How Not To Blow A Vein: 20 Useful Tips for Nurses

You can’t easily see a good vein but you will definitely feel it by palpating the area. Feel for its fullness and integrity. Choose the largest vein first as you will less likely blow it, especially if you’ll be using a large-bore catheter.

Needle size is important.

If you don’t need to infuse large volumes of fluid or if a blood transfusion is not necessary, you can just use a small catheter.

For adult patients, however, gauge 22 is usually recommended. On the other hand, gauge 22-26 IV catheters are commonly used for pediatric patients.

You can control the angle of insertion more when the bevel is facing upwards. You will also have an easier point of entry as the sharp end-tip of the needle enters the skin.

Elderly patients usually have fragile veins, like those in the dorsal part of their hands. If you know that you are dealing with a fragile vein on an elderly patient, look for deeper veins that are more stable and less movable.

Venous valves are often located at the intersection of two veins. For a smooth IV line insertion, you may want to avoid that area.

If you encounter venous valves upon catheter insertion, they will stop the needle from advancing forward, forcing it to puncture the vein wall sideways.

See Also: 35 IV Therapy Tips and Tricks for Nurses

If your patient’s arms are cold, you need to warm them up to dilate the blood vessels. By doing this, you can make veins pop out quickly.

You can use warm washcloths or a blanket if you don’t have hot packs in your area.

This will improve venous refill, especially if the arm is dangling downward. Also, when you are about to do a venipuncture, make sure to ask the patient to keep his/her hands and arms relaxed.

Improving venous refill will enable you to see the veins clearly and assess which vein is more prone to blowing.

You can do this by holding the skin and veins taut with your non-dominant hand. With this technique, you can keep an unstable vein from moving sideways as you puncture it.

Adjust your angle of approach according to the depth of your target vein. The common cause of blown veins is sticking the needle too deep.

Avoid side access as it can push the vein sideways even if it’s anchored by your non-dominant hand. Inserting the vein catheter on top of the vein will also reduce the chances of it going through the two vein walls.

Give yourself plenty of time in estimating the angle of approach so you can avoid jerky movements. Hit the vein slowly but steadily and make a short stroke through the skin to reach the vein quickly.

Feel the catheter penetrate the vein. In some cases, you can even hear a small click-like sound and feel that you are getting a flashback.

This is necessary for avoiding puncturing the vein wall again. Drop your angle of approach as you advance the catheter a little bit more.

The needle will serve as a guidewire as you push the catheter farther. You need to pull back the needle so there will be less chances of puncturing the vein again as you advance the catheter.

Their veins are so thick but very fragile so just a little pressure from the tourniquet can blow a punctured vein. If you suspect that there is poor vein integrity but you can easily see and feel the vein in an elderly patient, try anchoring the vein and do not use a tourniquet.

However, if you can’t really palpate the vein, you can also try applying a tourniquet a little farther from your target vein.

See Also: How To Insert An IV Device In An Older Adult

Ask the patient to let his or her arms dangle on the side of the bed. The gravity will improve the vein’s fullness so you can palpate it easier.

With a BP cuff, you can control the pressure you want to apply. Start with the lowest pressure first and see if you can already make the veins appear.

It is best to use the lowest pressure possible so you can prevent pressure-related venous blow.

Take note that a tourniquet is still your better option in vein dilation.

This is important in reducing the chances of pressure-related blowing of fragile veins. This trick works for large but weak vein walls.

You must be quick in releasing the tourniquet once you have ensured that the catheter is within the vein.

Rushing into starting the IV fluid might blow the vein wall due to the sudden large volume of fluid being infused. Just let the IV infusion start slowly especially if you are working with fragile veins.

If you don’t get a flashback, don’t make your needle go around digging for a good vein. It’s not only uncomfortable for the patient but it can also increase the risk of blowing up the vein.

Whenever you don’t get a flashback, just pull back the needle a little bit and redirect it. If you still don’t get a flashback, pull the needle out and start again.

This is a great help for patients with difficult veins so you could not risk blowing good venous access. There are many types of vein visualization devices around like transilluminator lights and pocket ultrasound machines. These devices can illuminate vein pathways so you can track the direction of where you should insert your IV catheter.

One More Tip!

As what most senior nurses say, once in a while you will experience a “dry spell” with venipunctures. If it’s not your day, let it go and ask for help from your colleagues.

You can also learn hard-to-explain IV insertion techniques by watching senior nurses do venipuncture. Always remember that there are lots of lessons to learn from other’s experiences!

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