NOTE:   When you have developed some skill in venipuncture, you will occlude the vein just below your planned puncture site. This will cause the vein to rise or fill faster.  When you are learning venipuncture you may not have developed a natural ability to align your needle and syringe correctly. You will need to view more of the distended vein to improve your alignment and accuracy.  

The ability to give an IV injection, the ability to assist someone with an IV injection, and skill to teach IV injection are three different things.  The following is an attempt to address the difficulties encountered most commonly during the period when learning venipuncture.  A true understanding these points will help you develop the skills you need to administer, supervise, and teach safe IV injection techniques.
Point by point:

1.IV injection is probably the most common procedure you will perform as an equine veterinarian.
  Developing skill in IV injection will reduce the chances of an arterial or perivascular injection. It is
  worth investing the time to learn to do it correctly.

2.Once you have found the vein and oriented your needle, PLACE IT!  Pricking the patient repeatedly
  without placing your needle will cause the patient to become im-patient at the least.
JUGULAR VEIN AND COMMON CAROTID ARTERIAL ANATOMY AS IT AFFECTS THE IV INJECTION
3.IV injections should be given in the upper
   portion of the neck (closer to the head).   

a.Closer to the head of the horse there is a
         muscle between the artery and the vein, 
  decreasing the chances of an arterial stick.

b.Closer to the body of the horse the artery
               is more superficial and closer to the vein.
  Venipuncture in this part of the neck 
               increases the chance of an arterial
  puncture and injection.  Until you have
               given thousands of jugular injections using                sound technique, you may lack the skill
               required to avoid arterial injection.
4.Placement of the needle into the vein should always be done with the bevel facing toward you.

a.Correct bevel orientation decreases resistance to skin puncture.

b.Incorrect bevel orientation can cause the bevel to rest flat against the wall of the vein, occluding
  the lumen.  

c.If you feel you have placed the needle correctly but have no “flash” or drop of blood in the hub
 of the needle, occlude the vein and rotate the needle by twisting the hub.

5.The stick and fish technique increases the chances of an arterial stick.  

a.Find the vein before placing your needle.  

b.If you believe you have found the vein, yet are unable to obtain a flash, rotate the hub of the
  needle as directed above. 

c.DO NOT fish blindly

d.DO NOT pull the needle out.  The skin stick is the step that generally bothers your patient the
  most.  

In order to redirect accurately, you must find where you have placed the needle in relation to the vein. Take a few moments.  Feel the needle.  Is it sub-q?  Watch the hub of the needle. Occlude and release the vein.  The movement in the needle will help you see where it is in relation to the vein.  Skipping this step cheats you out of a valuable learning exercise that can help you improve your accuracy and costs your patient an extra stick.

6.Many practitioners place the needle and syringe as a single unit. This method is appropriate for a
         skilled practitioner.  When learning, it is a good idea to disconnect the needle from the syringe 
         during placement. 
 
a.Overestimating the depth of the vein is common

b.You cannot distinguish vein from artery by aspiration of blood into your syringe.

c.Once the needle is placed, continue occlusion of the vein and watch for blood dripping from the
               needle.  An arterial puncture will pulse.
7.The Jugular vein is very shallow (review ultrasound in #2).  

a.Only skin lies between your needle and the vein

b.As the angle increases, so does the risk of running the needle into the artery.  

8.Failure to bury the needle (advance completely) increases the risk of two common errors. 
 
a.Your needle is more likely to come out of the vein during injection, causing perivascular drug
               administration.  

b.If your needle is pushed deeper by the patient's movement toward you, the needle may be
               pushed deeper, causing an arterial injection. 

To avoid these problems, once the tip of the needle is within the lumen of the vein, orient the needle parallel to the vein and bury it (advance the needle until all that is visible is the hub). 

9.      A 1 ½” needle is more likely to remain in the vein if the patient moves.
13 MOST COMMON MISTAKES WHEN LEARNING/MAKING AN IV INJECTION

1.Lack of commitment to accurate needle placement.

2.Lack of commitment to the act of needle placement.

3.Incorrect location.

4.Incorrect bevel orientation.

5.Blind stick, or ‘stick and fish’ technique.

6.Assuming that blood in the syringe indicates correct placement.

7.Needle angle too steep.

8.Failure to bury the needle.

9.Too short a needle. 

10.    Subcutaneous needle placement (with only the tip of the needle in the vein.)

11.    Use of a dull needle. 

12.    Failure to maintain hand position during placement, aspiration or injection. 

13.    Misalignment of the needle and vein.
10.     A needle placed using sound technique will pierce the skin and immediately enter the vein.  It will
          not run subcutaneously before it enters the vein.   The needle on the right has been buried,
          however, only the very tip of the needle is in the vein.  The likelihood of loosing the vein during the
          injection is high.

11.Each time a needle punctures anything it becomes dulled.  Dulled needles cause significantly more
           pain.  For this reason a new needle should always be placed on your syringe prior to administration
           of an injection to an un-anesthetized patient.

12.Shifting the hand position (and needle, and syringe) during aspiration. Focus on:

a.Maintaining the correct vein/needle/syringe alignment as you aspirate 

b.Maintaining a very still hand position during aspiration.  To help you do this, brace your hand
               against your patient.
13.      Another common misalignment.  When viewed from above rather than from the side, this 
           needle may appear to be aligned correctly, however, if placed at this angle, it will enter and leave
           the vein prior to being buried.  

Rural Veterinary Experience, Teaching and Service
An introduction to Intravenous (IV) Injections

First, find the jugular vein;

1.Locate the jugular furrow 

2.Occlude the vein 3 to 6 inches below where you plan to place your needle. 

3.Watch for the rise of the vein.   
To help visualize the vein; 

1.Raise the head. Try not to change the angle at the poll.  This will “stretch or tighten” the vein which
  will;

a.Reduce the amount that it can roll or push away from the needle.

b.Make it more easily visualized.

2.Push the patients head slightly away from you while holding it up. Do not turn the patients head
  during this step.

3.Wet the hair with alcohol. 

Ponies, donkeys, and very muscular or thick necked horses, can be more challenging.  When learning, start with an animal with a slighter build.  
Check out the Donkey Welfare Symposium website and visit us at the symposium for a great educational opportunity!

http://donkeywelfaresymposium.homestead.com/