IV insertion problems

[nursing_problem]

hi guys. just want to ask how do you deal with relatives who demands nurses to make sure they can insert or start iv just once esp. in pediatric patients. we all know that we dont like failing an iv to any ptient but their are times that we have bad luck on starting one. The relatives kept on telling me that i dont know how or im not good at inserting an iv for failing once.i tried again and i succeeded.

It bothered me how they yelled at me infront of other and told that i dont know how to insert an iv.

[Dianas1086]

Don't take it personal. Put yourself in their shoes. Who likes to be stuck repeatedly? If my daughter needed an IV, I would probably be that parent that puts pressure on the nurse (although I would do it nicely). My point is more than likely the patient has had a bad experience before making them act out.

[turnforthenurse, MSN, NP]

I have good and bad days when it comes to starting IVs. There are some days where I can get the most difficult IV starts no problem. Many times there are patients who are impressed that I was able to get their IV in on the first try because most of the time they have to get stuck multiple times.

...Then there are my bad days. No matter what I do, I just suck! I'll miss or just blow everything, lol. I think everybody experiences this.

Most of the time I'm okay when a patient tells me, "You only get 1 try!" But when they start refusing everything, that's when I'll tell tell them that they won't be getting those IV fluids and really important antibiotics or *GASP* PAIN MEDICINE. That turns things around.

[iluvivt, BSN, RN]

The truth is that patients can range from having the best kind of veins to the worst and the nurse and licensed practitioners can have the a skill level from weak to outstanding. So yes! I can see this issue from both sides. I even had to put my own IV in when I was hospitalized. They attempted four times and I was so sick and just needed and wanted my IV medications. This was late in my hospitalization and many of the few veins I had were poked and damaged so I even had to put it in left handed on my right arm ( I am right handed). I could not tape it though but held on to the hub until she got it secured.

I know that often the skill and art and speciality of IV therapy as a whole is often not appreciated. I think that may times patients do not realize how difficult this reallly can be on many patients. I only get the difficult starts after the nurses have already tried and often the patients are upset so I am very good at calming them.reassuring them and I am always very confident. I also listen to what they have to tell me,gently correct any misconceptions if really needed and let them know I will take good care of them.

[iluvivt, BSN, RN]

There is a faily new reccomendation from INS to no longer use the vein near the wrist (often called the interns vein) from the wrist and up to five inches. They have discovered that on autopsy the radial nerve crosses over the vein up to 3 times (sometimes less) and is thus very prone to nerve damage and can result in chronic nerve injuries and pain syndromes. If a nurse gives you a good reason not to place an IV in a certain location they may very well have a good reason that you are unaware of. There are also many other reasons why a certain vein and/or location is not suitable &/or less desirable.

[cjcsoon2bnp, MSN, RN, NP]

Personally I only give a patient 2 attempts at poking someone and if I miss them both then I find someone else. In an emergent situation I might continue on if there is no one else available. If a patient tells me that I only get one shot then I explain that I will do my very best to get it and if they don't want me to try again then that is fine but it will delay their treatment for me to find another nurse. We all have our good and bad days. There are some days where I can go in and get it in on every patient (even the elderly and pediatric patients). And then there are days when I will blow a vein on someone with huge pipe veins (although those days are rarer now.) I personally really enjoy inserting IVs (not because I enjoy sticking people) because it is a skill and I like the challenge, nothing makes me happier then getting a nice #20 gauge in someone who says that they are a tough stick and others have always missed on the first attempt.

!Chris

actually i brought the kid in our nursery to Ask for assistance. However, they went outrageous when they learned that the kid will be the only one to go inside and.without them. So i brought the kid back to er and inserted it myself. I actually believe tht sometimes having relatives who have attitude like that brings negative vibes. It may cause stress and pressure making you fail.more

I actually had a parent threaten me if I didn't get the line. I stood up and said, "I'm not going forward until you ask me to do it and then give me the space." When the vein blew, he actually started toward me and had to be restrained by his adolescent son. At that point, I refused to do anything else without (a) another direct request, (b) the doc at bedside, and © security.

The story has much more to it but it was a horridly stressful situation.

There is a faily new reccomendation from INS to no longer use the vein near the wrist (often called the interns vein) from the wrist and up to five inches. They have discovered that on autopsy the radial nerve crosses over the vein up to 3 times (sometimes less)

I'm not surprised.

I've let students and newbies practice lines on me and that spot usually burns very badly and the pain persists.

Now I know why.

Thanks.

[IrishErin]

I'm not surprised.

I've let students and newbies practice lines on me and that spot usually burns very badly and the pain persists.

Now I know why.

Thanks.

Same! I've had lines placed there several times and the pain lingered! I always just avoid that spot when possible thinking its just overly sensitive

[nrsang97, BSN, RN]

When I am called to start a difficult start I will tell the pt that I am going to promise I will get it the first time. I assure that I will try twice and if not I will get another staff member. Usually the floor nurses have tried before me. Sometimes I get the first try other times I can't hit the broadside of a barn.

[SherriJones]

An ER nurse at the VA missed her first try on me. She knew I was a retired captain RN, and an ER nurse at a much larger ER than hers that saw heavy trauma; I think that made her nervous. I have a large, visible enough vein in each arm despite my few extra pounds and I think a fairly easy stick. I was very cool about her miss, smiling, almost jokingly, pointing out that I have a second arm, and unflinching in my confidence of her. She got me on the second try. The VA has always taken awesome care of me; I have zero complaints and only glowing things to say.

When I start IVs I always assure the patient of my skill, decades of experience, and confidence. That makes most relax and they just give me their vein. I get most of my patients with one stick, and I assure them that is my goal every time, lab draw and IV in one stick. I sell myself as "one stick Sherri." The nervous ones I try harder to assure them of my skill, but you won't convince everyone. I was once horrible at IVs. I got good by researching IV start tips on the internet, then putting each technique into practice. I found blogs and websites written by paramedics were the most helpful. Whenever my accuracy got in a slump, or if I changed jobs that would require more IV starts than my previous job, I went back and reread the sites. Those sites gave me the best advice; you won't get them all. You are going to have misses. Just keep working on your craft and get better with each year of experience. I now LOVE starting IVs and would start them all if the other nurses would let me. I notice some procedure stealing on our unit. No bother, at least we're helping each other. It's a sign we love what we do. :-)

One last thing--I got great on technique from tips from other nurses. I no longer soak the bed or my shoes in blood on IV starts; I know just where to hold tamponade now. So if you're good, share your knowledge!

[iluvivt, BSN, RN]

I will post the exact wording from INS but right now I am way to lazy to get off the couch. NEVER let anyone stick you there anymore or the volar wrist as well.

I actually assess without a tourniquet to begin with so I can see the veins without any artificial distension and usually select 2 potential sites. Unless the vein is large I usually apply a heat pack. Not only does this dilate the vessel but the patient relaxes and and if they are a difficult stick they can see you are taking some measures to help them. So it is the first thing I do. Then while that is working I gather all my supplies and talk with my patient as needed.

I have found that when patients start demanding one stick they are trying to take control of the situation and a little reassurance goes a long way. I tell them I am going to take really good care of them and if they ask how long I have been doing THIS (many do) they are reassured when I tell them how long. That does not matter as much though IMO because it is really how you deal with that demand. For the nurse it's business as usual for the patient they are sick and scared and most do respond to human kindness.

[Rhi007]

I'm extremely difficult to start an IV in but after 3yrs in and out of hospital I've learnt to play pin cushion and can now sleep through IV insertion.