Insertion IV lines patients with poor veins
For a patient with a history of poor veins, a hospital or lab visit becomes a trying experience. The patient’s anticipation of a difficult venous access, adds to the stress that the patient is already feeling, as well as for the nurse or the lab personnel who is responsible for the veinapuncture.
For patients, it is essential that the nurse is competent in the skill itself. As accessing the vein of a patient who has poor veins, is better done by a more experienced nurse. Rather than a novice. However, this is a skill that has a learning curve , and becomes more refined through repetition and hands on experience.
In addition to the task itself, it is essential that the nurse use a calm and confident approach with the anxious patient. The use of diversion, by talking to the patient about other topics, as the “nice shoes or top they are wearing etc. ” helps them relax and distracts them temporarily while they tell you about the great sale.
An experienced nurse or physician will then visually assess the patient’s arms, the decisions related to the choice of a vein to access with veinapuncture should also include, understanding the purpose. If this is to be a one time insertion for lab work, and only to be done once. Then the anticubital area. The fold on flex ion of the arm/interior may be O.K. However, if this access is for cathlon insertion and is to remain in place for 24-48 hours. A different location may be the better choice; thus allowing the patient their arm flexion..
Through palpation, most veins can usually be felt. Nurses and physicians often have favorite veins that they access, because of their size and the probability of successful access.
For the patient who has recessed veins that are difficult to palpate or too small, and are at risk of infiltration with IV infusions or puncture during an I.V. insertion. Many alternate sites may be considered more reliable. A larger vein is the cephalic , inferior lateral arm area is often called “the residents vein” because interns often make this their first choice when doing veinapunctures.
*For difficult veins, applying a very warm compress or towel over the area of the arm or hand to be used. For at least 15 minutes is ideal. This often helps to dialate the vein.
*Another step that sometimes helps in finding an appropriate vein. Is to have the patient hang their arm down by the their side. In a short time, after allowing their veins to fill with blood. Thus, making veinapuncture and venous access easier.
Patience is the best approach to reduce a patient’s anxiety, which when out of control, can quickly become the nurse’s or physician’s anxiety too.
A tourniquet used above the chosen site of IV insertion, and occasional gentle tapping over the site of the vein, will allow the vein to fill with blood with noted protrusion. The standard skin prep, and the preparation of supplies should be done in advance of this step. Allowing for an insertion into the ideal vein to be done as immediate as possible. The release of the tourniquet should follow the access of the vein, as quickly as the cathlon is inserted, and secured with an appropriate dressing according to protocol.
Even deep veins can be accessed in some locations, with only feeling and finding a slight palpable vein. The return of blood and confirmation of access to the correct location, and suitable vein is usually done by the more experienced nurse or physician.
Along with the veinapuncture responsibility. The nurse or the physician has the responsibility to hold pressure on the sites that punctures have been made and caused bleeding. This pressure is to be held until the bleeding stops. And after each puncture has occurred. A patient should never have bruising that remains; as the result of the careless omission of this step..
In clinical practice in some institutions , there is an understanding in practice that a nurse or a physician who fails to be successful in the veinapuncture attempt on a patient . After three tries; should then defer further attempts to another staff member, or perhaps to a more experienced nurse or physician.
There are other options for patients who have poor veins. Those patients that are candidates for long term treatment or on going procedures, may be a candidate for implantable ports or central lines. Theses decisisions are made on an individual basis by a physican with this expertise.