IV Therapy – Tips, Tricks and Best Practices

Every nurse’s dream is an easy stick for every IV ever started. A constant running line with no alarms. IV bags that change themselves. And medications that don’t burn going in. You’ve become the life of the party when you’re around your friends checking out every vein in sight with glee!

We know that not every IV stick is a breeze and watching your IV pumps can take a good part of your day. We have mustered up some of the best IV Therapy tips, tricks and best practices to help this part of nursing go smoother for you.

I’ve been caught many times inspecting every single vein I see. “That’s a good one,” I think silently. I have to resist the urge to grab a complete strangers arm and gently push on those beauties.

“Oh My, Those Are Beautiful!”

You’re sitting in a restaurant and you feel bad for staring. The guy sitting next to you has arms like the one pictured above. You begin to daydream and slip into “la-la” land. “Oh my, those are beautiful,” you think to yourself. You find yourself wishing every vein could be just like those. But, they’re not and you can’t even always use those ones depending on therapy and need for IV therapy.

Your Dream Came True, But The Vein Blew!

It happened! Your new admit has beautiful veins just like the picture above. You begin to drool and run for your IV tray faster than you ever have. “This one will be perfect,” you think to yourself.

You set out your supplies, you place the tourniquet, you clean the area, and feel those nice juicy suckers. You open your cannula go in and “BAM,” the vein blows. You stare in amazement and think to yourself, “how did this happen.”

• For one, you don’t need a tourniquet on veins this good. Try just using a gently inflated B/P cuff and you will have more luck.
• These big guys tend to “roll” more than the smaller deeper veins. Use a finger to hold in in place just above your insertion site. If this doesn’t work, go to a deeper vein.
• You went in “bevel down” and straight through to the other side. Make sure your bevel is facing up and go in easy.

You Absolutely Need A “Hand” Stick

The reality of getting an IV started is that sometimes you need to deal with the harder sticks and the harder places to stick. Most often for an extended hospital stay where your patient will be staying overnight, you are better off in the hand.

Here are some tips and tricks for getting a good hand stick:

• Warm the area you need to stick. This will help puff up those tiny veins and relax the vein walls making them easier to get in.
• Get an order for EMLA cream. This will help numb the sensitive skin on the back of the hand. Patients who are not in pain are more relaxed and that means relaxed veins.
• Hold the hand downward. Gravity will help fill the veins if you keep the hand down and below the heart.
• Veins are blood return to the heart, so use your alcohol wipe to your advantage. Wipe up in the direction of the heart. This helps with blood flow and opening those sticky valves.
• Speaking of valves, avoid any intersecting veins pictured above. That is where those suckers live and you want to avoid their home at all cost!

Lastly, Run to The ER!!!

Practice makes perfect! If all your attempts to get really good at IV sticks on the floor fail, run to the ER and you will get really good at it really quick! If your hospital has a float pool, see if you can pick up a few ER shifts on your days off. Since it isn’t your regular assigned department, they most likely won’t have you working any trauma cases. What they will probably do is tell you to grab the IV tray and “draw a rainbow” (an assortment of blood tubes) on each patient admitted to ER. One or two shifts and you will be as good as a long-time veteran!

Tonic What???? Hypertonic, Hypotonic, and Isotonic Fluids

You have a patient in crisis on the floor and the doctor is shouting out what to do. They need fluids quick and you aren’t sure what to grab. If you grab the wrong type of fluid, it could be fatal to the patient. This was the part in school you never understood no matter how hard you tried.

Below is a handy chart that makes it pretty easy to know which tonicity is right for which situation. Simply put:

 

Here is a handy table for reference:

IV Fluid	Hypo, Hyper, Isotonic	What’s it Used For	Contraindication
D5W (Dextrose 5%/Water)	Isotonic	Hypernatremia Dehydration Fluid Loss	Cardiac Patients Kidney Disease
Normal Saline (0.9% NaCl)	Isotonic	Hyponatremia Shock DKA Resuscitation Blood Transfusion Fluid Volume Issues	CHF Edema
LR (Lactated Ringers)	Isotonic	Dehydration Third Spacing Blood Loss Electrolyte Loss Diarrhea Burns Labor and Delivery Surgery	Liver Disease Kidney Disease
½ NS (0.45% NaCl)	Hypotonic	GI Fluid Loss Fluid Replacement DKA	Burns Liver Disease Trauma
D5 ½ NS (Dextrose 5% ½ NS)	Hypertonic	DKA	Blood Sugar >250
D5NS (Dextrose 5% Normal Saline)	Hypertonic	Shock Addison’s Crisis	Cardiac Patients Kidney Disease
D10NS (Dextrose 10% Normal Saline)	Hypertonic	Nutrition to Maintain Blood Sugar Levels Increases Water	Diabetes

• If you see an order for fluids that doesn’t match what your patient needs, clarify it.
• When grabbing fluids, read the bag not the shelf label.
• When you have a change of condition, ask about new fluid orders.
• Make sure you have the right size cannula inserted for what you’re treating

It Burns!!!!

Potassium via IV burns like the dickens. It used to be standard practice to run K+ with some lidocaine in the bag, but due to possible fatal drug errors this practice cannot be done any longer in most hospitals. Still, your patient needs to be comfortable. If you hang your potassium and hear a howl coming from the room, here are a few things you can do:

• Get a second pump and hang some NS (with an order if not contraindicated) and connect to the primary line to the site. Hang the potassium from the first pump. Run the NS at the same rate as the potassium and you can bump up the NS until any pain subsides. For instance; if you are running K+ in at 50 ml/hr, run the NS at 50 ml/hr. If pain is still there, increase NS to 100 ml/hr and keep the K+ at 50 ml/hr.
• Cover your patients entire arm with a warm blanket.
• Use an ice pack on the IV site.

IV therapy doesn’t have to be traumatic for you or your patient. Make sure you show up with confidence. Always tell your patient that you will “be starting your IV now,” rather than saying you will “try to start your IV.” The above IV therapy tips and tricks will help make your life as a nurse easier and much less stressful.

Have more IV Therapy tips?  Let us know in the comments!