1. Pick the right site. Starting an IV is definitely a technique in which, the
more practice you have, the better you get. But nurses tend to stick to
old habits, which can be a problem when those old habits complicate
outcomes.
Case in point: Certain areas are not ideal for surgical IVs, even
though practitioners in a hurry have been starting them there for
ages. The radial side of the wrist, for example, has a large, easy-to-
find vein, but placing a catheter there also risks injuring the nerves
or tendons nearby. The antecubital fossa (the inner elbow) sports 3
large, prominent veins, but as it's an area of flexion, placing an IV
there could prove irritating to the patient if the catheter is intended
to remain for any length of time. Plus, if infiltration should occur, it
could spread into deeper tissue and go unnoticed until the patient
reports irritation.
Instead, seek out veins in the forearm, above the radial wrist and
below the antecubital fossa. The back of the hand may also present a
good, stable surface, but don't put too large of a catheter into the
veins there. And keep in mind that locating the right site for IV place-
ment to avoid injury risks isn't just anecdotal wisdom, it's a standard
of care. Disregarding the recommended practices of the Infusion
Nurses Society could land you in legal liability in the event that a sub-
optimally placed IV contributes to post-op complications.
2. Detect difficult-to-find veins. When your patients arrive in pre-op,
they've been under NPO orders all night. So it's no surprise that many
patients, even those with the best, healthiest vasculature, seem to
present with "flat veins" that are hard to palpate. Fasting doesn't do
any favors for those with difficult-to-find or difficult-to-access veins
either.
Nurses tasked with starting IVs should be well accustomed to the
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