Find Out How to Avoid Blowing a Vein
It’s common for newly minted nurses to worry about blowing a vein. Your first venous blow will terrify, and you’ll feel awful. With venous blow, the needle has punctured the vein from both sides. A blown vein distresses the patient and sends your productivity into a nosedive. So in this post, we’ll explain why veins blow and how to avoid this near catastrophe. Let’s jump right in!
Why the Heck do Veins Blow?
There are many reasons, including:
- Fragile Veins. Some people have weak vein walls by default, but veins can also become damaged through repeated venipuncture procedures or drug abuse. Additionally, geriatric patients tend to have weak walls. Infants and children may also present with fragile veins.
- Movable Veins. The cephalic vein is notorious for “rolling” when you try to puncture it. But this isn’t the only vein that likes to move around. In geriatric patients in particular, take great care when working with the dorsal venous network of the hands.
- Wrong Size Catheter. If you use a large-bore catheter in a small vein, the vein will collapse.
How to Avoid Venous Blow
- Use your hands.
Unless you’re using a good vein illuminator, you won’t be able to see the vein well. In this case, you must feel your way around. When palpating a vein, feel for “fullness.” The vein should resist gentle pressure. Always choose the largest vein to minimize the likelihood of a burst.
- Always go in bevel up.
A medical needle has three bevels: one primary, and two secondary. These bevels result from grinding the needle’s point at a certain angle. The bevels give the needle its sharpness by acting as a cutting edge.
When drawing blood, you should always position the primary bevel upward. This accomplishes three things:
- Prevents you from blowing the vein as you dig into it
- Gives you more control of the insertion angle
- Gives you easier glided point of entry
- When working with elderly patients, find a deep vein.
In geriatric patients, veins closer to the surface are more prone to blowing. This is because elderly patients have thinner vein walls.
- Avoid venous valves.
When inserting an IV, always avoid venous valves. These are located at the intersection of two veins. Valves stop the needle from gaining purchase within the vein, which can lead to a burst.
- Ask your patient to clench their fist when looking for a vein.
Though a good vein illuminator renders this advice useless for the most part, it’s still good to know. Clenching the fist will help the veins refill, which will make it easier for you to assess the veins. Note, however, that when you are drawing blood, the patient should keep their hands and arms as still as possible.
- If your patient is cold, apply hot packs.
Hot packs will cause the patient’s blood vessels to dilate. This will make veins more visible. However, always keep your patient’s comfort in mind. Consider applying the pack through a cloth. The heat reaches the skin with only a slight delay.
- Always anchor the vein.
Use your non-dominant hand to hold the skin and veins taut. Doing so will help you keep the vein stable. Some veins move or “roll” once punctured. If you don’t anchor these veins, they can blow.
- Use a 15-30-degree angle when puncturing a vein.
This takes practice, but doing so allows you to avoid a too-deep angle of attack. A deep angle is the number-one cause of a blow.
- If inserting a catheter, insert it on top of the vein.
Placing the catheter beside the vein—”side access”—can cause the vessel to move, which increases the odds that the vein will blow. Placing the catheter on top of the vein will also reduce the likelihood of piercing the vein on both ends.
- If inserting a catheter, go slow.
Never rush a catheter insertion! Move steadily through the skin, but slow down once you reach the vein. Contact the vein slowly, but don’t stop. You may or may not feel or see flashback.
- Stop advancing once you see flashback.
Seeing flashback in the flashback chamber is your cue to stop advancing. It’s a good idea to drop your angle of attack slightly to avoid rupturing the vein.
- Use the needle as a guide.
When working with a catheter, pull the needle back slightly once you’ve penetrated the vein. Doing so will allow you to use the needle as a visual guide as you insert the catheter.
- If working with geriatric patients, avoid using the tourniquet if possible.
Again, the veins of elderly patients are often compromised. These veins can appear thick, but that doesn’t mean they aren’t fragile. Using a tourniquet on compromised veins greatly increases the odds that a vein will blow. That said, if you don’t find a vein via palpation or a vein illuminator, you may have to use a tourniquet anyway.
- Use gravity to your advantage.
Gravity will increase the volume of blood in a vein. If you’re having trouble locating a viable vein, ask your patient to let their arm dangle over the bed. This increases vein fullness, which will make palpation easier.
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