5 6
O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | D E C E M B E R 2 0 1 4
apply the tourniquet, have the patient lower his arm, open and
close his hand a couple times, and then make a fist. Once you've
located the vein, tap it and rub in a downward motion with an
alcohol wipe to visualize it. Why a fist? Clenching and relaxing
your hands moves muscles and increases blood flow through the
venous structures below the tourniquet, causing further distention
of the vein.
Ms. Daily prefers a blood pressure cuff to a tourniquet. Speaking
of tourniquets, ever hear of the "double tourniquet technique?"
Take the patient's blood pressure, and then calculate the differ-
ence between the systolic and diastolic. Put the arm in dependent
position, place the tourniquet 4 to 6 inches above the site, then
put the blood pressure cuff over the tourniquet and pump it up to
the difference between the systolic and diastolic. "This will bring
up a vein nicely," says a respondent.
Sometimes it pays to be aggressive when tapping or flicking
the veins. "Most patients are not bothered by a more forceful
tapping and flicking," says
anesthesiologist Charles A. DeFrancesco, MD, of the Delmont
Surgery Center in Greensburg, Pa. "Gentle love taps often don't
do the trick."
A little verbal judo doesn't hurt, either. Wiggle your toes and look
over there. Does a relaxed patient mean relaxed veins? Yes, our
respondents say, diversionary tactics can improve first-stick suc-
cess. "Asking about where they live or their injury before the stick
can be a pleasant diversion," says Ms. Daily.
Most of our respondents follow a 2-stick policy, meaning they
call in an anesthesia provider to start the IV if the pre-op nurse
can't get it done in 2 tries. At the Riverwalk Endoscopy & Surgery
Center, the policy allows 3 nurses 2 attempts each. "After 6
V E N I P U N C T U R E
