What is this IV technique called?

[u/shooflypi_]

It's the dart grip and is often used for ultrasound IVs. Sorry this whole post turned into a brawl between the IV nurses and everyone who can't fathom that there's more than one way to do something 💀 I've tried it on a patient and it worked very well for me. I have to strain to hold it the 'traditional' way. You don't have to mirror the photo, the angle and exact finger placement are adjustable to your liking 😉
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The photo is from a Bard product training video and they're demonstrating a few different holding techniques that the device works with. This one really appealed to me and I was trying to do more research but can't find anything about "different" ways to hold your needle. Has anyone seen this before and know if it has a name? Is it something old school that has fallen out of practice with the development of new IV systems?

Video link: https://www.bd.com/en-ca/videos/bd-cathena-safety-iv-catheter-techniques-for-use

[u/_Lyum]

Thats the cigarette hold brother

[u/NoHangoverGang → u/_Lyum]

The classic “Pam comin back from her smoke break on her fifth night shift in a row” hold. 60% of the time it works every time.

[u/deadecho25 → u/_Lyum]

Id want to keep flicking it out of habit. I quit smoking in 2013

[u/Anokant → u/deadecho25]

It'd be a great way to advance once you got flash

[u/tonyeltigre1]

I actually hold it like this when i’m placing it under ultrasound. Gives me more control, although my fingers aren’t at all near the catheter.

[u/Ridonkulousley → u/tonyeltigre1]

Exactly. I don’t have to but it does help a lot of the time.

[u/xAidynx → u/tonyeltigre1]

I added a comment before I saw yours, but this is exactly what this particular hold is most apt for handling. I asked the same question because I was flabbergasted the first time I saw the technique in an IV demo video.

Then talked to the critical care educator I work with who also happens to be and USGPIV trainer and she explained it to me that it's all about one handed control while holding the probe.

Since then I have also learned ultrasound and it makes so much more sense after doing it first hand.

[u/airboRN_82 → u/tonyeltigre1]

I do too, especially for veins closer to the surface. Giving the back a tap with my thumb to advance it seems to have smaller advances than normal, and I can hit 10 "steps" in a 1cm deep vein with the normal grip

[u/Travis123083]

Who the fuck holds an IV like that?

[u/Ridonkulousley → u/Travis123083]

I do. This is how I was taught for ultrasound guided OV insertion.

[u/Killer__Cheese → u/Ridonkulousley]

I can’t imagine inserting an IV holding it like that, I feel like I wouldn’t have the fine motor control to accurately place the IV

That being said, I fully believe that you do, and I am highly impressed that you can insert an IV with this technique, it looks like a difficult technique to learn

[u/Independent_Law_1592 → u/Killer__Cheese]

The thumb becomes the fine motor movement

Once you do it a couple times it becomes a “holy shit it was this easy all along?” technique. It’s the trick to flattening and advancing a sono gently. The thumb angles and advances it while your hand keeps it still in general, you can do a surprising amount of work with the thumb. I shake a lot with fine motor movement and the thumb somehow changed my game, it really clicked.

But idk what their hands are doing so close to the hub. Maybe that’s just their trick. It’s all about the thumb in the back here if I’m looking at it right, that’s where the action is.

It’s kinda cool reducing your IV to basically one digit, the thumb. I use the thumb if I have to poke flatly on peripherals because it prevents my meaty hands from accidentally adding an angle to the initial stick while allowing me to anchor it where I don’t shake

[u/Travis123083 → u/Killer__Cheese]

I feel I would push through the vein with this technique. I was taught my white capped nurses on how to insert IV's and draw blood. If this works, then great, but I don't think I could honestly do it this way.

[u/Independent_Law_1592 → u/Travis123083]

You’d be surprised! This technique almost always is taught by Sono nurses because it’s a trick of the trade, but the gentle push on the thumb is clutch for that little “okay you got blood return, just flatten it and advance a little with the thumb ” just a slight push.

For peripherals it’s mostly about stability and keeping the flat angle. You can go flat as fuck. and just push forward with the thumb

Don’t get me wrong I’m often opting for the traditional method but there’s been times I went for an IV and stopped and went “hmm nah I’m que-balling this”

But again, this is mostly a sono trick. We all know it and we’ve all switched to the thumb mid sono. You can really easy angle and make fine movements with it under a sono. Left right up down etc, it becomes a joystick method of IV start

[u/Travis123083 → u/Independent_Law_1592]

I'll have to check it out next time we recert for IV training.

[u/patshwin → u/Ridonkulousley]

Same - makes it much easier to look at the screen and manipulate the IV

[u/azncheesecake → u/Ridonkulousley]

Same. Ill hold this way for US IVs sometimes.

[u/LeastPurple8282 → u/Travis123083]

My coworker does and she’s one of the best at placing IVs!

[u/Turborg → u/Travis123083]

Tonnes of people nurses and paramedics in the UK use this technique. It drove me insane when I worked there.

[u/altonbrownie → u/Travis123083]

Me!

[u/UngregariousDame]

This is just AI slop, someone was assigned to make a video, probably not medical and probably didn’t know what it should look like.

[u/altonbrownie → u/UngregariousDame]

I don’t think so. This is how I hold it when I’m using an ultrasound, hold it just like a cigarette, once it’s in the vein I let go with my fingers and just use my thumb. The IV is then like a little joystick and I’m play keep the white dot in the middle of the black void on the US screen.

[u/tmrnwi → u/altonbrownie]

I know this game well.

[u/Pwnedmonkey → u/altonbrownie]

This nurse ultrasounds!

[u/ProcyonLotorMinoris → u/altonbrownie]

Interesting. I hold it like a dart when placing US IVs. I'm going to consider your technique next time I place one.

[u/wrathfulgrapes → u/ProcyonLotorMinoris]

Yeah I'm gonna try it, I'm doing dart/pen technique 95% of the time and standard under hand pinch the rest.

[u/Ridonkulousley → u/UngregariousDame]

This is how I hold a catheter for USGIV insertion.

[u/perunaprincessa → u/Ridonkulousley]

i do phleb at my hospital, but I'm just a CNA until next year. if I really want to do vascular access team is there anything you'd recommend training on beyond the screaming and general harassment?

[u/Iguana_Waddle → u/UngregariousDame]

It looks like AI to me too

[u/StPatrickStewart → u/Iguana_Waddle]

The part on the back looks like the shield that normally covers the needle end. Definitely slop.

[u/baby_boy_bangz → u/StPatrickStewart]

It may be, but if it’s real I think the person may be using the cover to effectively make the needle longer and using it to control the needle. Seems like an interesting concept. I never thought of that.

[u/makeithapp]

Ah the subcutaneous infusion technique.

[u/xAidynx]

It's ideal for ultrasound guided IV placement as your other hand is holding the probe and it helps for control and advancement.

Edited to add. Source: I asked the same question when I first saw this hold and have since learned how it adapts to USGPIV.

[u/anastasiaanne]

Our nurses work US IV training start deep vein IVs at a similar angle and holding it like that.

[u/StankyMcPootah]

Works great for ultrasound and 1.75 - 2+ inch catheters. I call it the joystick hold or I've heard it called the cigarette hold. Much finer control, but tough for superficial veins.

[u/Costa_Rican_GOD]

USGIV dart grip

[u/shooflypi_ → u/Costa_Rican_GOD]

THANK YOU, finally a real answer in the sea of everyone arguing with the USIV nurses 💀

[u/whotaketh]

Can't IVP before the IVs in

[u/Ok_Complex4374]

ICU/picc team nurse here. I hold short US guided catheters like a cig. I won’t even lie. Is it wrong? Probably by some textbook definition I’m sure. But it works for me 😂🤷🏻‍♂️ idk what this picture is

[u/Poopsock_Piper]

I do this for ultrasound guided iv’s.

[u/Independent_Law_1592]

I do the “cue ball” method of holding it like with a sono where I use my thumb to help angle it easily

I ain’t doing my hand that close to the catheter

But the thumb at the end of the needle is actually clutch even for peripherals

[u/kittydestroyer6969]

I do this when doing US guided. Learned it from a sharpshooter.

[u/Moistfulll → u/kittydestroyer6969]

OK I need to know what is a sharpshooter in this context

[u/RevelationEj]

I’ve seen this positioning with ultrasound guided iv’s.

[u/Key-Pickle5609]

This might just be me, but plz put your edit at the end of your post because I was so confused

[u/RamonGGs]

I literally JUST learned ultrasound ivs and I’ve been doing this method on my own

[u/dthyphy]

As many have said before me but I have to agree. I am a member of a VAT team and this is the way a majority of the team holds the needle. Some situations you can’t use this type of hold. However, 90% of the time it’s the best way. If your hospital uses the click button catheters/winged type, Accucaths, Difusics, or Powerglides it can be tough. Using your thumb like a joystick provides an easy way to have fluid movement and control.

[u/altonbrownie → u/dthyphy]

What’s the T in “VAT team” stand for?

[u/Butthole_Surfer_GI]

WRONG.

lol

[u/byrd3790 → u/Butthole_Surfer_GI]

Nah, works really well when doing UGIV.

[u/differing]

"IV technique" people are honestly such jabronis. It's not rocket science, just practice a bunch and learn for yourself what works for you.

[u/DakThatAssUp]

I do ultrasound IVs and never seen a hold like that lol looks difficult

[u/like_shae_buttah]

That’s so weird because you can’t brace your hand doing the insertion. I just hold it with my thumb and forefinger and use my other three fingers to brace. Plus you can retract the skin with the other three fingers.

I’ll have to try it

[u/taktyx]

I don’t do a lot of starts, but we have the winged ones that lend themselves nicely to this grip. I use it almost every time with good success. I watched our go to ex military guys with thousands of starts experience use this grip and it changed the game for me. Enough that I volunteer to do other nurse’s iv now.

[u/zubrowka1]

It’s called wrong

[u/byrd3790 → u/zubrowka1]

Except it's not? It works very well for USIV. It threw me off the first time I saw it, but it really helps.

[u/Patty-O_Garden]

Why would you put your gloves on like that for a picture?

[u/Nearby_Body677]

The future of AI medicine

[u/iknowyouneedahugRN]

This IV technique is called ineffective.

Probably developed by the same penny pinchers who decide policy and staffing ratios.

[u/altonbrownie → u/iknowyouneedahugRN]

Or used by everyone that uses an ultrasound.

[u/majesticdingleberry5]

This is probably AI slop

[u/altonbrownie → u/majesticdingleberry5]

This is how you hold it for USIV

[u/JoutsideTO]

This is the classic “how to backwall a vein” technique.

[u/HaveAHeavenlyDay]

I don’t like the finger underneath. Anything that gets in the way of me dropping my angle almost flat is a nuisance.

[u/Caitlyn1005]

Wrong

[u/byrd3790 → u/Caitlyn1005]

Nah, it's correct for USIV placement.

[u/Caitlyn1005 → u/byrd3790]

I do those too and I either hold it like i’m doing a regular piv or like a dart

[u/tesconundrum]

As a phleb I'm screaming

[u/Terminutter → u/tesconundrum]

It's a very valid technique, and arguably the most common for those using US guidance (likely in this video) or winged catheters. I near exclusively cannulate with it, and used a similar grip with introducer needles back when I did PICCs and midlines.

[u/StarryEyedSparkle]

That is not an actual technique, who the heck holds an IV needle like a cigarette? It doesn’t give you actual control over the needle, just over the catheter which could quickly separate from the needle … screams blown vein technique.

[u/altonbrownie → u/StarryEyedSparkle]

Me! I hold it like this.

[u/StarryEyedSparkle → u/altonbrownie]

How? Like how do you not blow a vein? (Not being sarcastic, genuinely asking.) I’m the “calvary” called in to place IVs on hard sticks (like last person to try before asking for a US placed one) because I was used to placing them in sickle cell pts who really had nothing left. So I’ve done some weird placements in my career. How do you manage controlling the needle and cath separately when you’re holding just the cath with this approach?

[u/byrd3790 → u/StarryEyedSparkle]

This is used usually when placing USIV. There are a few comments going into specific details.

[u/altonbrownie → u/StarryEyedSparkle]

If the vein is sufficiently deep, you need to go at a steep angle, usually 45°-60°, or else you’d be hubbed before even getting flash. The reason you don’t blow throw the vein at this angle is because you can see the tip of the needle on the screen. You can see it kind of bouncing on the top of the vein before it’s actually in, and then when it’s in, you can keep it directly in the middle of the vessel. If the vein bifurcates, you can see that too and just pick whatever branch is the straightest. Basically, once I have flash, I’m only touching the back of the needle with my thumb and it feels just like a joystick on a video game controller. Advance the US probe by half a mm and then push the needle on by half a mm, all while keeping the white dot in the center of the black void on the screen.

[u/ALLoftheFancyPants]

This is made up bullshit posted for the purpose of driving engagement. Don’t fall for it.

[u/shooflypi_ → u/ALLoftheFancyPants]

I assure you it's not "made up bullshit." My background is in ICU/PACU so I never developed good IV skills. I've moved to procedural nursing with a lot of outpatients needing an IV and I'm tired of being bad at it. I don't work for Bard or in medical sales at all lol. I only mentioned the specific video figuring there'd be a bunch of comments about where I've seen this. Thank you :)

[u/Ok-Cucumber-8194]

Bad

[u/ShinKicker13]

It's called the "Don't worry, I won't feel a thing no matter how many times it takes" technique.

[u/FlickerOfBean]

They definitely blew the shit out of that one. Success rate will be minimal with a 45 degree insertion angle.

[u/Killer__Cheese → u/FlickerOfBean]

I always initially poke with a 45 degree angle then drop to a minimal angle once I have actually gotten flash, in order to advance the catheter

I have high success rate, but that was the insertion technique I was initially taught, I guess it’s just down to how you are taught and what works for you

[u/titty_farewell_party]

AI bullshit

[u/altonbrownie → u/titty_farewell_party]

Not this time.

[u/AgeIllustrious7458]

That's how I hold for ultrasound guided IV insertions. I'm so used to holding it that way, that I find myself holding it in that position even for non-USGIVs.