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Catheter advancemnt

Hi, relatively new IV provider looking for some advice. I'm having a hard time knowing how far to advance the needle once I get flash. Sometimes I feel like I barely advance at all at a shallow angle and the catheter won't advance, like I penetrated the other side of the vein. I watch a lot of videos and it almost seems like a lot of people do t even advance any further after getting flash, and some even appear to withdraw the needle some before advancing the father forward at all. Just looking for some advice from people who have been doing this longer than I have. 

First I am assuming you are

First I am assuming you are asking about insertion of short peripheral IV catheters, made over the needle, without use of any vascular visualization device like infrared light or ultrasound. Take a close look at the tip of a catheter with the needle stylet still inside the catheter. The bevel, which is the cutting edge of the needle, extends beyond the tip of the plastic catheter. Your goal is to get the plastic catheter tip into the vein lumen without damage to the back wall of the vein from the stylet. The bevel may have a short slant or a long slant, depending on the catheter brand and gauge size but it will be very hard to tell just by looking at it. The angle of the catheter from the skin level should be between 10 and 15 degrees. Make sure your chosen vein is adequately distended and you can palpate it well. THE MOST important aspect is to hold traction on the skin below your puncture site and align your catheter on top of the vein in the same direction as the vein, never on the side of the vein. Skin traction is a critical step. If you are right handed, the catheter will be in your right hand and your left hand will encircle the arm with your thumb holding the skin taut. Veins lie in loose connective tissue. If you don't hold this skin traction, the vein will always be moving away from you. I know you have heard patients claim they have "rolling veins". This is a myth. Everybody's veins roll from side to side and when you are trying to stick a needle into it, it will move away. Patients with hypertension may have vein walls that are thicker than other patients so feel that vein to determine its condition. It should be soft and elastic and bouncy. Press downward and slowly release the pressure while you feel the vein bounce back under your finger. Learn to always palpate with the same finger of the same hand and you will develop an additional sense in that chosen finger to feel move than other fingers. Advance the catheter through the skin and vein wall while you look for a blood return. When you see blood, you may need to lower the angle a little more, but don't allow the catheter to drag against the skin. You should have the picture of the catheter tip in your mind and advance the entire unit just a little bit, maybe 1/8 of an inch. If the blood return is still moving into the hub, use your index finger of the right hand to advance the catheter into the vein WHILE you continue to hold skin traction with your left hand. Activate the safety mechanism and you have successfully cannulated the vein. Skin traction is the MOST critical step both during the punture and catheter advancement. Good luck. 

Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Thank you so much Lynn... You

Thank you so much Lynn... You make it clearer in my mind what I have been doing. You are so kind and awesome to share your knowledge. 

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