Sometimes it seems like your performance on the whole call can be reduced to the success or failure of the IV start. Rarely does the successful treatment of the patient hinge on a successful IV placement but sometimes it can certainly feel that way.The best way to ensure that you’re ready when that make or break it IV start does come your way is to start a lot of them when the pressure is not on. If you wait until game day to practice, you’re a whole lot more likely to fail.
1. Avoid using tourniquet as much as possible. If possible, never use a tourniquet to facilitate IV insertion in a patient with very fragile veins. Older adults, for example, have dilated veins most of the time so using torniquet is obviously out of the picture. However, when using tourniquet is necessary, try to choose those that are made with light materials, apply it lightly, and remove as soon as you see a back flow of blood in the cannula. Improper use of tourniquet for this particular type of patient may lead to venous “blow”, hematoma formation, and skin damage.
2. Use the smallest catheter available. The size or gauge of catheter to be used will largely depend on the specific therapy the patient is going to receive. However, since the patient has fragile veins, health practitioners must choose the smallest size possible to avoid possible damage. As a standard, patient with fragile veins must only get gauge 22 or gauge 24 for the IV therapy. According to Infusion Nurses Society (INS), “When the catheter is too large for the vessel lumen, irritation from the catheter is very likely to cause mechanical phlebitis and possibly thrombus formation.”
3. Use “bevel-up”, “low angle” and “slowly but surely” types of approach. Before proceeding to the actual IV insertion, determine first the proper needle-skin angle to be utilized and provide good skin traction to stabilize the vein. Then, using the bevel-up approach, slowly insert the needle on the top of the vein, making at least 10-20 angle (or almost flat) with the skin especially if the veins are dilated and can easily be seen through the skin surface. You have to take your time to avoid causing additional harm and damage to the patient’s veins.
4. Choose paper-type tape in securing the catheter. A dry and skin can get unnecessary damage when plastic or silk skin adhesives are used to secure the IV catheter. To avoid this, paper-type tapes are usually preferred to maintain IV insertion for patients with sensitive skin types and unstable veins. Upon termination, use of adhesive solution will greatly ease the process of adhesive removal without bringing additional damage to the skin.
5. Provide the patient useful health education to improve his condition. As a patient advocate and educator, it is the nurse’s responsibility to provide patients valuable information that will definitely help to improve their condition in the long run. Use of moisturizers, avoiding excessive sun exposure, eating a balanced diet rich in protein, and adequate fluid intake are just some of the helpful information a nurse can impart to her patients. IV insertion for patients with fragile veins seem to be a very daunting task but with greater practice and exposure with these types of challenges, a nurse can surely get the fulfillment from a job well done. It is our responsibility of nurses to improve our craft for the betterment of the profession and the health condition of the society as a whole. It takes time but no one said it’s impossible to achieve. Good luck!