How Not to Start an IV

Today I spent my second day in a row as a pin cushion. The phlebotomy tech was so bad, being dangerous was his best ambition. Yesterday I gave up trying to give him a blood sample. After several attempts I asked him to please stop and promised to come back. Today I went back.

I don’t even know who I am anymore. 30 years ago I would have just hit him. 20 years ago I would have said something so insulting an incident report would have been generated. 10 years ago I would have insisted somebody else try.

Now I politely promise to come back. This has given me a unique opportunity to see how exactly NOT to start an IV or draw blood.

If you are right handed, insist on approaching your target from the right side. If you are left handed insist on standing left of the arm you are trying to stick. That will automatically position you to either miss the vein entirely or worse, spear it through and through.

Don’t line your feet up to the target. It does not matter. Golf, Baseball, Karate and every other sport has proven it really does not matter what body position you are in or your approach angle to the target. Everybody knows a backhand on the tennis court is no harder than a forehand.

When you feel for the vein, push real hard. That way you will crush the soft tissue and won’t actually feel much to guide you. No point being distracted by non-visual physical references.

Don’t stick what you can feel, stick the most superficial vein you can barley see. Stab at the feint traces of dark surface purple. That way if you do hit something with rudimentary blood flow, it won’t bleed too much and make a mess in your flash chamber or collection tube.

Use a cheap disposable tourniquet for the thousand time. It is just for looks anyway. Think of it like a blue band fashion statement. Like a Livestrong bracelet for the Medicare crowd. You know that occluding venous return is a just an old myth that cannot make venipuncture any easier or harder.

Don’t listen to the patient. He might have 35 years field experience and his or her first job may have been the one you hold now. The last thing you ever want to do is learn something. You were born with all the knowledge you will ever need.

When they ask you politely if maybe somebody else might want to try, feign complete hearing loss. The very last thing you can do that will help is to to give up. Show no weakness. Insist on trying one more time. You are a professional. You know that with every failure your odds of success will double.

Thank God for Band-Aids. Otherwise I might be distracted by the whistling sound of air blowing through my arms.


About Dan White

I'm a retired Paramedic and EMS Instructor with 35 years EMS and emergency medical product experience. I love canoes, cars and EMS. I have written a lot about EMS Technology on the Paramedic Blog, the Insights on Innovation column for, on and I can be reached directly at 573-240-0002.
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