There's no reason for your nurses to be sticking patients 2 or 3 times and then calling over the anesthesia provider to assist with a routine IV start. Here are 8 ways to improve your success rate.

1. Repetition, repetition, repetition. Performing a task over and over again is one of the easiest ways to become proficient, and that certainly holds true for IV catheterization. From finding the vein to inserting the needle to securing the catheter, the more times you do it the better and faster you will become at it. That's why Jay Horowitz, CRNA, president of Quality Anesthesia Corp. in Sarasota, Fla., finds it useful to appoint 1 person (or multiple people, depending on your caseload and facility size) whose sole job is to start IVs. "We run 40 cataract patients through the facility twice a week, so we don't have time to fool around," he says. "I've been privileged to have an LPN, RN or paramedic to start our IVs, and that's all they do. It's that sheer repetition that makes it very efficient."

2. Select the right IV site. Don't assume that a nurse who knows how to draw blood will be equally proficient at starting an IV. Each requires different skills. Staff members who will be tasked with starting IVs should be educated on how to assess patients' anatomies and should be aware of what medications and fluids the patients are going to be receiving during surgery so they can make an informed decision about IV site selection. For example, an area of flexion like the antecubital fossa should not be a routine choice as a site to start IVs. "If you have to use the antecubital area to start an IV, the nurse will need to check what kind of IV solution will be infusing into the vein and determine if it will cause any harmful consequences such as phlebitis or extravasation if infused," says Cora Vizcarra, RN, CRNI, MBA, a vascular access consultant with MCV & Associates Healthcare, who blogs at infusionnurse.org. "Sometimes, in an emergency, the antecubital fossa veins are used to start an IV. If this is the case, remove the antecubital IV as soon as possible and restart it in another site."

3. Palpate properly. There's a lot of vein-finding technology out there (tinyurl.com/bo4z3z2), but don't forget about an old-fashioned method: palpating the site. "If you just rely on seeing a blue line underneath the skin, that's not going to give you all the information you need," says Lynn Hadaway, MEd, RN, BC, CRNI, an infusion therapy and vascular access consultant based in Milner, Ga. "You have to be able to feel these veins by palpation." Be sure to use the same finger (usually the index finger) of the same hand each time you palpate; over time, you will develop a sort of sense memory in that finger that will help you locate more quality veins for IV catheterization. Don't just rub the area, but also "press downward and slowly release the pressure on the patient's skin," says Ms. Hadaway. "That will help you determine not only the location but the condition of the vein as well. A healthy vein will feel very elastic and bouncy."

4. Invest in vein-finding technologies. In venipuncture, you have very little margin for error. That's even more so the case in patients with difficult-to-locate veins, such as pediatrics, or in those with vascular damage, such as chronic steroid users and cancer patients undergoing radiation therapy. You may want to consider investing in light-based and ultrasound technologies that can help your staff visualize veins beneath the skin. Sarah Johnson, RN, perianesthesia nurse manager at the Iowa City (Iowa) Ambulatory Surgical Center, doesn't have to imagine how much more effective she'd be if she could locate the veins beneath the skin. She knows, thanks to the vein illumination device her facility rents.

You slowly move the handheld device over the appendage in which you want to start an IV, says Ms. Johnson. The device shines an infrared light that lets you see the vasculature within that limb. "You can see the vein as it runs down your arm," she says. "You can see the bifurcations within the vein and see if the vein is long enough to hold the catheter. This has been a huge help for us in minimizing failed attempts, especially in those patients that are more difficult to get IV starts."

5. Hold traction when advancing the catheter. "I'm difficult to stick because my veins roll." How many times have you heard that one? The truth, says Ms. Hadaway, is that everyone's veins roll. "No one's veins are anchored down firmly because of where they are, in loose, superficial connective tissue under the skin." For this reason, most practitioners know to pull traction on the skin during the initial needle puncture. But be careful not to let the skin go slack for the next step: advancing the catheter. Ms. Hadaway says it's vital to "hold traction on the skin during the entire procedure of advancing the catheter into the vein," usually with the thumb of your non-dominant hand. This keeps veins from rolling and lets you advance the catheter smoothly.

6. Don't forget infection prevention. The Centers for Disease Control and Prevention released updated "Guidelines for the Prevention of Intravenous Catheter-Related Infections" this year (www.cdc.gov/hicpac/BSI/BSI-guidelines-2011.html). Have your staff brush up on the specific recommendations pertaining to hand hygiene and site preparation for the insertion of peripheral intravenous catheters, which differ from the recommendations for central lines. Antiseptic agents should be applied to the skin with friction to penetrate deeper and kill more bugs below the surface, says Ms. Hadaway. Once the skin has been prepped, staff should not touch the access site again unless they don sterile (not just clean) gloves. Therefore, Ms. Hadaway notes that it's important to make sure you've already palpated the skin and identified your vein before you prep the site.

7. Train your staff on your products. Pretty much everyone is using safety needles and catheters for IV therapy these days, but not all products are created equal. Some devices are active, meaning the provider has to take steps to actively deploy the safety mechanism, while others are passive, requiring no extra work on the provider's part to make sure the needle is safely housed. Especially if you have staff placing IVs who also work in other facilities, it's critical to ensure that they are knowledgeable and proficient in using your facility's devices correctly. "Safety mechanisms and devices have greatly reduced needlestick injuries, not eliminated them," says Ms. Hadaway. "You have to know which device you're using and how to properly operate it each time to get the best benefit from those devices." Meanwhile, Mr. Horowitz cautions against trying to force products on your staff that they don't like or find difficult to use. "The product has to fit with the user, that's probably the most important thing."

8. Educate patients about potential complications. This step may save you on the back end by helping to identify and treat potential infection, inflammation and other complications before they escalate. Ms. Hadaway notes that while healthcare facilities typically have great discharge instructions pertaining to a patient's surgical procedure, they often omit any instructions about what to do if they experience complications at the IV site. Provide your patients with information about what is normal and what is not, and who and when to call when there appears to be a problem, such as redness or pain. "In many of the legal cases I have served on, there was no information provided, and delay in treatment caused the problem to be worse," says Ms. Hadaway. See the Infusion Nursing Standards of Practice (www.ins1.org) for patient education recommendations.