Life hacks for nursing - Part 4. IV insertion on fragile veins

In this series of Life Hacks for Nurses we will be offering up tips and clever solutions to the problems we face everyday. In Part 4 we take a look at tips for IV insertion on fragile veins.
IV insertion is an art. It takes a lot of practice and skill to master this procedure which is made even harder when working with thin, dry skin and fragile veins. Factors that can make a vein too fragile for an IV catheter to pass through easily include aging, exposure to UV rays of the sun, use of illicit drugs, malnutrition, long term use of particular drugs like anticoagulant and corticosteroids, heredity and use of products with drying properties.
In older patients veins are less stable due to the loss of tone and subcutaneous tissue and are more likely to slip or roll under the skin as you try to insert an IV device. These changes make vein tears, ‘blown’ veins, and bruising more likely in older patients.
Here are 10 tips for reducing the risks that come with performing and maintaining venipuncture in patients with fragile veins:

1. Be as gentle as possible. This will help to avoid bruising or skin tears. Apply a warm compress before performing the venipuncture.


2. If you are working with a patient with fragile veins, avoid using a tourniquet when possible. If a tourniquet is necessary, choose one made of soft material and apply it lightly to avoid hematoma or venous pressure resulting in a ‘blown vein’. Remove as soon as you see a back flow of blood in the cannula.


3. Use the smallest-gauge catheter possible (a 22 or 24-gauge works well) with the shortest length.


4. Note the depth of the vein to determine the right angle. Older patients tend to have shallow veins and the insertion angle could be almost flat to the skin (10 -20 degrees) if the veins can be seen easily.


5. Secure the vein before piercing the skin. Do this by applying traction with your nondominant hand to the vein below or to the side of the insertion site.


6. Give yourself plenty of time. Proceed very slowly but steadily—one short stroke through the skin with advancement into the vein. Once the needle has penetrated the vein, advance it and the cannula slowly. Feel the needle penetrate the vein.


7. If veins are small and hard to find consider following this method using a butterfly needle for blood draws. You may be more successful using a small (23-gauge) butterfly needle inserted carefully into a hand vein than trying to access an antecubital vein.


8. Use paper tape to secure the IV insertion to avoid damage to dry and brittle skin.


9. Many older adults have prolonged bleeding times, so after you remove the needle, apply pressure to the site for longer than you would with a younger patient.


10. If bruising occurs, apply cool compresses for the first 24 hours to promote haemostasis, then apply warm compresses.

References
How to perform IV insertion on fragile veins. NurseBuff.
Tips for Successful I.V starts with older patients. Lippincott Nursing Centre.