I am a moron--I need I.V. help

  1. Hi everybody. I was hoping someone can help me. I am in an awful slump. It seems I can't start an IV to save MY *******' life. I had an old lady with nice old ropey veins you could see clear as day, went in one side, didn't get a flash but I was sure I was in, went ahead and fished around, got a tiny flash tried to advance, and what do you know, I had blown that sucker to kingdom come.

    I was wondering if I could get some recommendations and help, books or manuals or weblinks as well as real advice. If everyone could just post one tip that they do before or during the insertion process I'd appreciate it. I'm quite tall and have big hands and have a hard time precisely moving that little IV around, and I have a hard time telling when I'm in the vein (when I don't get a flash right away, even when I swear I'm in, I get impatient and start fishing and blow it). And when I try to advance the catheter using the one finger method, my whole hand kind of moves forward and I blow through the other side. Anyway, I'm about losing my mind, and my self-confidence is totally blown. Please help...
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  2. 38 Comments

  3. by   canoehead
    Practice, that's the only way. And go very slowly, the more trouble you anticipate, the slower you do it. It helps me to sit down when I start the tough ones.
  4. by   BBFRN
    What gauge I.V. are you using?
  5. by   Sleepyeyes
    Biff, there could be a lotta reasons that you have problems, but keep trying, because this is one thing you get better with when you practice.

    Try #22 guage needles, try having the pt dangle their arm over the edge of the bed for a couple minutes before you use the tourniquet, and there are several good websites that can give you other tips.

    Good luck!
  6. by   Sleepyeyes
    This site was a big help to me:

    http://www.enw.org/IVStarts.htm
  7. by   gwenith
    Two pieces of advice 1) Line yourself up in the direction of the vein. Before you start to cannulate make sure that not only your hands but your whole body is facing the direction that you wish to cannulate. sounds crazy but it WORKS. 2) make sure that one hand/finger is holding down the vein as they may LOOK old and ropey but usually those are "coward veins" they run away from anything sharp. 3) find a vein junction - looks like an upside down "Y", place the cannula in the centre of the junction just where the two viens meet this site is usually more secure than single veins and will not roll around under the skin
  8. by   kaycee
    If you have an IV team in your hospital, ask to go around with them for a day. They can be very helpful and give you lots of pointers while you're doing it. Good luck!
  9. by   niteshiftnurse
    practice,practice,practice. Sleepyeyes, good website
  10. by   renerian
    I could not enter from the side I always go through the top. Maybe that might help.

    renerian
  11. by   flashpoint
    I almost always sit on the floor when I am starting IVs...I learned to start in a moving ambulance, so it's only natural for me to do that. On a lot of the big ropey little old lady veins, I won't put the tourniquet on too tight, or I won't use one at all. Anchor your vein of choice well, but not so well that you actually end up flattening it out. Unless the veins are very small and fragile, I won't use anything smaller than a 20 gauge. Also, with some brands of IV caths, the 18s have the same outside diameter as a 20, so if it looks like you can get a 20 in, you can probably get an 18.
  12. by   abnurse
    I know exactly where you are at! I was there a few weeks ago. I had no problems with IV's at another hospital but when I went to a new ER they used a different Jelco. What worked for me was closing my eyes and feeling the vein. Also, practice on finding your friends and families veins. Relax and tell yourself that you are successful and it will happen. Confidence is the key to good IV access. Good Luck
  13. by   BiffMalibu
    This is GREAT, you all are really helping me and giving some great ideas, I'm committing them all to memory! Please keep 'em coming. Does any of you use b.p. cuffs as your tourniquets?? I sometimes feel I don't have the ones I tie myself tight enough on some people, and too tight on others. I mean how can you really tell whether or not it's snug enough to occlude vein pressure but not arterial?
    Also, if you can't see anything at all (patient might be a little heavy), can anyone give me an idea on where I should at least attempt to search?
    Again thanks, reading this really is helping me confidence so don't hesitate to post....thanks again!
    Biff
  14. by   jeannet83
    Hi, BiffMalibu!

    In our ED, we prefer to use the antecubitals with 18g to allow for high volume resuscitation if needed. I especially like the AC area for those patients who are on the heavier side or check the hand veins or the wrist area.

    Usually I use an 18g or 20g (I don't work with children). Sometimes a 22g if the veins are really tiny. Very rarely a 24g if it is an extremely tiny vein and the patient is an extremely tough stick.

    If the patient seems tough, always ask the patient where their best veins are!! They will usually know if they have been tough in the past.

    On men whom I don't see a vein right away, I always check the back of the arm as those veins pop up nicely in men.

    For those difficult sticks, I do a few things. If the vein is small or not particularly palpable, I will get a washcloth as warm as possible (without being hot) and wrap it around the preferred vein, then wrap a chux or dry towel around the wet washcloth to keep the warmth in. It only needs to stay on about 5 minutes and in the meantime you can be doing other things, like checking the other arm for possible veins, etc. (Plus taking this 5 minutes and being able to hit a vein is alot easier than not doing it and taking 30 minutes of 5 sticks to find a vein!) The heat really helps to dilate the vein to make it easier to dilate, palpate, see and stick. You would not believe how much this helps. I will then use either a BP cuff OR 2 tourniquets. For some reason, the 2 tourniquets helps the veins to pop up better-I only use the BP cuff OR 2 tourniquet method in difficult sticks- otherwise one tourniquet will suffice. Place one tourniquet about 5 inches above the preferred vein and the other one another 3 inches above the first tourniquet.

    For any stick:

    I stick at a 15 degree angle and to the right side of the vein with my right hand while anchoring the vein with my left hand. I prefer to gently anchor the vein from above the stick site but don't press too hard or as someone said, the blood won't flow and the vein will flatten out. (Some people prefer to anchor the vein from below the site). Once you see a GOOD flashback, advance the whole catheter a little bit more. If your flashback is slow, don't get nervous and feel rushed- wait a few seconds to see if it will flow in, then if not, advance the catheter towards the direction of the vein and see what happens. Once in the vein with a good flashback, hold the apparatus with your insertion hand and use your OTHER hand to advance the actual catheter with your thumb and forefinger. I was never able to use that same-hand finger advancing method myself either.

    Always make sure the arm you are using is in a downward direction to improve blood flow.

    In those older folks, sometimes it is actually easier not to go for the huge rope veins because they tend to roll. Go for smaller diameter vein.

    Just remember that starting IV's is like learning to ride a bike. Once you get it down, it is like second nature, and you'll hardly ever think about it!!

    Good luck, you'll do fine! Jeanne


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