An excellent I.V. therapy nurse is made, not born. There is no way that the essential skills needed to master the art of
IV insertion, maintenance and termination can be developed  overnight. Just like other important Nursing skills, IV therapy is an art that really takes time to be mastered.
If you want to be the very best IV nurse that you can be, you also have to open yourself to a lot of challenging tasks necessary to develop the basic skills of
IV insertion. One of these challenges are those patients with moderate to severe fragility of veins. And to complicate the scenario, some patients also have thin and dry skin that further increase their susceptibility for infection and injury.
Factors that make patient’s vein fragile
There are a number of factors that make a particular vein too fragile for an IV catheter to pass through. Among these are aging, exposure to UV rays of the sun, use of illicit drugs, malnutrition, long term use of particular drugs like anticoagulant and corticosteroids, heredity and use of products with drying properties.
Though we can’t quickly change these risk factors the moment we face patients with fragile veins, there are still effective ways to make IV insertion possible. Whether you’re a novice or an expert, you have to remember that fragile veins are one of the toughest challenges you can ever face as an IV therapy nurse. But to help you surpass this challenge, I’ve listed five simple tips to make IV insertion in fragile veins a piece of cake for you:
1. Say NO to tourniquet as much as possible.
If possible, never use a torniquet to facilitate IV insertion in a patient with very fragile veins. Older adults, for example, have dilated veins most of the time so using tourniquet is obviously out of the picture.
However, when using tourniquet is necessary, try to choose those that are made with light materials. Apply it lightly then remove as soon as you see a back flow of blood in the cannula. Improper use of tourniquet for this particular type of patient may lead to venous “blow”, hematoma formation, and skin damage.
2. Use the smallest catheter available.
The size or gauge of catheter to be used will largely depend on the specific therapy the patient is going to receive. However, since the patient has fragile veins, health practitioners must choose the smallest size to avoid possible damage.
As a standard, patient with fragile veins must only get gauge 22 or gauge 24 for the IV therapy. According to  Infusion Nurses Society (INS), “When the catheter is too large for the vessel lumen, irritation from the catheter is very likely to cause mechanical phlebitis and possibly thrombus formation.”
3. Use “bevel-up”, “low angle” and “slowly but surely” approach.
Before proceeding to the actual IV insertion, determine first the proper needle-skin angle to be utilized and provide good skin traction to stabilize the vein. Then, using the bevel-up approach, slowly insert the needle on the top of the vein, making at least 10-20 angle (or almost flat) with the skin especially if the veins are dilated and can easily be seen through the skin surface. You have to take your time doing this to avoid causing additional harm and damage to the patient’s veins.
4. Secure the catheter with a paper-type tape.
A dry skin can get unnecessary damage when plastic or silk skin adhesives are used to secure the IV catheter. To avoid this, paper-type tapes are usually preferred to maintain IV insertion for patients with sensitive skin types and unstable veins.
Upon termination, use of adhesive solution will greatly ease the process of adhesive removal without bringing additional damage to the skin.
5. Provide health education to improve patient’s condition.
As a patient advocate and educator, a nurse should provide patients with valuable information that will definitely help to improve  their condition in the long run. Use of moisturizers, avoiding excessive sun exposure, eating a balanced diet rich in protein, and adequate fluid intake are just some of the helpful information a nurse can impart to her patients.
IV insertion for patients with fragile veins seem to be a very daunting task, but with practice and enough exposure to these types of challenges, a nurse can surely get the fulfillment from a job well done.
