to start again at a different vein site, maybe even in the other arm.
Even better, though, is avoiding blown veins to begin with. Start
with a catheter that's a bit smaller than the vessel. A catheter that's
too big won't easily enter the vein, plus the rubbing will irritate the
vein wall. You're aiming for an insertion that's less angled, and closer
to the surface, than usual. A common problem is, nurses hold the
angle and don't notice the flash, so they go through.
Technological advances can assist on this front, too. One newly devel-
oped IV catheter incorporates a guide wire, similar to that long used by
midline catheters and PICCs. Advancing that wire helps to guide the
catheter safely into the vein. Another safety IV catheter delivers a dual-
flash effect to verify the needle and the catheter placement, providing
thorough assurance.
4. Be confident. Botched IV starts leave patients in discomfort and dis-
satisfied. They create workflow inefficiency and are infection control
risks besides. You're better off getting the job done with one stick.
As mentioned above, improved technique comes with practicing the
process. Position the patient's arm so you can clearly see the potential
site and yourself in an ergonomically stable and comfortable posture.
Use your eyes as well as your fingers to locate, size up and determine
the patency of the vein, outlining and pressing along its length. It
should be soft and bouncy to the touch and refill easily. It won't have
the pulsations of an artery, and won't be hard or flex like a tendon.
Hold the skin over the vein taut so it won't roll, and aim for a 15-
degree insertion angle. When you see the backflash of blood, immedi-
ately lower your angle closer to the skin and advance one-eighth of an
inch, which will allow you to insert both the needle and the catheter
into the vein. Be aware that it is easy to lose your access by prelimi-
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