How to start an IV: Dorsum of hand
ฝัง
- เผยแพร่เมื่อ 15 พ.ย. 2013
- Start an IV in the dorsum (back) of the hand (18-20 gauge)
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As an oncology nurse, I'll give you all a little trick for when you insert an IV in a hand or near the wrist. Put the patient's arm on a table or armrest and ask him/her to grab underneath the table. The wrist is now flexed and the skin is pulled so you can see the vein better and your thumb isn't in the way :)
Thank you!!! I've never had an IV in my hand
thank you. used this and it worked.
Ahmad Morad as a patient that's all you need to do :P just take a deep breath and try to relax your muscles. Once the Iv is in you will be able to move freely, it's just to facilitate the insertion :)
Thank you
Thank you nurse! 💕
Because the needle’s bevel sticks out a little farther than the catheter, you have to advance the needle a little further after you get a flash. If you advance the catheter as soon as you get a flash, the catheter is likely not yet in the vein and you will probably push the vein off the needle, missing it completely and causing pain and bruising to the patient.
Great advice, couldn't have said it better!
@@MedSchoolMadeEasy essesseewwwwfrfgr3 qfefdddf0ddffffref de e
Yes happens way too often with beginners. Thats a great advice! :)
It depends on the brand of angiocath. The one used in the video is an Autoguard by BD. It's a 20 gauge because of the hub's color and also has a technology called "InstaFlash," which is simply a small notch in the needle maybe 1 cm proximal to the bevel. Only the 20 to 24 gauge needles have this feature. The notch is also proximal to the opening of the polyurethane catheter. So, when the needle's in the lumen, you'll see flash in the catheter, because blood will enter through the bevel opening and through the notch. The purpose is to minimize or eliminate fine movements or deviations of the operator when looking behind the fingers and underneath the hand for blood in the flash chamber (depending on the experience of the operator, it may be easier to keep eyes on the puncture site and visualizing for blood flow in the catheter to assess for venous access).
To ensure successful cannulation, operators should always lower the angle (or lift the skin) and advance both the needle and the catheter slightly (millimeters) before advancing the catheter. Another brand, such as the Introcan by Bard, which I think has been owned by BD for several years now, requires the operator to advance the catheter before blood can travel into it; unlike the Autoguard, it lacks a notch in the needle.
Btw, I'd rarely use an 18 gauge for the hand hahaha.
As an RN, also get your syringe read, burped, etc. if using an extension set, prep and burp air out. Apply one 3”x 1/2 inch tape under wings of catheter so that once in vein, you can fold like a butterfly and hold cath down. Also, super important, determine that the location in the vein is not in such a location that it will protrude past their knuckles. Ie, when their fist is clenched, it sticks out. That situation always ends badly with it getting caught on blankets, trays,toilets. Consider use of non dominant arm, and possible going on dorsum of forearm to keep it more protected. Also a flashlight can be helpful in finding a vein, along with alcohol wipes. PLEASE clean the skin more and look several times before trying. Do it right and once. They will thank you.
Excellent info for this basic EMT going for IV endorsement. Thank you for sharing! Consider making videos as well.
This video is particularly valuable because it focuses on the dorsum of the hand. For a lot of practitioners it’s the antecubital fossa or nothing. In the field I’ve seen, more than a few times, someone spend twenty minutes looking for a vein when they could have used the hand and had fluids flowing in five minutes.
Then they are inadequately trained.
Before you flush the saline, its always good to pull back on the plunger to make sure 100% you're in the vein. Blood will flow back into the flush, if you are in.
I was about to say the same, I was watching and thought your supposed to aspirate???
Chris M there was blood flow into the catheter before flushing
Great point. Always a good troubleshooting first step as well. Thanks
At most time your getting labs when starting am iv
And to make sure that no air goes into vein??
"Don't spend too long looking for a vein." Um no. I will take my sweet time and stick once I am confident I have found a good vein. I would much rather continue to communicate with and reassure my patient than be hasty and have to stick them multiple times because I'm worried about their impression of me.
Measure twice, cut once. Explain to the patient, calm their anxieties, be calm and confident, but friendly and humble. Love always, Nurse.
Exactly. I spend a good amount of time looking for a vein that I know I can successfully start a peripheral line in.
Jesus Christ you people will pick apart anything in any video. “Ummm no would rather do x”. Then make your own video and shut up
Nun worse then a nurse who rushes a needle
Ikr they stupid
Thank you guys for a concise video without all of the frills and extra. You rock.
No, you rock, Arbaz! Thanks
In my experience I would rather spend time choosing & prepping in order to stick once. If the patient seems to be getting the impression that I don't know what I'm doing I reassure them. Working on an IV team taught me that :)
the real pain will be when removing that surgical tape off a hairy hand.
happy543210 I know that frustration. That’s why I’ve trimmed the hair around where the IV could be placed before my surgery tomorrow.
@@My03Tundra f me
Pp
@@My03Tundra hope you are ok man
Wipe under tape with alcohol
Pull tape in the direction of hair growth. Shaving hair around insertion site promotes infection with skin flora.
That retractable needle was the coolest thing I've ever seen.
I know, right? technology man
@@MedSchoolMadeEasy a
I've seen the great importance of natural herbs and the wonderful work they have done in people's lives. i read people's testimonies online on how they were cured of herpes, hiv, diabetics etc by Dr. Okooh herbal medicine, so i decided to contact the doctor because i know nature has the power to heal anything. I was diagnosed with hiv for the past 7 years but Dr. Okooh cured me with his herbs and i referred my aunt and her husband to him immediately because they were both suffering from herpes and they were cured too .I know is hard to believe but am a living testimony. There is no harm trying herbs. He is also a spell caster, he cast spells to restore broken marriages and a good luck spells to prosper and excel in life. Contact Dr. Okooh on:
drokoohmiraclehome@gmail.com or
/Whatsap me no:+1 (315) 217-1185 for more info thanks..
Ch'ti gy'nvyuh
@@jiancheng3345 stfu
I love watching this💖 It gives me inspiration to pursue med school... Im from the Philippines, 💖God bless
My biggest tip for new IV placers is don't doubt while putting the needle through the skin. Puncture the skin in 1 smooth and quick motion. I had 1 nurse who was new in placing IV's and she took atleast 5 seconds to pierce through the skin. This was absolutely horrible, so yeah, don't do that
it just a like a pinch though
@@laurawilliams8005 it's supposed to be. But I've had nurses like delay the puncture, and just keep the needle halfway through the skin. Now that hurts like a bitch
@@meenik6489 not really though you don't need to watch. but I did
Being a med student in this pandemic is challenging...thank you for this video
tell me about it
OMG, this makes me lightheaded just watching it!!
The digging for vein not gold comment made me laugh so hard 😂. ♥️
Glad to hear that! Thanks!
I've seen the great importance of natural herbs and the wonderful work they have done in people's lives. i read people's testimonies online on how they were cured of herpes, hiv, diabetics etc by Dr. Okooh herbal medicine, so i decided to contact the doctor because i know nature has the power to heal anything. I was diagnosed with hiv for the past 7 years but Dr. Okooh cured me with his herbs and i referred my aunt and her husband to him immediately because they were both suffering from herpes and they were cured too .I know is hard to believe but am a living testimony. There is no harm trying herbs. He is also a spell caster, he cast spells to restore broken marriages and a good luck spells to prosper and excel in life. Contact Dr. Okooh on:
drokoohmiraclehome@gmail.com or
/Whatsap me no:+1 (315) 217-1185 for more info thanks..
🤣🤣🤣
No se ve el punto d puncion y haz una vena dificil que no se vea
“I typically hold the vein..” 4:27
I almost had a heart attack.
Watching this to desensitize myself to needles puncturing veins
me too!
I've seen the great importance of natural herbs and the wonderful work they have done in people's lives. i read people's testimonies online on how they were cured of herpes, hiv, diabetics etc by Dr. Okooh herbal medicine, so i decided to contact the doctor because i know nature has the power to heal anything. I was diagnosed with hiv for the past 7 years but Dr. Okooh cured me with his herbs and i referred my aunt and her husband to him immediately because they were both suffering from herpes and they were cured too .I know is hard to believe but am a living testimony. There is no harm trying herbs. He is also a spell caster, he cast spells to restore broken marriages and a good luck spells to prosper and excel in life. Contact Dr. Okooh on:
drokoohmiraclehome@gmail.com or
/Whatsap me no:+1 (315) 217-1185 for more info thanks..
@@jiancheng3345 You claim that 'herbs' cured your HIV, yet only 2 people in recorded history have been cured of HIV, and those being because of a stem cell transplant. If you had truly been cured, it would be all over the news.
You are offering your alternative medicine to me because I said that needles make me nervous. If your methods actually worked, you wouldn't have to be seeking out vulnerable people like me just so someone would accept what you're selling. From the looks of it, you're a business. Not a doctor.
Additionally, just because something is 'natural' doesn't make it more safe than something synthetic, arsenic is naturally found in fruit seeds and it is poisonous. There is no way to tell if a substance is safe to consume by knowing that it wasn't grown in a lab. Unlike herbal supplements, the FDA has to approve drugs before they go into the market.
And for the love of god what do you even mean when you say 'herbs'?
i am okay with pretty much any gory, bloody things in life imaginable. but needle and veins always get to me and i don't know why. gonna watch such videos till they don't nauseate me anymore.
I just got out of the hospital and this video was more respectful then actually getting it done they poked me 3 times trying to start a iv because my veins are so small
When he pulled the needle out before removing the tourniquet, I almost screamed! That could end in a bloody mess! You don't need the tourniquet on anymore after you've advance the catheter. Ah!
If you're a pro u can pull them out at once.
Exactly, the vein could blow especially in an elderly patient.
As we advance the needle we have to move the needle downwards at the same time?
Would you want to connect the luer directly to a primed saline lock then test the patency by flushing. You are reopening the connection by flushing with syringe first, you risk a blood bath. This was you secure the hub with a lock then you can feel free to attach any iv lines securely. You are able to draw back from the lock.
I always had a hard time with hand IV sticks. This was very helpful. Thanks, Med School Made Easy!
So it is more painful than that of antecubital fossa (at the elbow)?
Thank you....i am from middel east and your videos is so good😁
Im going in for surgery on Friday and I have to get a iv I have a huge fear of needles but this helps me understand what will happen
Why are people afraid of needles?
Amazing. Thanks for the video 😊
Great, no nonsense video start to finish...
Informative great short and straight ti the point well done . Thank yoy refresher ...
this video is so helpful!
Thank you
You're welcome, Zul. Thank YOU
After the tourniquet is on, feel for the pulse. If still present the tourniquet is not too tight. Now the patient can pump his/her hand and let the arm hang. If needed rather use a baumanometer and inflate the cuff to between systolic and diastolic pressure. Wait the arm will become dark and acidotic which will cause the veins to dilate. When pin and needle feelings start, the sensation in the distal area will be deminished. I do not find pulling the distal part helps, since it also tends to flatten the veins.
Thank you for the video. Great technique. Remember in Pediatric patients you may not get a 'flash' of blood. It is at that point you just have to try and flush with NS to be sure you are in the vein.
Mary Ronan Great point, thanks Mary!
that's very true sometimes in any patient you made not get a flash or maybe a valve
thanks for instruction, needed to do stem cell IV on myself
OMG - you are a teacher and a guinea pig? Thanks for the video.
+Mara we prefer the term "test dummy" but yes! :-) thanks for watching Mara
It's amazing. I just started school, but yes, testing on live flesh vs pillow, straws etc does not compare :)
+Med School Made Easy This is awesome! I'm starting my first semester next year for nursing so I'm just trying to get some knowledge under my belt! :D
Great video!
hehe me too :)
Me how is nursing school so far?
Great video, the detailed explanation is v helpful. THANKS!
My hand started hurting watching this and i was cringing the whole time and I’m usually good with needles
very informative, thank you very much
So helpful
thanks friend
Well done!
I am 57 years old and had Lupus since I was 17 years old....only ONE time in my life did someone start an IV and was painless. So many are clueless on how to start an IV.....they need better training I think and love what they do. It would help a lot!
Btw...the one who did it right was in Germany. So much for the US they need yo go back to school and learn something next time around.
All my patients say I am good at placing an IV, none of them ever complained, thank Allah for that.
Por favor que las explicaciones también sean en idioma español ya que hay público con lengua española, gracias
fantastic job 👍
OMG G 18... lol! Thank you for this demo, very helpful :)
You're welcome, Haizen. Thanks
Ya this is the new technique I think for me mam
Thanks doctor good tip
ありがとうございます!
When I start watching curious about what if I had an iv on wrist. I start feeling a sudden beat at my heart and tension towards it. Realizing the fact that yes. It's confirm I had a needle phobia and I don't how to cope of
Great teaching
Excellent!!
When you put the tourniquet on you are supposed to have the “bunny ears” up away from the the sight of where your drawing the blood.
What does it mean?
i lost it when he said."we are not looking for gold for veins" laughs*
Excellent
What if you encounter a venous valve and the catheter does'nt advance any further even after the first and second flash?
what i do is i advance the catheter as far as i can. if it's less than halfway in, i would abandon the attempt. if it's more than halfway then i pull out the needle , and try to flush the cannula in. 8/10 the inflow of saline pushes the valve open and the catheter will slide the rest of the way.
Okay! Thanks. I'll try it
EXCELENT, THANK YOU VERY MUCH !
You're welcome vily. Thanks
I’m not in the med field and I’m just scared of getting an IV
jack keith it will pinch for a second but I’ve got a IV a lot of times and it is not fun ok so do not worry ok
Helen Hines oh ok
Me too! Hopefully watching these videos a bunch will help
No worries, Jack. It'll be just fine. Thanks
Med School Made Easy hi
Wow very informative thank you. Lots
Me at 5 years old that got a iv: no reaction.
Now 13 watching people get an iv: *SCARED*
thank you Mr. Doktor
Hi am very new with bedside care pls help with some procedures that i need to be more confident in doing .i am now experiencing Discrimination in the area that hurting me so much and feel uncomfortable and uneasy for everything.pls do help..
Thanks, but here's a question how often is the tourney changed from patient to patient?
+Kathleen Roberts Tourniquets are disposable and are not to be reused on different patients. Each patient gets their own and they are disposed of once they are no longer needed.
Nice video.
why do they almost never use Braun IV safety IV needle systems (Venflon) for starting IV's in the USA?
I have wondered that too. In any IV start video that is not filmed in the US they use the Venflon. They don't seem to be available in the US. I looked at both Braun and BD's US websites and they do not have the Venflon. In the US we mostly use the Braun Introcan and BD Autogard which are both safety needles. Neither have the little luer lock the Venflon has. We use what we call an extension set. Which is a very short IV tubing that screws on to the end of the catheter after you remove the needle. I have never flushed a catheter like they did in this video. I always attach a primed extension set first and then flush. I think they do this in the ED when they draw blood from the IV catheter first then attach the extension set. This is a good video but the safety feature on the IV needle was not used correctly. After you thread the catheter, you push the safety button to retract the needle before removing it completly from the catheter. At least that's how I was taught.
My service uses bd nexiva. which is a closed catheter system similar to the one you are talking about just a different and in my opinion a more updated and better design.
www.bd.com/en-us/offerings/capabilities/infusion/iv-catheters/bd-nexiva-closed-iv-catheter-system
william keeling that one looks so cool!
Remove the tourniquet as soon as you put your thumb on the vein to stop the blood from dripping out, it took way too long and the blood has nowhere to go as you stop above with the tourniquet and below with the thumb. Yes there is more vasculature that will take on that blood flow, but, it is ideal to avoid restricting blood flow when possible. Also, elevating the syringe before injecting the saline, will allow the air bubble to travel to the surface rather than getting injected in to the vein. The extention tubes provided in the IV kits, prevent large air bubbles from making it into the vein, of course need priming with sterile saline first.
Thanks🙏
Great video
really?!!!
how do you make your own hands stop from shaking?
very easy to learn and absorb....thanks so much....
You're welcome, Mavis. Thanks for watching
Also, to be sure you're not going to end up giving iv fluids paravenous ( it's when you do inserd the catheter into the vein but the fluid goes into the tissue beside it, if it does the part of the hand will start to swell, but it won't change color or anything) have it in mind to check on the iv in the first 10-15 min, just in case
Just had a drip this is why i am watching this
Awesome 👍🏻
i'm having a operation in a month so would like to ask is it painful when inserting in ?
no it is like where someone is pinching you
Hey bruh I am also going for surgery next week how does it feel to get an iv
@@vaibhavgupta2213 not painful just like ant bite. It may feel uncomfortable at first but it will feel normal afterwards.
@@vaibhavgupta2213 not scary at all just a pinch I had all my surgeries done in the past
So beautiful hard terms
You even forgot to hold the catheter while injecting the SALINE.
Which can cause to splash out of bloods due to force exerted by pressure given by plunger.
Anyway it was nice vid keep going.
Not really but he should have aspirated first and then removed the tourniquet.
Starting IVs has always been my most favorite part of nursing 😄
Soooooo satisfying as long it goes well
WBM haha true 😆
Wow I am the same thing like insert IV
I love starting iv i went got my iv certification to do iv im Emergency room charge head nurse so when someone need iv they go get craig he best give ivs I love it
Formidable cette intrafusion du serum.
Merci pour la video des prises des abords veineux, priere de nous faire les liens faciles 'a ouvrir.
tnx miranda 4 the info. :-)
I'm sure the test subject was happy to see you used a piece of tape, on his hairy hand, to hold the gauze. Ouch! Thanks for the info. After ten or more methods of this and I will be able to work out the best way, for the most average case.
We're hardcore, Bruce
Rubbing alcohol helps break down the adhesive so it won't rip the hair out when you take it off!
Thank you so much for the video.
I have a doubt; after my second flashback when i pull the needle out a little and insert the remaining cannula, my flush doesn't go through. How do I correct that?
It sounds like your catheter is not in the optimal position when you are trying to do a flush. When you see a flashback, make sure your catheter threads into the vein easily. If it meets resistance while trying to thread the cannula in, you are likely in the surrounding tissue instead of the vein. Here is my recommendation: Once you see a flashback, it means the tip of your needle is likely in the vein lumen, but it is at an angle into the vein. If you level off the needle just slightly (bring the needle MORE PARALLEL with the skin), and advance the needle just slightly, that will allow the catheter to be a little better positioned within the vein lumen. Then, you can advance the catheter. This should allow for a better catheter position, meaning your flush should go easily into the vein. Hope this helps.
Thank you so much. Will try it out today.
You want to advance the catheter slowly and withdraw the needle at same rate. Once you get flash, pause, separate the two and slowly advance. Then secure cath and try to flush. You can also be too close to a valve. Practice! You will get it.
What about an easy vein were can you find it at if yur veins are not good an showing at all? ?.
hey jayden- any vein in your extremity can serve as an entry point for a venous line, but the most commonly used locations dorsum of the hand (above), cephalic veins (forearm), and antecubital fossa (bend of the elbow). the technique to access any vein is similar to that which is show in the above video. hope that helps
interesting videos!
thanks for stopping by!
Galing naman thanks for sharing
Any tips on finding a good site on elderly patients? I work in a Geri-Psych unit and the patients are old, uncooperative and easily angered. I find that older people have really rollie and skinny veins and I have a hard time starting IVs on them.
Maria GoGa Use a 22 gauge IV cannula and always anchor, ( immobilising the vein) very very important in geriatric patients with rolling veins, alittle reassurance and a helping hand equally works for me..
And lots of praying. I used to have to draw PT/INRs on elderly hospice patients who still took Coumadin.
Eke N agree! Sometimes trying dorsum of lower arm is a better site than hands, they tend to infiltrate. Another person can also provide traction to sides of the arm, hand, toholdloose skin, et out oftheway.
So THATS what they do to me when I end up in the ER every other month with nonstop seizures 😂
I had this done today
That's awesome. Hopefully you have healed well. Thanks
Amazing
Late question not directly related but, I'm looking to go into med school and was wondering what your high school and undergrad GPA was if you don't mind me asking
You have to take the MCATS
I got one 7 days ago on my left hand on the side where the pinky finger is at. For some reason it hurts and I can't move that pinky finger very much. I wonder if it hit a muscle or a nerve or something.
Sulfen is your pinky ok?
Probably. Weird choice of insertion site.
Very nice
That's very interesting and I would like to be a nurse
Proud of you, Kamenje!
I've seen the great importance of natural herbs and the wonderful work they have done in people's lives. i read people's testimonies online on how they were cured of herpes, hiv, diabetics etc by Dr. Okooh herbal medicine, so i decided to contact the doctor because i know nature has the power to heal anything. I was diagnosed with hiv for the past 7 years but Dr. Okooh cured me with his herbs and i referred my aunt and her husband to him immediately because they were both suffering from herpes and they were cured too .I know is hard to believe but am a living testimony. There is no harm trying herbs. He is also a spell caster, he cast spells to restore broken marriages and a good luck spells to prosper and excel in life. Contact Dr. Okooh on:
drokoohmiraclehome@gmail.com or
/Whatsap me no:+1 (315) 217-1185 for more info thanks..
I'm taking my nursing prerequisites and I will start nursing next year. I plan to watch videos like this and educate myself before starting nursing school. Do you think practicing on dummies purchased from Amazon would help before starting the nursing school? ☺️🐭
Hello CheekyMonkeyGirl: Just like all things in life, the more you spend time with it the more proficient you'll become. So, yes, by all means, practice on dummies if you have them. Handle those IV catheters, get familiar with how to hold them and manipulate them whenever you can. You'll be surprised how well you will do when you insert your first real IV in real patient. I'm a 29 years RN and had at least one million successful IV starts(pediatric patients), so, good luck with your future career.
very nice
Thank you
I appreciate
Well those were the "bookends" of IV therapy. 'a bit disappointed your excellent instruction doesn't include connecting a primed IV line or a saline lock, covering with a transparent dressing and writing the date and time of insertion on the dressing.
A big cheer to the volunteer IV recipient! 🎉
Personally, unless I'm admitted through the ER, if I know I'm going in for any type of procedure, I shave the dorsal side of both hands. Usually the IV is painless but ripping off the yard of tape getting a free waxing is what hurts. Perhaps the IV Tech/practitioner could do a quick shave. Just a thought.
It is often not done because, believe it or not, shaved skin has a slightly greater risk of leading to infection. This is especially true in ERs and similar places where attention to aseptic technique is OFTEN suboptimal.
Kci wound vac
Suck it up buttercup
Thank u great 👍 video
Thanks, Maria!
WHAT SUPPLIES DO I NEED NOT THE VIDEO
I'm finally scared shittless now😹😹😹
😂😂
Why are you scared?
I've seen the great importance of natural herbs and the wonderful work they have done in people's lives. i read people's testimonies online on how they were cured of herpes, hiv, diabetics etc by Dr. Okooh herbal medicine, so i decided to contact the doctor because i know nature has the power to heal anything. I was diagnosed with hiv for the past 7 years but Dr. Okooh cured me with his herbs and i referred my aunt and her husband to him immediately because they were both suffering from herpes and they were cured too .I know is hard to believe but am a living testimony. There is no harm trying herbs. He is also a spell caster, he cast spells to restore broken marriages and a good luck spells to prosper and excel in life. Contact Dr. Okooh on:
drokoohmiraclehome@gmail.com or
/Whatsap me no:+1 (315) 217-1185 for more info thanks..
Is that a bubble in the saline?
yep a tiny one! has literally no clinical significance
I would personally rather spend the time Looking for a proper site than to worry about the patient’s impression of me. When I move too hastily and either puncture or miss their vein they will DEFINITELY dislike me for having to start again! As a patient it would make me more comfortable and faithful with a provider that actually takes the time to assess the quality of a site before proceeding. Newbies take your time and do it right. Do your best to be sure first. Most people new to placing IV’s have a bit of time to get good at it first before developing the speed needed for trauma patients. Impressions of your speedy, flashy, confident provider will be thrown out the window if you have to stick them 20 times!
tnx nicole
Man I’m so excited for med school
Me tooo
did you reach the goal