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Inserting IVs in patients with edema

If anyone could offer tips or suggestions on finding veins in patients that are a hard stick it would be much appreiciated.  Especially edema in both arms. For some reason I seem to be in a slump for getting difficult sticks when in the past I have been able to. We do not have access to a ultrasound for vessel locations.

Thanks all!

Have you tried using double

Have you tried using double tourniquets? Place the first one above the AC, then look and palpate. If you do not find any veins, place a second tourniquet a few inches lower on the arm. Palpation is the most effective tool we have without some type of technology. Use the same finger of the same hand **always** to feel for veins. Press downward and then slowly release the pressure to feel the bouncy resilience of the vein. For severe edema, I have had to actually press the edema out of the area to find a vein. Ultrasound and infrared light devices are best in these situations though.  


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

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Angela Lee
I agree with Lynn.  Using

I agree with Lynn.  Using the same fingers will "train" those finger to be more sensitive.  With our patient population, I teach nurses to use their dominant hand as the other hand is holding the patient's extremity.  We do not have the luxury of using two hands so I teach a one handed technique.  Also, "displacing" the edema allows the veins to be more accessible.  Venpuncture has to be done quickly, however, as the fluid rapidly returns to the area.  Even with technological tools, vein depth is more difficult to determine without compression of the area to displace fluid.

I have also found that sometimes a tourniquet will increase edema by creating a "sausage" effect.  In this case digital pressure above the vein may work.

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