Recent years have seen the introduction of several useful vein-
finding technologies. Devices that incorporate LED lights or infrared
imaging can improve venous navigation and IV placement. While
they may not be as helpful for obese or edematous patients, the
development of portable ultrasound scanners can fill the need for
deeper visualization. For this technology, you may need to designate
and specially train a few staff members to be expert users for best
results. Vein-finding technology isn't just for learners: It can help
anyone avoid missing veins and subjecting patients to multiple
sticks.
3. Advance with caution. You'll find that some patients have more delicate
veins, such as the elderly, those who are taking steroids or those
who've been subject to long-term IV access. Their veins may not be
difficult to see or palpate — they may have arms like a map — but
they're fragile.
You'll have to exercise much more caution when starting these
patients' IVs. The big risk here is "blowing the vein," when the
catheter goes through the vessel and breaches the opposite wall,
which can lead to hematoma. If, while placing an IV, you see the
blood flow stop immediately after you catch sight of the backflash,
that's a likely sign that you've gone through.
In theory, it is possible to salvage a blown vein (see "How to Rescue
an IV That is Otherwise Lost" on page 48). With a small catheter, you
could potentially pull it back, then advance beyond the breach into
the vein. But this is not advisable. A breached vein can lead to fluid
infiltration and tissue irritation and damage. Also, if they later require
a hospital transfer, the continued use of that IV for other (leaking)
meds could do damage to the surrounding tissue. Your best option is
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