IV Difficulties with Patients

How many times have you been in the predicament of trying to start an IV on a patient, and it simply is not working? It happens often, and is especially difficult for patients who already have a fear of needles.

Reasons For Uncooperative Veins

Most often if you have a patient recently admitted, it may be a matter of dehydration. If they have been ill, and low on fluid intake, it may be enough to cause problems in locating a vein. Options may be limited, if you can't start IV fluids with a properly inserted IV. Having the patient squeeze their fist and release may help to make a vein visible, however, when dehydration is the issue that does not always work. So how many sticks are appropriate? 3 maximum, or 2 if the patient is resistant to another try. There is usually someone else that can take a fresh look and have different results.

Positioning the IV

There is no limit to the creative places an IV can go. After a hospital stay myself, I am saying with absolute sincerity, an IV in the thumb is very uncomfortable, and in fact rarely works. After a couple tries on some already painful veins, I just requested a person from the Cath lab, and they got it first try. Another very painful IV procedure is adding potassium too quickly and without lidocaine. This will make for one very pained patient if not administered correctly. Potassium must be administered slowly and with lidocaine, otherwise it is very painful. Always keep in mind, if an IV becomes suddenly painful for the patient, you can always pinch the tube in order to stop the flow immediately. Work with the patient to determine where the best location for an IV may be. Some patients are fine with any location, however, others may be very bothered with an IV into the hand. Occasionally you may not have options to accommodate the patient, the IV is being administered for the patient's well being, and their safety is the number one priority. In most cases, explaining to the patient that the IV is necessary in case they need medication administered quickly.

Monitoring the IV

IVs should be monitored at each check on the patient. It's vital to make sure the medication can flow freely, and if it's not, it may need to be repositioned. In the event of swelling at or around the site of the IV, it will have to be repositioned, as it is not able to flow appropriately. In the event of swelling, keep in mind, that the IV is not effective and should be changed.

Communication with Patients

Many patients are reluctant to receive or continue IVs. Let's face it, they can be a bit of a pain, especially for mobile patients, dragging the pole along to the restroom is not the easiest task in the world. Of course IVs can be uncomfortable at the site, and can prevent freedom of movement as well. It's understandable that IVs are not a favorite among patients with regards to their treatments. On the flip side, IVs are absolutely essential for many patients. After all, they are not in the hospital because they are healthy and feeling well. Patients should have the purpose and need for the IV explained to them. In the event of an emergency, the need for immediate medication administration depends on an IV. If the patient, argues that they are not expected to encounter emergencies per say, even unknown allergies, or interactions could result in the need for quick admittance of medication. The positive reasons far outweigh the uncomfortable, and awkwardness of an IV. Bottom line, it is essential.

Related: What is Prader Willi Syndrome?

Interesting IV History & Facts

1628 - Wm. Harvey - discovery of circulation of blood led to further experimentation.
1656 - Sir. Christopher Wren - used a quill and bladder; injected opium into drops.
1662 – J.D. Major made first successful injection in man.
1665 - A dying animal was successfully transfused with the blood of another.
1667 - A Parisian 15 year old boy was first successful human transfused with the blood of a lamb. Led to many problems and death.
1687 – Edict of Church and Parliament “animal to man transfusions prohibited in Europe” – 150 years lapsed. Dr. James Blundell, English O.B., proved animal blood was unfit for man, only human blood is safe.
1900 – Dr. Karl Landsteiner proved not all human blood is alike.
1935 - Slow drip – continuous method of transfusion was published by two English physicians Pyogenes introduced in the solutions were a problem.
1940 – A nurse was assigned as I.V. Therapist at Mass General Hospital, prerequisite to perform venipuncture successfully. NS – Used at first in early 1900s – fluid and electrolyte knowledge grew and today more than 200 commercially prepared IV fluids are available.
1965 - University of Penn- nutrient given IV to dogs – research led to today’s total parenteral nutrition.Metal needle was used prior to World War II.
1945 – Development of plastic catheter due to frequency of infiltrations. Glass container used first individually packed/prepared by hospital pharmacy – later by major company as enclosed unit. Plastic containers introduced in 1970s.

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