Here are some of the most common mistakes nurses make when starting IVs.
The first mistake is failing to anchor the vein. Anytime you start an IV or even draw blood, you should anchor the vein. The reason is that when you apply pressure with the needle, if the vein is not secured, it can shift to the side, a phenomenon known as a “rolling vein.”
To prevent this, take your hand, place it below the insertion site, and apply pressure by moving the skin downward to keep the vein in place while you insert the needle.
The next issue is hitting vein valves. In veins, there are small valves that prevent the backflow of blood. How can you tell if you’re about to hit a vein valve?
By examining your patient’s veins, you may feel a small, knobby region along the vein that could indicate a valve. In patients with low body fat, these valves might even be visible on the skin. When you hit a vein valve, sliding off the cannula can be difficult. To prevent this, some nurses try to “float” the cannula by flushing as they advance.
Another common mistake is failing to advance the catheter once you get blood return. It’s exciting to see blood return when starting an IV, as it indicates you’ve hit the vein. However, you’re not quite ready to advance the cannula into the vein just yet. For adult patients, once you get blood return, insert the needle slightly further, about the width of a nickel, and then slide off the cannula, which should go in easily.
Using a tourniquet when it isn’t necessary is another mistake. Not all situations require a tourniquet. When patients have veins that are already visible on the surface, using a tourniquet can apply too much pressure, similar to poking a balloon, causing the vein to burst under the skin.
Using the wrong needle gauge is another error to avoid. Assess the vein size and determine if it can accommodate the gauge you plan to use. The smaller the gauge number, the larger the needle. For instance, an 18-gauge needle is larger than a 22-gauge. If you have a small vein and need an 18-gauge, it might not hold, leading to a collapse.
Inserting the needle at the wrong angle is also a frequent mistake. Aim for a 15 to 30-degree angle to prevent going straight through the vein, which makes it impossible to advance the cannula.
Finally, failing to prepare your IV supplies before inserting the IV is a critical mistake. Before starting an IV, ensure you have all necessary supplies ready. Since you have a limited amount of hands during the procedure, it’s vital to have everything set up, including flushes, so you’re prepared to advance when you get blood return.
For a live demonstration of starting an IV on a patient, you can access via the provided link.