Flick, don't slap
Most of were taught the traditional 2-finger "slap" to "wake up"
veins. But I find that lightly flicking — using my middle finger after
pressing it against the inside of my thumb — works better. Not only
does it help bring the vein to the surface and help open the lumen, it
also seems to numb the area a little bit. Patients often ask, "When are
you going to poke me?" They're usually surprised when I tell them I
already have.
Let it hang
If you're having a tough time finding the vein, let the patient's arm
hang down below the heart. The vein will fill up a bit and become eas-
ier to palpate and locate.
Make an impression
When you're dealing with a vein you can feel, but can't see, make
small parallel fingernail impressions in the patient's skin on each side
of the vein. Obviously, you don't want to hurt the patient, but a gentle
impression won't disappear immediately and will help you see where
your target is. Clean the site, wait for the solution to dry and insert the
needle. This is especially effective with younger patients with healthy
skin, but doesn't always work on older patients with loose skin. (It
shouldn't be done with fragile skin.)
Know how it rolls
Most veins don't roll, but every nurse has dealt with ones that do.
You can end up missing a vein because when you tried to stick it, it
rolled to one side and completely disappeared. To prevent that from
happening, first try palpating to determine if the vein rolls, and if so,
which direction it's more likely to go. If it rolls, apply pressure on the
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