it is scrubbed, it causes blood culture contamination rates to skyrocket.
- Knowing the anatomy and location of veins will help you tremendously when it comes to blood draws and IV insertions.
- “Pop” or undo the tourniquet and draw the lactic acid. This should be obtained last and without a tourniquet because the results can be skewed and create false positives.
- Thank the patient for allowing you to care for them. A little kindness goes a long way.
These are things I have learned over the years and have proven to be very helpful.
Happy vein finding!
With care,
Jamie L. Silvey, RN, BSN, MHA, CIC
