When I get that vibe from patients/families I take a timeout. I actually sit down, if possible, to have a conversation. I review with them what we're doing and why. I calmly and matter of factly state that no clinician in the history of the world has gotten every patient, every time, in one stick. That one stick is absolutely my goal. That if I truly do not feel/see anything I am confident of I will call another clinician. That these are the things I'm doing to maximize our chances of success (making sure the arm is warm, letting gravity assist us, using ultrasound when needed and available, etc.). That if they would be more comfortable stepping out for a few minutes while we do this, I absolutely support them in that.
Do they have any other questions or concerns about what we're doing or why? And if they insist that only one stick will be allowed, what is their plan for the patient if one stick is unsuccessful?
One of three things happen:
1. About 1/2 or 2/3 of the way through this spiel they get bored and say "just do it". (seeking additional information or even emotional support really wasn't the goal of these folks)
2. We proceed, with or without family present, and access is obtained. About half will be genuinely grateful, and about half are disgruntled that that potential source of complaint has been removed.
3. The patient/family asks for a different provider. Most IV team nurses at my hospital tell ED patients up front, "I'm happy to take a look, but if the ED staff was unsuccessful that will probably be the case with me as well."
Be confident in your skills. Take your time with someone who appears as though s/he will be a hard stick. And let comments roll off you -- trust me, the comments are not about you. They're about someone else acting out.
Good luck to you.