As a patient you may feel relaxed as IV insertion is considered to be an invasive procedure and nobody will start the procedure without your agreement. However, as it is always your doctor who orders IV insertion, it is highly advisable to consent to the procedure as you can be sure that it is necessary.
Before the IV insertion all the equipment should be prepared at the patient’s bedside and a medical assistant who is going to do the procedure should thoroughly wash his or her hands. These simple steps will guarantee asepsis and smoothness of the procedure.
A medical assistant should always explain the procedure to the patient and answer all his or her questions as the IV insertion will go more smoothly if the patient is not afraid and feels relaxed. The next step is to choose a vein proper for a needle insertion.
Distal veins of the non-dominant hand will be the best choice as in case of any damage you can still use the proximal part of the vein. Using the non-dominant hand will guarantee the patient freedom of movement.
To avoid infiltration it is not recommended to use areas which are easily bent such as a wrist or hand. The arm which is chosen for the IV insertion should rest on a firm surface. At this point it is a must for a medical assistant to put the protective gloves on to maintain asepsis.
The next step is to clean the insertion site. It should start in the middle of the site and go outward. This will reduce the potential transmission of any microorganisms. The skin area should be dry before the needle insertion.
It is easier for a medical assistant to insert the needle with the use of a tourniquet. It should be applied about five inches above the selected area. In order to stabilize the vein the medical assistant will place his thumb over the chosen vein and stretch the patient’s skin against the insertion direction.
The stylet-catheter should be inserted at about thirty degree angle with the bevel up. It should prevent any potential damage to posterior wall of the patient’s vein. Now, the medical assistant checks for blood backflow, which is quick due to the pressure from tourniquet.
Now it is the time to loosen the stylet and advance the catheter into the vein so that the hub rests on the IV area. To prevent any blood leaking and reestablish the blood flow, the medical assistant will hold his or her thumb over the vein just above the catheter tip and release the tourniquet.
The pressure over the vein should be quickly released and the needle adapter of the IV set should be promptly connected to the catheter hub. Smooth connection will reduce blood loss. To keep the vain open and ensure the patency of IV the infusion should begin at a slow rate.
To secure the catheter in place and to prevent infection or bleeding the hub of the catheter should be taped over and the site should be covered with a transparent dressing. It is recommended to secure the tubing in a loop fashion to prevent its dislodgement.
At this point the medical assistant can remove the gloves and document the procedure, which will be a guide for the person who will perform the next dressing change. The document should provide the information about the time and date of the IV insertion and about the size of the used catheter. It should also state what fluid has been infused and the prescribed rate.
When the IV insertion is performed according to the above described steps, the risk of a blown vein is lower. For sure, the medical assistant should be double careful when serving elderly patients as their veins are more fragile.
Also, to prevent any potential infections or complications the IV site should be changed every three days. It is also worth remembering to insert IV in the direction toward the heart as it can prevent any venous valve damage.
Blown Vein – Extra Thoughts
Thanks to the clear IV procedure a blown vein does not happen frequently and even when it does, it can be easily treated. If you are a patient, you cannot blame a nurse or a medical assistant for the situation as a blown vein may be caused by a number of different factors, including the patient himself.
Similarly, if you are a nurse and a blown vein happened to your patient, you should not feel guilty as it happens to even the most professional and experienced nurses. The key rule is to stay calm and quickly deal with the injury.
In most cases a blown vein is not caused by the incompetence of a nurse, but by the state of a patient’s veins. While a nurse knows that children or elderly people may have weak veins, some people are simply born with fragile veins. Some veins are also easily movable, which makes it easier to blow them.