Tricks how to hit a vein every time
Choosing the Catheter Gauge depends on the clinical scenario:
- 16-gauge-: large amounts of fluid must be given quickly;
- 20 or 18 gauge: administration of blood products;
- 22 gauge: routine administrationof maintenance fluids and antibiotics
- 18-gauge for IV contrast–enhanced computed tomography (CT) studies, pulmonary CT angiogram.
- 22-gauge catheters: hand veins
- Large-bore IV lines: cephalic, accessory, or basilic veins
- Avoid veins that are not resilient and feel hard or cordlike because they are often thrombosed
- In patients who have undergone radical mastectomy, avoid the arm on the same side as the surgery because IVs may impair circulation, affect flow, or lead to edema.
Tricks for Finding a Vein:
- Ask patients to open and close their fist
- Lowering the arm below the level of the heart
- Light tapping can likewise be effective, although heavy tapping may cause the vein to spasm.
- heat packs can be applied for 10 to 20 minutes to increase venous engorgement.
- Nitroglycerin ointment.
- Once the tourniquet is applied to the wrist, apply a quarter inch of 2% nitroglycerin to a 2.5-cm2 area, leave it on for 2 minutes, and then rub it off
- The combination of topical nitroglycerin with local anesthetics has been shown to increase success and decrease the pain
Cannulation:
- Wash your hands, wear gloves.
- Clean the injection site with iodine, alcohol, or both.
- Stabilize the vein: position one’s thumb alongside the vein and pull down while the index finger is positioned more cephalad and pulls upward.
- Take the angiocatheter, angle the angiocatheter 10 to 30 degrees between the catheter and the vein.
- Puncture the vein. Once a flash of blood is seen, advance the catheter several millimeters more to ensure that the catheter has entered the vein and not just the wall.
- Avoid advancing too far and puncturing the posterior wall.
- Advance only the catheter, not stylet. Use the fingers to occlude the vein at the tip of the catheter to prevent extravasation of blood from the angiocatheter.
- Remove the needle; connect the saline lock, IV lining, or syringe for phlebotomy; and release the tourniquet.
