How to Perform IV Insertion on Very Fragile Veins: 5 Essential Tips For Nurses

There’s no book that can help you master IV insertion, maintenance, and termination right away. In fact, there’s no way you can develop the skills overnight. It takes a lot of time and practice.
And even if you are a veteran nurse, you’re still bound to experience challenges in IV insertion from time to time. One of them is fragile veins.
Some patients also have thin and dry skin that increase their susceptibility for infection and injury. As a nurse, you need to know exactly what to do in handling such patients.
Before we get to the tips, below is a list of the most common causes of fragile veins:
  • Aging
  • Exposure to UV rays of the sun
  • Use of illicit drugs
  • Malnutrition
  • Long term use of particular drugs, like anticoagulant and corticosteroids
  • Heredity
  • Use of products with drying properties

Though we can’t quickly change these risk factors the moment we face patients with fragile veins, there are still effective ways to make IV insertion possible.

Say NO to 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 a tourniquet is obviously out of the picture.

However, if using a tourniquet is necessary, try to choose those that are made with light materials. Apply it lightly and remove it as soon as you see a backflow of blood in the cannula. Improper use of a tourniquet for this particular type of patient may lead to venous “blow”, hematoma formation, and skin damage.

If you really need to use a tourniquet, here’s how you should do it:

Use the smallest catheter available

The size or gauge of the 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 to avoid possible damage.

As a standard, patients 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.”

Use “bevel-up”, “low angle”, and “slowly but surely” 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. Make at least 15-30 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 doing this to avoid causing additional harm and damage to the patient’s veins.

Here’s a video about the correct needle position:

Secure the catheter with a paper-type tape.

Dry 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, the use of an adhesive solution will greatly ease the process of adhesive removal without bringing additional damage to the skin.

Provide health education to improve the patient’s condition.

geriatric nurse

As a patient advocate and educator, a nurse should provide patients with 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 seems to be a very daunting task, but with practice and enough exposure to these types of challenges, a nurse can surely get the fulfillment from a job well done.

Related Articles:

How To Perform IV Insertion On Obese or Edematous Patients

How To Perform IV Insertion On Pediatric Patients