Creativity can exist in a medical practice or hospital. As long as we do no harm and are ethical, new techniques should at least be tried. Numerous times I am asked to start an intravenous line when the nurse has fallen short. One of the most effective techniques which was taught to me in the eighties by an elderly pediatric physician, is the blood pressure technique.
This technique is simple, quick and causes no harm. Check the patient’s blood pressure. Let us hypothetically say the blood pressure was 140 over 80. Leave the cuff on the arm, release the pressure, and pump it back up to a number somewhere between the systolic and diastolic. The veins will rise within minutes, and you will be surprised. Even in obese or dehydrated patients, I have found this technique to work very well.
So how does this work physiologically? By clamping down the blood pressure between the systolic and diastolic you are preventing the venous back flow, but allowing the deep arterial flow to continue distally. I have taught this technique to numerous health care providers in many disciplines. When tried they have been very pleased at the outcome. The patient benefits, as they do not have to suffer numerous sticks.
Old behavior dies a hard death. Still many of those I have taught still use the old techniques, which do work. Myself included, will start out arm dangling, and tourniquet applied mid bicep area. Should I not feel comfortable with finding a vein, I then resort directly to the BP technique.
Research has not proved that slapping the skin does any more benefit to raise a vein. Let us as clinicians stop this archaic behavior. The most effective maneuvers are as follow:
1. Dangle the arm below one’s heart for at least four minutes.
2. Try the tourniquet first, before any other method.
3. Prep the area as instructed.
4. Should these methods fail, try the blood pressure technique.
Remember, humility equals wisdom. At our clinic, no patient is stuck more than three times. If you cannot be successful after two attempts, please wave the white flag and allow someone else to try. Many of us, all too often allow our own ego’s to get in the way of patient care. All of us in the health care field have witnessed this behavior. Know what you do not know, this will make you a better clinician and more proficient at starting an intravenous line.