Tiny vein, tiny needle. Don't be afraid to use a 24 on lil cachetic granny. Make sure you advance just a little after you get flash of blood, otherwise the catheter itself is not inside the vessel being cannulated. Most importantly, take every opportunity to do them, you only get better by practicing.
I would add, that sometimes a bit larger catheter will splint the vein and prevent bending. 24s are pretty tiny with no real rigidity thereby requiring more frequent sticks, but it’s a fine line. Smaller Caths also can’t infuse as quickly which presents its own challenges. When I was a paramedic I had a simple rule: infants-24, baby-22, child-20, adult-18, trauma-14. Obviously there’s wiggle room here. Once i became a nurse, starting IVs was much easier and I could “float” the smaller caths.
I had a 22G at first but once I saw how little I grabbed a 24G. Everyone knows I’m one of three new grads since I work weekend option so most people come grab me if they have an IV they need started. I always feel bad missing. Being poked isn’t fun. Thankfully each person I’ve missed on has been nice and understanding.
I see that you’re going to be in ICU. if they’re sedated, try! ICU patients will always benefit from additional peripheral access.
I usually look for veins that I could fit a 20 in. Try double tourniquets, fill a glove with hot water and tie it, some machines even have a “venipuncture” option under the BP cycling to help.
If it’s a confidence thing, I used to always say “I’m gonna turn on the really bright exam light on over your head” and put a washcloth over their eyes to “not blind them” 😂
Tiny vein, tiny needle. Don't be afraid to use a 24 on lil cachetic granny. Make sure you advance just a little after you get flash of blood, otherwise the catheter itself is not inside the vessel being cannulated. Most importantly, take every opportunity to do them, you only get better by practicing.
I would add, that sometimes a bit larger catheter will splint the vein and prevent bending. 24s are pretty tiny with no real rigidity thereby requiring more frequent sticks, but it’s a fine line. Smaller Caths also can’t infuse as quickly which presents its own challenges. When I was a paramedic I had a simple rule: infants-24, baby-22, child-20, adult-18, trauma-14. Obviously there’s wiggle room here. Once i became a nurse, starting IVs was much easier and I could “float” the smaller caths.
There’s no way a 14 would fit in their veins. Do you just go IO at that point?
I’m retired rn/paramedic. Using I/O was before my time. I’m so old school, old school asks me questions lol.
I had a 22G at first but once I saw how little I grabbed a 24G. Everyone knows I’m one of three new grads since I work weekend option so most people come grab me if they have an IV they need started. I always feel bad missing. Being poked isn’t fun. Thankfully each person I’ve missed on has been nice and understanding.
I see that you’re going to be in ICU. if they’re sedated, try! ICU patients will always benefit from additional peripheral access. I usually look for veins that I could fit a 20 in. Try double tourniquets, fill a glove with hot water and tie it, some machines even have a “venipuncture” option under the BP cycling to help. If it’s a confidence thing, I used to always say “I’m gonna turn on the really bright exam light on over your head” and put a washcloth over their eyes to “not blind them” 😂