I cant start IV's!

Well apparently I'm backwards! I've been doing this about a month and a half now. I can almost always get one in anywhere from the hand to an inch below the ac... For some reason, I can't get one in the ac for the life of me! The "easiest" place and I've never successfully inserted one, don't know what my problem is lol Oh well, practice practice practice right?

Dear SecondGen, Read previous post. One trick, if you can't totally palpate a great big vein in AC.. Use a hand blood pressure cuff, pump it up to about 200 and leave it there. If not there go to other arm,don't stick unless you palpate a really good one. Use a long angiocath an 20g or 18g. When you stick wait for the flash, if you can't proceed then take the needle out and pull back on aniocath sheath until blood comes out (messy but you get it) then advance slowly, hold pressure above cath site, put extension on, use syringe to pull blood out for lab, release the tourniquet. Can you invision this? Let me know if it works for you? Good skill...luck has nothing to do with it!!

I'm having the same problem. When I started medical nursing 6 months ago, they sent us to the class where you start IVs on dummys. Other than letting me learn the supplies, not really helpful. So I asked to go to Amb. Surgery. I was told that it would be fine, they'd work on setting it up. Then, a few months later, I said I'd come in on a day off. Sure, sure. Now I am in the process of searching for a new job, and I almost feel guilty trying to get her to help me set up anything. But I think I am going to ask again. I just don't feel like a "real" nurse until I at least try.

Depending on the size of your ER, you may have to start 20 IV's or more per shift. You cant help but get better at it. Dont ask someone else to try until you have at least attempted 2times on your own. The more practice you get, the faster you will learn.

I've been an lpn for almost 5 years and i used to be terrible at starting iv's. I too learned how to perfect my iv skills in ambulatory care. It doesn't matter how awful you think you are, you are going to get better. Every stick you get it will only get better. Boost your confidence by saying i going to get this vein and read a chart or take an iv therapy course. I wish you well. I can also say some days you just have a day to where you just wont get them. I wish you well and before long you will be telling us that you have perfected your skills. One other suggestion ask a nusre that you trust to show you her technique.

Don't you get to have IV therapy trainings? When I had my IV training, our exam was to be paired of with a total stranger through draw lots. You have to successfuly insert the needle in a vein. You only get to have 2 chances of inserting to get a passing grade. Thankfully, I inserted the needle and hit a metacarpal vein on the first try. I had to apologize to my partner if it hurt her (of course it did! It's a bloody needle! doi!) Anyway, when it was my partners turn, she was so nervous, her hands was a bit shaky, and it trembled more when she was about to stick the needle in my hand. I was so afraid, I gave her words of encouragement, telling her that she could do it and not to be afraid.Guess what? She sticked my THREE TIMES!!! The first one was acceptable, she didn't hit a vein at all. It was too shallow, I think she inserted it in a 5 degree angle. O_o The second one on the other hand was painful since she inserted the needle, not hitting a vein and looked for a vein while the needle was in my hand. I was like.."It's ok. go on! you can find one." But in my head I was like, "Lord, please let her hit a vein. >_<" Still, she ended up not hitting any. So as for the third one, the preceptor helped her find a vein, I thought all my good sites had been used, but they found one. This time, IT WAS HELL! She still didn't hit any! I felt very sorry for her so I told her to keep looking. So she moved the needle in any direction while still in my hand, looking for a vein to hit. It went on for like 2 minutes...gah! The preceptor took charge, told my partner to let her do it, and in just like 10 seconds, she hit a vein. whew...I eneded up having hematoma in both my left and right hands after that. It was an experience that I could never forget! Damn her! hehehe..j/k

You'll get use to it! Rule is to always start for the distal to proximal vein. If you encounter a patient with crooked veins especially for geriatric patients, find a vein that's not so crooked. Just streched them out to be smooth and insert away!

If it's difficult for you to bulge a vein even with the help of a tourniquette, ask the patient to close and open his hand for a couple of times. Veins will surely pop out. ^_^ If that doesn't work, palpate the vein. If you have a patient whose veins are not visible due to fats, palpate and remember the anatomy of the veins in our hand and arms, that helps! It's called blind shooting...it maybe risky, but there are times especially for obese one that you have to do just that. Well, that is if you're already confident.

Start with gauge 20 to most patients. For geriatrics, it depends on the vein. Usually they end up with gauge 22 or 24 since the vein is already too thin and crooked. Ask the patient not to look when you insert the needle if they're scared. Inform the patient not to clench their hand tightly because this tends to hide the veins. Tell them to inhale deeply and relax. Talk to them, make them feel comfortable. Distract them. hehehe...=D

I started in ER 7 mos ago & HAD NEVER started an IV!! (they didn't ask, I didn't bring it up) but had tons of central line experience. Preceptors were v. patient/knew I had come back from years out of nursing & figured it was a part of my being rusty.

Here are some ideas...
> practice with the start kit/supplies away from bedside to really get comft handling gear
> look on you-tube
> I recited verbal steps in my mind for the insertion (eg. "poke, lower, in a bit, withdraw stylet/advance, secure..."
> LOOK first... if the person looks like they're going to be really tough, consider asking an RN to take a look with you/shadow. I would ask like I wanted site advice, and end up with a reinforcement of technique too.
>For extra practice, offer to do the second set of blood cultures on someone else's patient, such as a new admit. Easier, less pressure.
>Little things can make a difference in making vein visible that we're sometimes too rushed to do - pt lying fully flat, arm lower than bed a couple mins before tourniquet. Look & feel with no glove, taking your time first. Sometimes I also clean FIRST while looking again (then again before the stick) I never slap.
>Sit down next to patient - leaning over with sweaty gloves stressing out made me feel like passing out

Before you know it it'll be just one more thing you do while you're talking to the patient.
I was so stressed when I started about this!! I knew it would be ok the day a mega-experienced RN missed an 18 and I tried a 20 and got it!

Just a technique that helped when I first got started......if you have access and your employer doesn't mind, use drip tubing, foam tape and betadine/water in a syringe.......tape the drip tube to a mayo stand covering tubing with foam tape.......gives a great "vein" have someone else put betadine/water in tubing and start an IV in the tube.......gives you a feel for veins and flashes like blood in the IV needle chamber........sounds silly but works until you get a feel for the equipment!!!!!!! Hope this helps

I feel your pain! I was an ICU nurse for about 6 years and thought I was pretty good at starting IV's until I transferred to ER. I missed more than I would have liked. Believe it or not watching paramedics and experienced ER nurses helped a lot. The medics are more aggressive with their approach (they have to be) and usually start bigger lines because they need them. Years later I helped train paramedics and was teaching them how to start IV's. Guess what? In order to teach someone else how to start IV's (and by now I was good at it) I had to go back over how I learned including reviewing all the basics. Try going back over how you were taught in the first place. Then find either an ER nurse or Paramedic who would let you watch their technique (on your own time if necessary) then see if you can spend time in an area of your hospital (with approval) that starts more IV's. Also see if you can do ridealong time with medics in the field. Usually you have to sign a waiver of some sort but most areas encourage nurses to do ridealongs. It is great experience in many ways. You will gain respect for the job they do and see a different side of medicine! Good luck! In asking for help you have taken the first step on the road to excellence.

Just a technique that helped when I first got started......if you have access and your employer doesn't mind, use drip tubing, foam tape and betadine/water in a syringe.......tape the drip tube to a mayo stand covering tubing with foam tape.......gives a great "vein" have someone else put betadine/water in tubing and start an IV in the tube.......gives you a feel for veins and flashes like blood in the IV needle chamber........sounds silly but works until you get a feel for the equipment!!!!!!! Hope this helps

I'm in pre-nursing and would like practice before NS next semester.
Can you simplify the tubing example and where I could purchase the items?

Thanks.