Dr. Peter Bailey: I’ve been starting IVs for 30 years and have gotten pretty good at it. The things that I do that most other clinicians don’t is to get the hand (the preferred first puncture site most of the time) as dependent as possible so that in combination with the tourniquet gravity can do its work. After having patients open and close their hand like a fist several times with the hand dependent (well below the heart), I look at the veins on the dorsum of the hand. Gently slapping or “flicking” the vein with my index finger can cause the vein to dilate further (supposedly due to histamine release). Occasionally this can be uncomfortable but not often and it is well worth it. Usually venipuncture is easy after these maneuvers.
Clinicians should learn to appreciate the three-dimensional characteristics of the vein and surrounding anatomy and puncture it, not try to too gently thread the catheter. This latter approach will make rolling vein problems significant and lead to through and through punctures. If a good vein is not apparent, I make sure to look elsewhere (don’t get locked in to one site no matter what) and if the patient volunteers information (“oh yeah, my best vein is here”), I’ve learned they are usually right.
