Flick-Spin Methodology for Improving Cannulation Success in Tortuous and Valve-Rich Peripheral Veins

Peripheral veins often contain tortuosities and valves that hinder the effective passage of intravenous catheters to the full extent of catheter length. This report describes a methodology termed flick-spin that has proven efficacious for venous catheter passage in tortuous and valve-rich peripheral veins. The method relies on (1) applying longitudinal tension to the vessel in an attempt to straighten it, (2) rotating or spinning the catheter along its longitudinal axis, and (3) flicking the skin or visible vein just beyond the catheter tip, all during catheter advancement. Additionally, lateral pressure may also be applied to the vessel—ie, proximal to the catheter tip and during catheter advancement—to fine-tune catheter tip direction. The report contains multiple illustrations to communicate the anatomic, physiologic, and technical underpinnings of the technique, as well as instructions for troubleshooting common problems.