I cant start IV's!

Yes, it's a practice thing. Once you get the knack of it, your skills will build.

I go for a shallow angle and often don't use tourniquets. I have a good success rate. Just keep practicing and don't stress about it. Be sure to advance the catheter a smidgen after getting flashback. Watch for valves, they are lumpy, and go far enough below them to not hit one. Stabilize the vein!

I did an ABG once when the lab tech couldn't. It wasn't really that difficult, just aim for the pulse. It's not like you have to advance a catheter. The artery has so much pressure, the syringe fills itself.

Good to know. I think starting IVs is probably my worst fear when I become a nurse, especially since I don't have steady hands.

Ugh. I have been a nurse for two years now on a hematology unit and my IV skills are worse now than when I was a student. Ninety-nine percent of our patients have central lines and the ones that don't have terrible veins. I've tried to stick three in the two years I've been employed and had zero success.

My nursing school didn't stress IV skills. They told us that was the least of our worries. It's merely a technical skill, even EMTs start IVs. They wanted us to understand things, the mechanical skills come later.

I work in one of the largest/busiest ED Trauma centers on the East Coast and I honestly feel that IV's are one of the easiest parts of my job. We never use the IV team unless we have multiple unsuccessful attempts by a couple nurses only because its hospital policy to call them. We do as many IV starts if not more than IV nurses and I believe we're better at it.

There really isn't a shift that I don't do atleast 5 IV's and I've done in the upwards of 20+ IV starts in some shifts where I'm extremely busy. I get more annoyed having to do my own EKG's than IV's.

Most ED's don't hire you with a contigency you know how to start an IV. Alot of people in my orientation group had never done an IV before and are good now. I can't speak for all ED's but the one I work at, I'm not always in the assignment with the trauma's. We have 2 designated trauma bays and 3 critical care rooms next to they bays and that whole assignment has 3 RN's working it per shift, one of them being a trauma clinical leader. So what I'm saying is I can go a couple of weeks and not be assigned to the trauma assignment because we have almost 200 nurses in our ED alone. Of course I've gotten trauma's in less acute area's when we're full but most of the time it doesn't work that way.

If you need practice, start off with 20G IV's..they're not so big where its hard to advance but they're still stiff enough where they're not going to bend too much. I hate 22G for that reason, they're too damn flimsy. And I've never even used a 24G, not even for a newborn.

I'd say that probably 95% of my IV starts are 18G. Some people think 18G should only be used for trauma's or critical situations but in critical situations, I'm using a 16G or 14G. And you never know how serious a pts situation is. There are people that you think just have a cold or indigestion and they end up coding. I've seen it multiple times, so I rather have atleast 18G for those circumstances. I will say that I've been putting in a few 16G IV's per week and alot of nurses look to me when they can't get large bore IV access. Just this past weekend I put in 3 16G and a 14G on top of numerous 18G.

Don't worry, you just need to practice. During our orientation they made us practice on each other. One piece of advice I'll give you is, in the beginning during you first few weeks, don't tell pts you're new to starting IV's. It makes the pts nervous and less likely to let you stick them and in turn makes you nervous and anxious starting IV's.

"My nursing school didn't stress IV skills. They told us that was the least of our worries. It's merely a technical skill, even EMTs start IVs. They wanted us to understand things, the mechanical skills come later."

Actually EMT's don't start IV's, paramedics do. EMT's work for the fire company and all they basically do is transport pts. Medics are the one's that can start IV's, give meds, and even intubate.

EMTs here can get IV certified, I know a woman who is.

I think spending a few hours with the IV therapy team would be a great idea, but really you just need practice, practice, practice. They get to be like second nature. At my place the floor nurses call the flight nurses when they can't get a stick (or if ER, ICU, OR, NICU, can't do it) and if it is a down time for them they will come start it, so I have sent new grads/inexperienced stickers with them for a while before. Also our ER, ICU, advanced care nurses do all of their own ABGs, a lot of the floor nurses con the RTT into doing theirs, but still do quite a few. These are sooo much easier than piv starts. Its a blind stick, about a 45 degree angle, and you just find the pulse and "dig around" until your syringe start to fill on its own. Don't fret, everyone has to start somewhere, in no time at all you will be so good that you will get tired of having to start IVs for everyone else.

LOL - it's the same way in the ICU that I used to work at...charge nurse would send someone who wanted to practice their IV starts because we really don't do too many IV starts in the ICU. In the past year in the ICU I've started 5 IVs successfully and have had a few failed attempts. Usually ICU patients have some type of central venous access for medications and blood draws. I always thought it was weird that they called us and we always joked that they're calling upon the unit in the hospital that is probably least competent with IV starts....

Nonetheless, you'll get plenty of opportunity to start IVs in a ED setting. The idea to go to ambulatory surgery/same say surgery would be a great place to build your skill level...or if your hospital has any type of outpatient infusion center, that'd work too. Ask about it! Even if it's just for 4 hours a week in addition to your regular shifts so you don't get OT and can still complete your regular shifts....