How Not to Blow a Vein.....

As an IV therapy nurse, no matter how “pro” you consider yourself to be, there are still times when you encounter problems when it comes to IV insertion, such as very fragile veins.
Here are some tips to avoid blowing veins in IV insertion.
Assess. Feel the veins.
Don’t just look at a vein, instead, try palpating the area to search for a vein. It is important to palpate using your index and third finger pad to evaluate the vein’s resilience, patency, valves, and size. Check if the vein is straight, soft and bouncy, and large enough to accommodate the catheter needed for the IV therapy. Go for the straightest vein. For geriatric patients, a deeper vein may be less prone to blowing since they are more stabilized and less movable.
Choose the right size.
This is with regards to the IV cannula to be used. If possible and if not contraindicated, try using smaller sizes. For adults, G-22 is commonly used while for pediatric patients, G-22-26 are used.
Check tourniquet application
A too tight or too loose tourniquet can cause veins not to distend and may result to you cutting off their arterial circulation. A BP cuff may be used as a tourniquet when dealing with very fragile veins of elderly and chemo patients.
Check the bevel. Make sure that it is facing upwards
This technique is done to make sure you don’t blow a vein when advancing forward. Also, you can control the angle of insertion more when the bevel is facing upward as you have easier glided point of entry as the sharp end-tip of the needle enters the skin.
Use warm/hot packs of the arm is cold
This is to dilate the blood vessels and them pop out quickly. Warm washcloths or blanket may be used if hot packs are not available.
Anchor the vein
This is to keep an unstable vein from moving sideways as you puncture it. This can be done by holding the skin and veins taut with your non-dominant hand.
Angle well and insert the catheter directly on top of the vein
Adjust your angle of approach accordingly if your target vein is too shallow or too deep. Usually, you may do it in a 15 to 30 degree angle. Then, insert the vein catheter on top of the vein to reduce the chances of going through the two vein walls. Do it slowly but steadily.
Upon hitting a vein and seeing backflow, stop advancing the catheter and drop the angle approach.
This is to avoid puncturing the vein wall again. Release the tourniquet first. Drop your angle of approach as you advance the catheter a little bit more. Then pull back the needle a little bit before advancing the whole catheter. When you have successfully inserted the catheter, pull back the needle quickly to attach the IV fluid set and start the IV infusion with the first few drops running very slowly.
Use available visualization devices
This may include transilluminator lights and pocket ultrasound machines. These devices will illuminate vein pathways so you can track the direction of where you should insert your IV catheter.
Sources:
http://www.nursebuff.com/2014/10/tips-for-nurses-on-how-to-prevent-blown-veins/
http://piccresource.com/piccnurseblog/how-to-start-ivs-8-tips-to-improve-your-iv-success/