What is a definition of a good vein?



Dear Nurse Janx,

I have read the post on how to find a vein for iv in this forum. The post was informative and detailed. But I got some doubts that I would like to clarify.

The only part of the arm that I learn how to set IV is on the forearm using a 18G catheter and using an arterial tourniquet really tight till all the veins pop up. And I practice with the combat medics of the military. They are all young and fit people who are vascular.

Yesterday when I attempted to set IV without tourniquet as that arm has a bp calf on and it was puffed up. I could see his vein colour but when I palpate, it was not puffy. I attempted while his palm was facing up to the ceiling. I went for it anyway as I only have the right arm to set IV. I go in at 30 degrees and 4 millimetres. No primary backflow. I took out the catheter without wasting anymore time and let my paramedic take over. Patient right arm was decorticating from time to time. My paramedic attempted IV on his hand but because patient decorticates, the canular comes off.

How do I secure the iv line when the patient decorticates?

My paramedic told me to find a puffy vein for IV attempt and my patient was muscular. Can I only find it on the back of the hand?

Yours Sincerely,
Md Haziq


Decorticate posturing is going to make IV sticks difficult in some areas (see pic):


The hand and dorsal forearm are probably the best areas to target, forget the AC and ventral forearm. Hand veins can be huge, so no worries there.

If the movement is the issue, use lots of tape and lots of slack on your tubbing.