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.


Choosing the Appropriate Site:
    •  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.

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