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I V
S T A R T S
FEEL AND FIND
How to Locate Hidden Veins
I
f no sizable vein is apparent when
You don't need to start a central
attempting an IV
venous catheter in the
start, apply a blood
jugular — a simple 1¼-
pressure cuff from an
inch, 20-gauge periph-
automated blood pres-
eral IV catheter will
sure machine on top of
suffice. Because the
the elastic tourniquet.
size and diameter of
Activate the blood pres-
the jugular is larger
sure cuff in "stat"
than most arm veins,
mode, or repeatedly
and because the jugu-
inflate the cuff in "manual" mode. The pneu-
HIDDEN TALENT Skilled caregivers
have no problem starting IVs in elderly patients with small, fragile veins.
lar is typically quite
superficial, skilled
providers can cannu-
matic blood pressure
cuff is a superior venous tourniquet, and late the vein rather easily.
will be effective in making even small
To access the external jugular, attach
veins grow prominent. If you still can't
a 3cc syringe onto the hub of an intra-
locate a vein on either arm, check the
venous catheter before attempting the
feet and ankles for a potential IV site.
insertion, and then aspirate back with
If you can't locate a vein in any
negative pressure as you advance the
extremity, the external jugular vein on
device. Once the catheter enters the
the side of a patient's neck is an option.
vein, the syringe will fill with blood. You
The external jugular vein swells when
can then fully advance the catheter
the patient, with his head slightly down,
into place. Fixate the catheter with tape
performs a Valsalva maneuver —
instead of suture.
forcibly attempting to exhale against a
— Richard Novak, MD
closed airway.
J U LY 2013 | S U P P L E M E N T
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O U T PAT I E N T S U R G E R Y M A G A Z I N E
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