Q&A on venipuncture and IV catheter placement

Venipuncture and intravenous (IV) catheter placement are core technician skills, and choices about vessel, catheter size, and preparation can affect both patient comfort and procedural success. In this Q&A, Alyssa Mages, BS, CVT, FVTE, cofounder and chief visionary officer of Empowering Veterinary Teams, discusses her hands-on session from the Fetch dvm360 Conference in National Harbor, Maryland earlier this fall, including how to choose a catheter, the mistakes she sees most often, and why practice models matter before working on a live patient.

Read Part 1 of this Q&A here: Q&A: What veterinary teams need to know about effective patient triage

Editor's note: This dvm360 Q&A has been edited and consolidated from a verbal interview to better fit a written format while retaining the substance of the original conversation.

dvm360: Before a blood draw or IV catheter placement, what patient factors should a technician consider when choosing a vein and approach?

Mages: It's going to be situationally dependent, deciding what size catheter. I used to be a huge subscriber to the school of "go big or go home," but that's not necessarily appropriate, particularly if you have an oncology patient. [The] smaller bore the better. So it's really going to depend on your patient status. It's going to depend on the procedure that's being done, and it's going to depend on the skill of your team.

We'll go back to the Great Dane that I talked about [earlier]. If you have a large or giant breed dog, it makes sense to use a larger bore, like a 16 [gauge], even in those big guys, and longer, so it can actually stay seated in the vessel better. And then conversely, if you have a domestic shorthair cat, you want a 22-gauge short standard IV catheter.

It depends on how long they're going to be in hospital. Is it an outpatient procedure? Is it overnight? And how are you maintaining that access port? Are you cleaning it regularly? Are you unwrapping it? And what is your taping technique? So there's a lot of factors to consider, and it really is going to depend on a multitude of things, but primarily what your patient is, what the procedure is, how long that procedure is going to be, and how the hospital stay also accompanies that, and the doctor's preference.

dvm360: What are the most common mistakes technicians make when placing a standard IV catheter, and how can they improve?

Mages: Common mistakes, and I'm guilty of them, are rushing—you just want to get that in—or being overconfident. That's the 2 things that we tend to see the most with my team. When an EV trainer is working with them, it's really making sure you're having those different types of conversations. You train the skill, but you coach the person.

If you're nervous and you're shaking, you're not going to have that smooth, fluid movement. So it's making sure that you understand the vasculature, you know the different branches of the vessels that you are phlebotomizing, and again, really not stepping over that line of confidence into arrogance. It's taking your time, not being too slow, but not rushing, and reading the cues from your patients as well, because you have a very small window with some of them to place this, and you don't want to stress them out. You don't want to cause any pain or discomfort. So it's making sure you're confident in your skills, which is why we are so excited to have the EV training veins that we’ve developed, so you can really get that muscle memory on an artificial vessel and then translate that to a live patient.

dvm360: What steps should technicians follow to perform a blood draw safely and efficiently?

Mages: Have everything ready before you even start. There's nothing worse than having a cat that is so far so good, but they only have a certain limited amount of time, and you have to go get a different needle, or you drop the syringe, or you forgot the tubes to put the sample in. So make sure you're prepared with all of your supplies for the procedure, and make sure you're prepared [yourself]. You know what the patient's history is, you know what you're sampling for, you know which vessel you're going to be sampling from, and you have someone that's going to be helping you in restraining this patient appropriately, so everyone is safe.

dvm360: What are the key takeaways you hope attendees left your hands-on session with?

Mages: The session [was] really geared towards hands-on training. [It] was taking a look at why you're doing blood work. Hopefully, you have placed a catheter before, or you're looking to really develop those skills.

[The takeaways] are to understand that you don't have to be the best at everything. You have to be good at a lot of things, and [it's] relying on your team to lift you up for that, but also taking that time to get practice models, so you are absolutely certain that you know what you're doing before you take that skill and translate it to a live patient.

There's nothing worse than thinking you can do something and then it goes wrong and you don't know what to do, and your hands don't know what to do. Your brain is all scattered. So if you practice it beforehand, and you have that tactile, that didactic memory already in place, then you're good to go. It's not practice makes perfect; it's practice makes progress.