Dark Skin: IV Insertion

All right guys. In this lesson we’re going to talk about placing IVs in patients with darker skin tones. Now, these patients can sometimes be a challenge because the veins are sometimes difficult to see. This creates a problem in that you’re really just going it kind of diminishes your confidence a little bit because if you can see a vein and you can feel a vein, you’re, you, you feel like you’re, you’re all in, right? But if the veins are difficult to see, it makes it a challenge. You don’t really know where to start. So use a little bit of experience and use that you know, your nursing instinct and your training to know where all of that anatomy is. Now, there are a couple of important things I want you to think about. You can actually use an alcohol swab. And if you think that, you know where Venus cephalic veins are great basilic veins are great what you can use as an alcohol swab.

And it actually creates a little bit of contrast in the light too, so that you can actually see, apply your tourniquet just a little bit about like 10 to 12 centimeters as standard above the place you think you’re gonna go. And then use an alcohol wipe and rub it pretty aggressively. It does a couple of things. Number one, it creates a little bit of contrast with the light glistening off the skin. And the other thing it does is that that agitation releases histamines locally and allows that vessel to distend just a little bit. So that will actually help you. Another thing you can use as, as blood pressure cuff for patients that are typically a little bit more difficult to see because of darker skin hones, you can actually apply a blood pressure cuff, apply it just a little bit above instead of just using a tourniquet.

A tourniquet may not night, may not be enough, so you can actually use a blood pressure cuff to get this. Now, one other little trick that I want to tell you about is using the end of the cap of a, an IV catheter or even a pen. And what that does is it allows you to Mark a spot. Let’s say you find it, you go through all this work and you finally find a vein, but you’re afraid that you’re going to lose it. What you can do is you can actually use this trick and I’ll show you the way it works. What you can do is you take the end of, this is an IV catheter. You can use either use the cap here or you can use the end, but what you do is you find your patient’s vein. Here’s the vein right here.

What’s going to happen is you just take it and you push it over where your insertion site is going to be at, twist it back and forth a little bit. And what it’s going to do is it’s going to create this impression in the skin where you can actually see where you’re going to a place that IVcatheter, so that whenever you do use it or whenever you do scrub it with your antiseptic that you don’t lose your spot. So IV insertion should be the same way every time you want to go through that routine. That routine is so very important. Just like those NBA players at the free-throw line, maybe it’s two dribbles, maybe it’s three dribbles. Maybe it’s you close your eyes as Michael Jordan did. But what you want to do is you want that routine now, prep your supplies, get all the supplies you need to know what vein you’re going to go for.

This can be done in assessment. The first two things kind of go hand in hand, so look at your assessment. Okay, Hey, I need a vein and about know where I’m going. Again, add your, when you’re to the point where you’re practicing on your own, you’re going to have to start multitasking. So, Hey, I’m talking to my patient and I’m looking at their veins. Hey, this is where I need to place it. Okay, cool. I’m going to go grab your supply real quick so I can go. So I can get your IV catheter placed. I’ll go grab everything I need and then I’m gonna get everything set up. That’s so important because that allows you to have everything in place where you need to apply a tourniquet. And this is where step number three, this is going to be your big step.

It’s going to really help you to employ those tips and tricks we talked about, to use that alcohol swab or if you need to you can use that blood pressure cuff too to get that those veins to distant and a little bit so you can actually see where you’re going and to give yourself a better Mark and then use that little pen cap that I showed you and mark that impression of where you’re going to go. Then swab it just like you would place that IV once you’re in, then secure it and you want to make sure that you use that primed extension set. That way everything is all ready to go. Now, depending on your patient history, hands can sometimes be a great spot if your patients are older or they’re very Atrik patients. They may not be ideal because of either excessive tissue or decreased skin integrity.

But hands can be a great location sometimes. And one of the things you need to look at or one of the things you need to remember is that they can be painful. And the other thing is you are presented with several challenges in that they’re not, all the veins are always awesome to work with. And this is an example of that. Sometimes you get a lot of branching veins. They’re not straight. There’s a lot of valves. Sometimes your patients just don’t have great veins. But this is an instance of where it happens is that sometimes we just struggle a little bit as nurses and that’s totally okay. Admitting that you can get better or that there are certain areas that you can get better in are a great opportunity for you to become a better nurse. So here’s an example of what happened. So it’s not going to work. What we’re going to do is we’re going to call it and just understand that this is not a great location for this patient.

All right? In this scenario, what’s going to happen is we’re going to place that IV in the forum, which is a great location. What we’re going to do is insertion and attend to 20 degree a insertion angle. One thing I want to point out here is that we are going to get a little bit of blood on the patient and that’s totally okay. This is why we have gauze in those IV kits. It’s really a, a great feature of them because what it does is it allows us to clean up our patient. If there is a mess, we can’t expect everything to always be clean and perfect all the time. But what we can do is use the tools that we have available to make our life a little bit easier. So a couple of things I want to point out. So she flushes this IV and we obviously see that we get some blood return back after that’s in place.

We’re going to use a securing device to secure the IV in place that keeps it from running around. And the other thing too is we’ll apply some tape, but there is one important thing that I want to show you that she does here. And just one second, you can see that there’s actually blood in this extension tubing and she flushes it, she flushes it and once it’s clear she’ll apply that or that clamp and keep that clamp in place. That keeps blood from flowing back from the patient into the IV and into that extension set and keeps Claus from happening, get it all secured. And then time, date and initial.

And finally, another great location is that AC? The AC is great. Just one thing to remember is that it can include because it’s always being bent, 10 to 20 degrees in a certain angles. Bang. Got it. And then we’ve got that the, the blood return, we’re gonna apply the pressure to try to keep the blood from flowing back. And if we do, then that’s great again, sometimes we just want to be aware that it can happen and we want to try to keep that site clean, ply that extension set put it on. And then the other thing we’re going to do is we’re going to flush and just make sure that the IVs, Peyton, get some blood return. Great. And then flush it through and then we’re going to reach up and clamp it. And once it’s clamped and then we’ll grab that securing device, make sure that it’s all good to go.

And once you’re all set, then I just make sure, again, you’re following policy. Then you use some tape to tape it down. And then we’re going to time, date and initial our IV site. Now to recap for patients with our skin tones, it’s not always an easy task to put IVs in these patients just because you can’t see the vein. So always go by field. That should be your first strategy for these patients. Use experience and knowledge and your knowledge of anatomy that will help you identify locations that you can actually place those IPS. If you need to get a little bit more visualization, you can Al, you can use the alcohol prep, the alcohol preps are going to allow you to maybe see a vein a little bit better by creating a little bit of contrast with the light. Also, that irritation from actually running that alcohol prep over that vein with the pressure is actually going to cause that Bain to distend a little bit and you can use that. The other trick you can use as a blood pressure cuff and that’s going to help with this tension. All right guys, I hope that these tips and tricks have been helpful for you to get your IVs in these patients with darker skin tones or veins that you can’t see all that well. We love you guys now go out and be your best selves today and as always, happy nursing.