Difficult-start IVs can be tackled with Penrose drains

Many of the tourniquets that come in prepackaged intravenous (IV) start kits are not adequate for "difficult-start" patients, says Linell Jones, RN, BSN, CEN, ED nurse at Good Samaritan Hospital in Puyallup, WA.

"In obese patients, they tend to roll into a very uncomfortable, thin band much like placing a rubber band on the arm," she explains. "In other patients, they stretch too much and don’t compress enough to distend the vein."

Although there are many manufacturers, the tourniquets are all the same size, says Jones.

A relatively small percentage of patients are difficult starts, but they tend to be the sickest and need the IV the most, explains Jones. "There may be additional sticks or searching for the vein that occurs, which is painful," she adds.

One-inch Penrose drains can be used the same way as regular tourniquets, suggests Jones. "They are wider and since they are thicker with two layers, they don’t roll into a thin band as easily," she says. "I wash mine afterward with regular soap, rub with our alcohol-based hand sanitizer, and re-powder with baby powder."

In addition, blood pressure cuffs can be used, by placing them in the same location you would place the tourniquet, with the tubing at the top, going away from the venipuncture site, adds Jones. "The cuff is then inflated to a pressure above diastolic but below systolic."

[Editor’s note: For more information, contact Linell Jones, RN, BSN, CEN, Staff Nurse, Emergency Department, Good Samaritan Hospital, 407 14th Ave., S.E., Puyallup, WA 98371. Telephone: (253) 697-4200. E-mail: linelljones@goodsamhealth.org.]