Tattoos IV Insertion

Patients with tattoos
1. Have decreased visibility of veins due to the pigment of the tattoo
2. Tips and Tricks
  1. Use an alcohol swab
    1. Helps to create contrast in the skin so you can see the vein
  2. Make a mark in the skin with a pen cap or cap of a needle
    1. Not the actual needle!
    2. Create an impression in the skin by pressing the pen cap and rotating at the site of insertion
    3. This gives you a landmark for visualization during the insertion process
Identifying the vein
1. Use methods similar to patients with dark skin tones
2. Use palpation rather than sight for confirmation
  1. Use an alcohol swab to help visualize the site
  2. Use a pen cap to make an impression in the skin
Insertion
1. Verify order, education, and consent
2. Gather all necessary supplies
3. Prepare for insertion
  1. Place the bed at a comfortable working height
  2. Place the vein in the optimal position
  3. Setup all necessary supplies
    1. Techniques vary but use the technique that follows unit or facility policy, and that is most comfortable
    2. Be sure to prime the extension set
4. Insertion
  1. Apply the tourniquet 10-12 cm above the insertion site
    1. Do not allow the tourniquet to stay on the patient’s arm longer than 2-3 minutes
  2. Using the antiseptic from the IV start kit, begin scrubbing in concentric circles, moving outward
    1. Allow the site to completely air dry
  3. While the site is drying, remove the cover from IV catheter
    1. Inspect for damage (if damaged, discard catheter and get another)
  4. Stabilize the IV site with your non-dominant hand
  5. Tell your patient you are about to insert the IV
  6. With your dominant hand, using the appropriate angle, insert the IV smoothly with the bevel up
  7. Once a flash (blood return in the IV hub) is seen, begin to advance only the catheter
    1. If there is resistance, retract the catheter back onto the stylet, and advance the catheter AND stylet 1-2 mm
  8. Advance the catheter until it is seated in the vein and activate the safety device
    1. Quick Tip – Place a gauze square underneath the hub of the catheter before adding the extension tubing to catch drops of blood
  9. Remove the stylet, and add the extension tubing
    1. Check for blood return and flush the catheter
      1. Should flush easily with no resistance
5. Securing
  1. Using the desired technique, secure the catheter with tape
  2. Apply the transparent dressing
  3. Secure the extension tubing with tape to prevent the patient from catching the tubing on equipment
  4. Sign the dressing, indicating time, date and your initials

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Transcript

All right guys. In this lesson we’re going to talk about putting an IV in a patient with a tattoo. So why do we think about patients with tattoos being difficult to put in IV catheters? Well, first off, veins are difficult to see. They’re obviously covered by some sort of pigment and this case it’s artificial and that makes it difficult to see. You can’t always see these you know, the blue colored veins, they’re just not going to show up as well. So what we do is we’re going to use a couple of different methods since they are difficult to see, this is where you’re going to go over a feeling, the vein overseen, you’re never going to be able to, well, I say you’re never, you’re going to have a less likelihood of actually seeing a vein versus feeling it.

Some patients, especially like lean or patients with lower, lower amounts of body fat, you can actually see all their veins, which is great, but they’re just going to be some instances where you’re not going to be able to see them and you’re going to have to rely on feeling for the vein. In any case, the feeling of the vein is actually better than seeing them for the most part. Seeing is kind of a last ditch option. So what we want to do is we always want to feel and see it first. If we can’t do that, we would rather feel the vein rather than see it. There are actually a couple of things that we can do. The first thing we can do is apply a tourniquet and then use an alcohol swab and wipe downward in a really hard direction. This is not the replacement for a ChloraPrep.

This is an attempt to visualize the vein a little bit better. This actually helps to create a little bit of shadowing and using the lights that are in the room to create a little bit of contrast, maybe a little bit better for your eyes to see, but you can use that alcohol swab just to wipe down on the vein where you think it is to see if you can get the vein to pop. The next thing you can do, and I’m going to show you here in this really cool video, is to make a Mark with the cap eyes. So you can use a pink cap or you can use the end of the catheter and be very careful. This is specifically about the end of the catheter where it goes. And you can actually use a Mark or you can use like, you can actually use an old pink cap.

You could take that pen that or that IV cap off of the IV. But I’ll show you what I mean. We’re going to do here is we’re gonna show you the, and see how it makes us circle. What’s going to happen is we’re going to invert it and turn it upside down so you’re actually not gonna run the risk of poking the patient, but see how the vein is right here. Then what you’re gonna do is you’re gonna take it and you’re going to set it on there. It pushed kind of hard and twist and twist and twist and twist, and you get this outline right in here and you can actually see that. So what you can, what you guys can do is you can use that method to create a marks in the skin, and what it does is after that Mark is made, then you can actually use your core prep and that core prep won’t actually take any sort of Mark away, so there’s an indentation in the skin. You’re always going to treat all of your IV insertions, the same prep your supplies, tourniquet on extensions at primed.

Once you’ve identified your vein, then you’re going to anchor it down and then you’re going to insert. Once you get that flash, then you may need to advance it. What’s happening here is there’s a little bit of a valve. We’re gonna advance it just a little bit further above and you could see that little pop once it’s inserted, advance it, and then you’re set. Drop that tourniquet off and then what you’ll do is you’ll reach over, grab your extension set and apply it and get it all locked in. The method I like to use here is to use a tape Chevron. So actually take a Chevron, go underneath and then loop it over, and then I’ll also use another tape over the top to secure it.

Then I’ll apply that transparent dressing. Once that’s set, then I’m good to go and make sure all the time, date and initial. And then I want to flush that catheter one more time for patency and make sure it’s locked in. For this patient, we’re actually going to place the IV outright in that and a cubital fossa right here. So this for this patient, this little piece symbol is actually right where that cephalic vein is running right along with that right along there. We’re going to use that core prep, get everything set up, all of our supplies are set up, and then we’re going to insert, we’re going to anchor that vein down and insert the IV catheter, advance the catheter, and then we’re going to activate the safety device. Now all of your patients aren’t always going to be clean. Not every process is going to be you know, mess free.

So do your best, get them all cleaned up and then once your IV site is clean, dry, and intact, then what you’ll do is you use policy and a, or whatever policy you guys have, and you’re going to place a, a securing device. So in this case, it’s going to be a transparent dressing. It’s going to go right over that catheter. And then in order to secure it just a little bit more, we’re going to apply another piece of tape. Sometimes it’s just necessary, but once it’s all set up, then your patient is good to go.

Okay, so let’s recap with patients that have tattoos. You want to focus on feel rather than my site, you’re never going to be able to see all of your IV locations. So trust your instincts and trust your experience and use that process to get those IVs successfully in these patients. Establish that routine and practice the same technique over and over and over, over both in your setup and in your process. When you can’t see the vein, sometimes you can use these alcohol swabs to make the vein pop. This is not a replacement for the core prep, so always use the necessary antiseptic to clean the site. This is just to help you visualize it, and then if you need to use that technique to make a mark with a pen cap or the IV cap just to make an impression so that you don’t actually lose your sight once you identify it. And identifying tips, tricks, and techniques, and getting IV successfully in tattooed patients. Now go out and be your best selves today. And as always, happy nursing.

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