Geriatric: IV Insertion

All right, and in this video, we’re going to take a look at inserting the IV in the geriatric patient. So we’re going to look at some tips and tricks in getting those IVs on those geriatric patients with a high level of success. The first thing that we need to look at are the use of hand veins in geriatric patients are going to come in, they’re going to be dehydrated, they could have several different comorbidities. So these are things that we have to be thinking about when we are replacing our IV and picking out the right place to put that IV in. So when we take a look at hand veins, we need to use this with caution. Our hand veins appropriate. Absolutely. But the thing that you need to be considerate of is that they can be branched and due to other comorbidities like atherosclerosis, the veins can also be hard.

You want the veins to be spongy, to be a little bit forgiving when you place the IV, but you need to also be prepared that in the geriatric patient this could happen a lot more frequently. So you can use hand veins. They’re also painful, but just proceed with caution when you’re trying to make that right selection. The other thing you want to think about in geriatric patients is the skin integrity of the patient. So if I’m going to place an IV in, let’s say the hand is I placing it in a place that’s going to potentially have a skin tear. If that’s the case, then maybe we want to select a different location and the reason we want to do this is that we don’t want to give our patients skin infections or those skin tears. We want to avoid that. So make sure that you’re picking out locations that are the going to be optimal for that patient and for the type of therapy they’re going to use.

The last thing we want to think about when we’re talking about geriatric patients is the idea of anchoring the vein. You want to use your non dominant hand to anchor the vein down and the reason is is because of those veins are hard, they have a tendency to roll, they’re going to move. What you want to do is to anchor that vein down so that you can give yourself an area of stabilization so that you can insert that IV with efficiency and with confidence and get it on the first try. When you’re doing those IVs, you want to have that routine set up. You want to approach every IV just like those NBA players do, you’re going to tell them up to the free throw line, get set, so this is the same idea. You want to get all your supplies and you want to identify your vein during the assessment phase of what, what’s going on with your patient.

Hey, I’m going to go in, look at Mrs. Smith. I’m going to check her the potential IV site that I need, and then at the same time, I’m doing my assessment. I’m going to be thinking about all of the supplies that I, that I have to go get. Once I do that, I’m also going to do set up these two often go hand in hand. You want to get all the supplies, you want to get it all set up and you want to look at the vein and it kind of happens simultaneously. The next thing you want to do is apply that tourniquet. Now I want to you guys a little bit of a heads up with the tourniquet. A lot of patients have excess skin, especially up around the bicep, and if you apply the tourniquet too tightly, you can create those skin tears, so make sure that you’re using just enough pressure from the tourniquet to distend the vein and to give yourself good visualization but also not create skin problems and integument problems for your patient.

Once that’s all set, remember you want to anchor that IV down to keep it from rolling and place that IV and afterward secure. This is really important. You want to make sure that you’re using the right types of securing devices, whether this is like a transparent dressing or different types of tape. Some of those micro port tapes are absolutely fantastic because they are sticky enough to keep the IV where it needs to be, but it’s not going to create problems for your patient. So let’s take a look at placing an IV in the hand of the geriatric patient. Again, this is not typically your first line, but sometimes patients have great veins in their hands and that’s totally okay. Just remember they’re painful and you want to make sure that the integrity of the vein is great, meaning that it’s not hard, it’s not gonna roll.

It’s gonna stay right where you need it to when you insert it. One thing you want to keep in mind is that you don’t want the end the lumen to be way up here because when the patient bins their wrist, it’s actually going to occlude that, that catheter, and it’s going to create problems for you and your patient. Be patient with this insertion because sometimes it’s just a little bit tricky because sometimes you have to float them. Sometimes they’re not all that great, but what you need to do is just be patient and make sure that you get it in the right location. Make sure the Lumen, that catheter is not budding up against the wrist. And then you want to make sure that this is secure. Also, again, check your patient’s skin integrity. For this patient. It worked out well as she had great veins that were easy to place and that’s why we chose the hand for this patient.

Now let’s take a look at placing an IV in the form of a geriatric patient. Forums are great because they typically have fewer valves. They have, the veins are straighter, they’re more pliable, so they like to play with IVs pretty well. Um, and so the same thing applies in terms of getting the IV set. The entire process is the same start to finish, but the selection is just a little bit more, uh, easy to, to approach because you have fewer challenges.

Now as you can see, we’ve got the flash, we’re going to insert, apply the safety device and then uh, even though we’re applying tampon here, there’s still going to be a little bit of blood for this patient, but that’s why we have the benefits of having the gauze in that IV kit. But one thing to remember about forearms is that they are typically great locations because they just happened to play well with IV catheters a little bit better. So this is just one thing to keep in mind when you’re picking your locations for your geriatric patients.

Now let’s take a look at placing it in the antecubital fossa. That AC same process applies your setups the same. Remember, you want to be a little bit, when we with this tourniquet you want to be a little bit more careful and applying it. You don’t want to have those skin tears for that patient, but the same process again starts to finish. The beauty here is that for a lot of geriatric patients, the AC is also a great location because it has fewer valves. One thing you do want to keep in mind is that some geriatric patients have a little bit of extra tissue there that could cause some occlusion problems. So just be mindful and be very judicious when approaching IV site location, depending on your patients. So the same thing applies. Release that tourniquet, you’ll get that blood return and then flush that IV to maintain patency.

Remember you want to clamp that extension set to make sure there’s no blood return that stays inside that extension. It’s set to create blood clots and give you another one more problem. Use your securing device, that transparent dressing, apply it, use whatever tape necessary to make sure that their extension loop isn’t or extension tubing is not going to get caught on anything. And then educate your patient. Just make sure that they are aware, Hey don’t bend your elbow, make sure that you keep the arm straight cause we don’t want those pumps going off and then timed it an initial. So very important. So let’s recap. Hand veins are totally appropriate but always approach them with careful consideration. We need to think about the patient’s co-morbidities. We need to think about if this is going to be an appropriate location, given their potential needs. Do they need blood? 

Are they going to need a viscous fluid? Sometimes veins can just not be great. So, uh, hand veins can not be great places to put IVs in, especially in geriatric patients. Some patients that are great use your clinical knowledge to make sure that you’re selecting the right location. And another thing you want to keep in mind is skin integrity. Skin integrity is so important, especially in the geriatric patient. We want to make sure that we’re being diligent when we’re selecting and securing the IV. We want to make sure that we’re not creating a skin. Tears of skin tears create all sorts of excessive problems for the geriatric patient in the hospital. So just make sure that before you place that IV site or the IV in that site, that you’re checking out your patient’s skin integrity. And lastly, anchor the vein. Those veins tend to roll because they are hardened from usually atherosclerosis or some sort of another cardiovascular disease. So to help yourself out, anchor the anchor, that vein, using your nondominant hand, and then start low and use that shallow 10 to 20-degree insertion angle as kind of a starting point. Typically, your geriatric patients don’t have a super amount of excess skin that would cause you or have you approach it with a steeper angle. So always make sure that you’re using that shallow angle as a starting place.

All right, guys, I hope that this lesson has been insightful and giving you tips and tricks and even techniques and approaching, placing IVs and geriatric patients. We love you guys. Now go out and be your best selves today, and as always, happy nursing.