Do you ever miss?

  1. So, here is a question for all you CRNAs/SRNAs/MDAs out there.

    Now, I am pretty decent with IVs. Obtaining about a 90-95% proficiency in dealing with old, septic, shutdown ICU types.

    But, I can't help wondering what will happen after I start my clinincals. I mean, as a nurse perhaps the, "wow, I can't believe I misssed!" comment might be accepted. But as a CRNA/SRNA/Anesthesiologist, how does the patient react when you miss. Their confidence level in you must hit rock bottom.

    So, how do you all deal with this. Do they teach you some magic method in school for obtaining 100% accuracy? Do you simply get so proficient that you never miss or maybe 1/1000? Are your patients just so generally healthy that you can't help but hit? In difficult pts do you just forget it and go for the jugular? What excuse do you use when you do miss" "Sorry Miss Jones, it looks like the needle is defective"?

    Thank you for your honesty.
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  2. 18 Comments

  3. by   Tenesma
    even the most proficient will miss... the nice thing is that you can place a topical anesthetic (lidocaine) if you feel that you might be using a large bore IV, or if you think you may end up missing or "searching"... that way if you do miss, only your ego will be hurt, and the patient won't even notice the discomfort... the more confident you behave, without being outright cocky, the better the patient will feel about you.
  4. by   kmchugh
    Sure, I miss sometimes. Not holding my tongue right, or something. Thats why I work in an anesthesia group. I can always ask someone else, who maybe is having a better day, if they can put one in. Haven't missed an art line in a long time, though.

    Kevin McHugh
  5. by   g8rlimey
    I had a pretty good one last week..."dry as a bone" renal and liver failure pt.---MDA spent about 30 mins in there, lido everywhere, stuck the pt. at least 5 times..no dice. I walked in, first try, 18g R forearm...it was money. Felt like gloating to him, but later that day I missed a great vein cause of poor judgement of valves...oh well :}
  6. by   nrw350
    seesh, sounds you guys have starting iv's as a sport! lol

    Nick
  7. by   Brenna's Dad
    Of course it's a sport Nick.
  8. by   alansmith52
    I consider a sport as much as golfing and shooting skeet. absolutly, it's an art really, we take much pride in our ability to thread a nearly microscopic peice of plasitiv through a vein we can't even see.
    matt
  9. by   AL bug
    I have a sick love of starting IV's. As much as the pt might lose some confidence in you (although I don't think that very likely) you can also boost their confidence by getting the hard stick. Many people are used to being stuck a dozen times by medical workers, and they are very impressed when someone can get it on the first stick. Just the other day, a lady was almost in tears because she just new she would be stuck several times for her IV. Relief just fell on her face when I got it the first stick.

    I thought they would teach us some magic trick too, but it ain't so. I guess it's just that SRNA's and CRNA's are experienced nurses and have confidence.
  10. by   Tia
    I find myself looking at friends and families arms for veins. They find it kind of weird, but I love a great vein. Relish more in the challenging sticks though Hope eveyone had a good thanksgiving. I spent part of my holiday working in the ICU. Had Friday off, on call Saturday and work tomorrow. All while juggling finding time to spend with my family that drove 8 hours from South Dakota. I am ready for some peace and quiet Later

    Tia
  11. by   TexasCRNA
    I find myself now looking at necks, teeth and how wide people open their mouth when they talk. Thinking to myself on some of the people I see " boy that intubation looks like a bi#$h"
  12. by   g8rlimey
    Lee--

    How much experience have you had with fiberoptic intub.?
  13. by   l.rae
    [QUOTE]Originally posted by Brenna's Dad
    [B]So, here is a question for all you CRNAs/SRNAs/MDAs out there.

    Now, I am pretty decent with IVs. Obtaining about a 90-95% proficiency in dealing with old, septic, shutdown ICU types.

    But, I can't help wondering what will happen after I start my clinincals. I mean, as a nurse perhaps the, "wow, I can't believe I misssed!" comment might be accepted. But as a CRNA/SRNA/Anesthesiologist, how does the patient react when you miss. Their confidence level in you must hit rock bottom.

    So, how do you all deal with this. Do they teach you some magic method in school for obtaining 100% accuracy? Do you simply get so proficient that you never miss or maybe 1/1000? Are your patients just so generally healthy that you can't help but hit? In difficult pts do you just forget it and go for the jugular? What excuse do you use when you do miss" "Sorry Miss Jones, it looks like the needle is defective"?


    Why would a "l can't believe l missed" comment be more acceptable as a nurse?....are you not STILL a nurse?....in fact, being a "nurse" and in an area of practice that hones IV skills (l work ER) is what makes us the pros...In fact, the residents come to the ER to be taught by the lowely nurses how to start IV's...(and they quite frankly suck at it). Regardless of the initials behind your name, you will have days you are in the zone and days when you feel like you aren't even on the right planet.....ask any "nurse" who has been at it for a while. I understand that you might think you will be held to a higher standard as a CRNA, but your choice of phrasing the question is a little disturbing....not trying to be spiteful, just a little honesty that you requested....Excuses?...l don't make any, l say, "l'm sorry, l didn't get it. l am going to look for a better site and try again."....just be honest......medicine/nursing is not an exact science.....hope this helps...............LR....ps...l just love it when the pt or family member requests that a Dr. start the IV......if l don't like them, l say "ok fine!"
    Last edit by l.rae on Dec 1, '02
  14. by   Tenesma
    l. rae... you are absolutely right - it is a purely technical skill - the more often it is practiced the better it gets... when i was an intern i always used to cringe when the families would ask for the dr. to start the IV... in the beginning I would end up fishing around for veins, while the RNs sat back and grinned
    personally i am still amazed at how some people are just born talents at getting IVs into neonates and small peds...

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