Save An IV
Quick Trick for Your "Unsuccessful" Starts

I'm sure you've experienced this situation before. You perform an IV start that you think is successful. After opening the roller clamp on the tubing, you stare in disbelief as the site's surrounding tissue expands while the IV bag's fluid flows. Obviously an unsuccessful, infiltration-blown IV, right?

Not so fast. Things might not be as bad as they seem. Sometimes, the IV catheter is in the right place. How can you check if it's intravascular? A simple trick: Apply firm pressure some distance above (proximal to) the IV site while observing the drip chamber.

For example, if this happens with a hand IV site you would compress the forearm using either a tourniquet, or more simply, by encircling the patient's arm with your thumb and index fingers of both hands. Logic dictates that if the IV is intravascular, compressing the venous system proximal to the site will slow the flow of the fluid. If it's misplaced, the fluid will continue to flow into the surrounding space and the pressure will have no effect on the flow rate.

If this trick shows the IV is in fact intravascular, the observed fluid leakage/infiltration is usually transient and will stop spontaneously after a few minutes. I find a firmly taped 2x2 gauze helps in this regard. This technique has saved many of my patients from additional and unnecessary IV attempts, and has saved me time and effort.

Charles A. DeFrancesco, MD
Delmont Surgery Center
Greensburg, Pa.
[email protected]