In my clinical days, I was adept at IV sticks. I had a lot of experience from my days in the ER, but especially from working as a chemotherapy nurse, where I had patients with fragile and damaged veins. I learned every trick to coax a vein to appear and which gauge needle would work the best to avoid puncturing through the vein. I was so “into” IVs at one point, I’d note the veins on people’s arms, judging whether they’d be an easy or hard stick.

Venous access may be difficult to achieve in older adults. Photo © Alto / Alamy Stock Photo.

Little instruction in starting an IV.

But it wasn’t always so. I recall approaching the first time I had to draw blood with much trepidation. There was virtually no training—a more experienced colleague had me watch her and then walked me through it in a few minutes:

“It’s not that hard: see which hand or arm has the better veins; tie the tourniquet around the arm; swab the skin with alcohol; insert the needle, bevel down; pull back and see if you get blood.” 

Fortunately, the patient had “good veins” and it went well. But there were many times it didn’t go as well and patients had to endure repeated attempts. These were painful for the patient and—as the ones inflicting the pain—upsetting for all of us who tried. It was a matter of try and try again, and there was no organized approach to evaluating how difficult the procedure might be for a patient.

Identifying patients who might present a challenge.

In the July issue, we’re pleased to present a report on an initiative that provides an evidence-based approach to discerning in which patients starting a peripheral IV might be difficult. The article, “Making It Stick: Developing and Testing the Difficult Intravenous Access (DIVA) Tool” (free until August 1), includes the tool itself, which lists patient assessment parameters to check that, when totaled, will indicate whether there might be difficulty in establishing IV access. 

A policy change, plus education for novice nurses.

The authors note that the tool resulted in hospital-wide policy change that brought the institution into alignment with the Infusion Therapy Standards of Practice. The hospital now also provides vascular access education for all novice nurses.

(A related article that might be of interest: “A Nurse-Led Ultrasound-Enhanced  Vascular Access Preservation Program,” from our December 2017 issue. This will also be free until August 1.)