I cant start IV's!

I just want to mention to people, it's really not necessary to use tourniquets if you can see the vein. You will blow veins with tourniquets. You can always use one temporarily, in order to mark two points on the skin as targets, but really, you have more luck on these old folks without a tourniquet.

Tourniquets help lab people, of course, because they create more pressure, causing the blood to flow for the lab draw. But they will definately contribute to blown veins in the elderly.

Well where I work we use tournequets because we get labs from the IV when we place it. I've done IV's without the tournequet before but veins that are very small and hardly palpatable they work better for. I'm not gonna put an IV in and then stick them a 2nd time to get bloods via a butterfly unless I can't anything from an IV. I would also like to say we don't take blood off IV's after for repeat labs or new labs that we didn't get the first time, those instances we'll use a butterfly. Even in trauma's, we keep the tournequets on to get trauma labs, but if its a serious trauma and we need immediate access, we'll get bloods later on.

I agree that a tournequet can lead to blown veins in the elderly but I don't think that's neccessarily true for all ages.

Hi there!
I'm a new grad who just started in the ED last week. I have to go with the confidence idea. As funny as it sounds, the best advice I got was to quit being so worried about whether or not I will be successful and "just put it in" lol Obvioulsy more to it than that, but I found when I relaxed, it led to better outcomes. On my 3 shifts last week I attempted over 30 iv`s and was successful on all but 4. Also I have a friend who just started in ICU and they had her come down to the ED for a few hours and do nothing but start IV`s. I wonder if they would allow you to do something like that?

I'm a first year student, and today was my first time doing clinicals in the ED (LOVED it!), but I was so nervous about starting my first ever IV. The nurse I was paired up with was fabulous... He spent about 10 minutes of his time talking me through everything step-by-step at the nurse's station before we went into the patient's room. His advice was also to just fake the confidence (seems to be a re-occuring theme). Well it worked, I got it on my first try! I've been all smiles the whole day!!

once you move to the ER, you'll become excellent at them. You'll never be alone in the ER and if you have difficulty, you can ask another nurse, all the while gaining experience. You'll get better and be able to start one in even the most difficult patient (COPD on steroids, dialysis patient, etc.) It takes time, don't worry.

Last week was my first week in the ER, after working 2 years in med/surg night shift. I maybe had to start 3 IV's on med/surg. I am still really nervous about starting them. But I know that I will get lots of experience where I am now.

I work with some pretty great nurses, from what I have experienced. I know I will learn alot from them!

In the 3 days I worked last week, I failed alot on my first try but often got it on my second. I had alot of blown veins. The tourniquet idea may have contributed, but we collect labs on the iv start.

I have to say that I love the ER! Why didn't I just start out there?!

What works for me is getting it in to the flash point, then just a little further, then advancing the catheter without the needle so I don't blow the vein. That works pretty well in most cases.

I have a trick. If you first get a flash and your angiocath will not advance then, take the needle out leaving the plastic sheath in and slowly pull out until blood drops out of the end, then slowly try to push the sheath in. Works everytime. Use a 22 or larger because they are longer. Can't do it with a 24. Also always start at the AC for it is the largest vein you can palpate. Practice, Practice, Practice... do follow the IV team around the hospital for that would give you practice the differance is... they only have to stick a vein and not thread an agiocath. Do follow IV team and not lab. Let me know how it works out and if this helped.

i went through nursing school without ever starting an iv.
except on the kind emt/ fellow nursing assistant who let me try one on him.
of course he had excellent veins.


i would suggest something involving a paramedic or emt. they are most excellent at iv starts

i also look at my own hands, and then the hands/ arms of the person im trying to stick and try to visualize about where the vein is on them, especially if i cant really see their vein or they have a lot of edema or tiny old people veins.
it helps for the most part.
i agree with practice helping. get as much experience as you can.
most patients will let you try at least once.
where i work, the nurses are supposed to get any labs from the patients (we are not allowed to draw labs from ints) so that has been good practice also.

I really think the best thing is to find super easy sticks and do a ton of them. You won't be able to get a difficult line without knowing how to do an easy one, what it's supposed to feel and look like. Find a bunch of dumb teenage males with pipes who won't care if you stick them over and over and then the harder ones start to make sense.

One thing I found, especially in the older folks with more fragile veins--If the patients blood pressure is really high and they have fragile viens they seem to blow one after the next no matter what I do, even using the largest cath....and I never blow veins any more.....theis has happened to me a few times. I taked to the doc and got some meds in for the BP--either a one time dose of something or a med early--and once the pressure came down it went in like a charm --no blown vein....and yes for the elderly no tourniquet or even not so tight helps!
The other thing is ....I am in NY state and here students in all the schools I know of are not allowed to do IVs--that is a skill you have to be taught and learn---as far as on real people-- once you get a job. I can't say for certain but I think it's against the law in NYS for a student to put in an IV.