if you know how to do an IV but you're still bad at them you've come to the right place because today I'm going to teach you how to become so good at IVs that you're going to become the best stick in the hospital so in order to get there I'm going to show you the five most common things that people are doing wrong when I watch them blow IVs and in other words if you will follow these five simple steps that I'm about to show you you're going to become amazing at IVs for the rest of your career let's do it so the first reason that I see people missing IVs is they did not give themselves as big enough of a Target as they could have so if you want to become graded IVs you need to make that vein as big as possible and I want to show you how I do that and in order to help me I brought a volunteer here one of my best friends rocking the thrill house shirt and she's gonna help me to to show this so if I want to make this van as big as possible I use gravity I let this hand hang down at first and I want you to see what it looks like before I've made the vein big and then we'll compare it to after I've made this vein big so we're going to start with the tourniquet okay once that tourniquet is on you can see that I still can't really see the veins so this is what I'm going to do I'm going to start by just kind of shaking the hand a little bit and then I'm going to give some gentle flicks with the back of my finger after I do that for a couple of seconds I'm going to ask my helper to squeeze her hand five times one five okay now after that I'm going to let the hand relax I'm going to rub on it a couple of times and then I'm going to flick it and you can see there is a much bigger difference with how it looked beforehand and after so again you want to have success at IVs make this vein as big as possible so the second reason that people Miss IVs is that when they insert the needle into the vein they are not completely parallel with the vein oftentimes it's taught for you to go in at an angle and then when you hit the vein then to go parallel before advancing and I think that's totally unnecessary and it's going to increase the likelihood that you're going to blow the vein so if the needle is always parallel when you puncture the skin and when you advance it's going to be really hard for you to blow that vein so the third reason that people Miss IVs is that they do not hold good enough skin traction skin traction is absolutely essential to prevent this Vein from Rolling because if that vein rolls it is very likely that that vein is going to blow the bad thing about skin traction is as you can notice that vein becomes much less visible so my question to you is if you had a choice would you rather take less traction but good vein visibility or really good traction but low vein visibility I'm telling you the answer in every case is you would rather have really good traction even if you can't see the vein as well so I want to show you how to hold good vein traction so do you remember how I told you that we want to be completely parallel when inserting this needle we have to be able to hold Traction in a manner to where our thumb is out of the way because if my thumb's in the way there I'm not going to be able to go parallel so the most common way that we do this is we would hold skin traction with our thumb behind the knuckle and then we can insert the needle that way now if this skin is able to be moved at all your traction is not good enough so sometimes you have to hold Traction in two different directions so here I'm holding traction with my uh thumb uh beneath the knuckle there sometimes you can hold counter traction just by flexing the wrist sometimes you can hold counter traction with your finger here and holding it that way sometimes you can even just kind of hold traction like that but sometimes it takes holding Traction in two directions whatever you need to do you need to hold traction good enough to where that skin is not going to move so the fourth reason that people Miss IVs is they did not hold this catheter correctly so the correct way to hold it is to use your thumb and your middle finger you have to hold it to where you can see this flash chamber at all times holding it in this manner is going to allow you to once you are in the vein to push the catheter off the needle with your index finger so the last reason that people Miss IVs is that they did not Advance the needle after seeing a flash of blood you have to remember that when you first get a flash the needle is in the vein but the catheter isn't you need to advance the needle until the catheter is in the vein now how far do you advance the needle it depends on how big your IV is so in order to know how far to advance the needle after you get a flash all you have to do is look at the back of your catheter and you'll be able to see the tip of the catheter and the tip of the needle and what you'll notice when I'm doing that here is that on the blue uh needle that's a 22 gauge needle much smaller you're not going to have to advance that needle near as far as the orange catheter which is a 14 gauge catheter so again if you want to know how far you need to advance just kind of look at the distance between the tip of the catheter and the tip of the needle and always remember when advancing after you have a flash as long as you stay completely parallel you're not going to blow the vein so what I thought would be cool is if I could actually do a few IVs so that you could see me perform all of these steps in real time let's do it okay so for this attempt I've tried to make the veins as big as possible and I think I'm going to go with this vein right here so I'm going to start off with lidocaine bevel up just underneath the skin now this is a big vein but traction here is critical so I'm going to hold Traction in a manner that my thumb is out of the way but I think I'm going to need counter Traction in this direction because you can see that the skin still moves so I'm actually going to ask an assistant to hold counter Traction in that direction so you can see that vein completely almost disappeared but I know where it is let go of the traction again so I can see it one more time okay now go ahead and pull that traction now what's critical here is that my vein that my IV needle is completely parallel as I go to insert now we're going to be able to see the flash chamber here so back out to see the flash chamber we're completely parallel I'm going to insert okay now I see a flash now I'm just going to chill here because I know that my vein is in or that my needle is in the vein but my catheter needs to go in so I'm going to be completely parallel I'm going to advance this whole thing and now it's time to advance the catheter over the needle okay now I always put gauze under here before I connect my IV just in case I get a little blood back connect this here okay now it's time for our Tegaderm yep just like that now I want to flush this thing just to make sure it's good flush is very nice we're golden baby so this one's a lot more straightforward because I've just got a straight vein there so a little bit of Lidocaine right under the skin okay so I'm going to hold the catheter to where I can see the flash chamber I want to get good traction and keep my vein completely parallel I'm going to go right where I did that lidocaine he is I'm completely parallel I'm going to go until I get a flash see I've got a flash of blood so I chill needles in the van right now but the catheter isn't so I'm going to advance ever so slightly as I'm parallel now I can advance that catheter over the needle so I got some gauze there I'm gonna take that needle out well thank you gods for not doing anything connect up and let's put that oxide on we're just going to flush a little bit to make sure that we are in it flushes really nice so I thought it'd be helpful to demonstrate a really difficult one I've got a vein right there that I'm going to have to use a 22 gauge on and so I'm going to start by just doing a little bit of Lidocaine now I can kind of see the vein going that way so I'm just going to go right through where I did my numbing medicine I'm going to look at my flash chamber okay I'm in the vein I'm gonna Advance ever so slightly now I'm going to push this catheter over the top of the needle and I'm just going to see if this flushes before I put my upside on flush is real nice without swelling and we were able to get a difficult one on that one okay so now another straightforward one here you know I'll just demonstrate that you can do lidocaine right on top of a vein okay so the difficult thing with this one is the veins rolling so I'm holding traction really weird but whatever works and I'm going to hold counter Traction in the other direction I'm going to hold my catheter to where I can see the flash chamber and now that I've got good traction I'm completely parallel I'm gonna go in watching my flash chamber until I get a flash okay so I'm in the vein so I'm going to advance the whole thing completely parallel now that catheter's in and I can push the catheter over the top see if this flushes looks like it's flushing good no swelling we got it okay one final thing that I want to say is sometimes once you've Advanced the needle and the catheter into the vein and you're trying to thread this off the finger sometimes this catheter gets a little bit stuck if it's not really wanting to push off the needle what you can do is hold the catheter there and then pull the needle back slightly with your uh thumb and middle finger and then once the catheter is past the needle in that manner it it tends to float much easier fight dad