by Lynda Lampert

Created on: September 19, 2009

One of the most challenging skills for a nurse to master is the venipuncture of veins for IV access. IVs provide the most direct access for administering medication. They are invaluable in code situations for the emergency delivery of life saving medications. Here are a few ways that medical professionals can make the job of venipuncture easier for those who suffer with bad veins.

Warm compresses

Nothing pops a vein out like warm compresses. Sometimes it pays to try this method even before attempting to palpate a vein. For those who are looking "dry" a warm compress may reveal veins that where completely hidden. Warm compresses can be applied by filling a disposable water bottle with hot water and applying it for ten minutes or so bilaterally. However, an easier method may be to place a chux under a patient's arm and directly place warm washcloths from the AC space down. Wrap the chux around the arm and let sit for ten minutes. This "wet" method is effective because the warmth is being directly applied to the skin. This is by far the easiest way to increase the probability of a successful venipuncture.

Alternative sites and smaller gauge needles

Of course, we would all like to get a 18g in the AC space, but this is very difficult to achieve with patients that have chronic disease. This population usually has undergone multiple venipunctures from IV insertion attempts and phlebotomy for weeks at a time. The forearm is a good place to find an alternative site as well as the hand. By anatomy, these veins are usually smaller than the AC space, but when you need access it is a viable alternative. Also consider the veins in the wrist and thumb area. One benefit of using alternatives to the AC space is that the patient is less likely to occlude the vein and set off the pump. This allows the patient to get adequate sleep and prompt delivery of IV medications.

A smaller gauge needle will not be compatible with things such as CT scanning and large fluid boluses, but they can still provide access for those on telemetry or IV antibiotics. Consider a 22g in the hand. This also provides for patient comfort because the smaller needle is less invasive and therefore less painful.

Using a blood pressure cuff

This is not a technique that often occurs to nurses, but a blood pressure cuff is in effect a tourniquet. Those narrow bands that are often used proved adequate venous stasis for patients with good veins, but they often are not useful in patients with bad veins. A blood

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