Need help with IV technique

  1. Hi All!

    I figured that this was the group of nurses to come to with this, so maybe you can help me.
    I am an RN student through Excelsior College and have been a paramedic for 15 years.I currently work for a Fire Department that does 5-10 medic runs a day. My problem is that I have never been very good at IV's. It is a no brainer for say the big AC that pops up or a big hand vein but when thay become a challenge like in a forearm I am not the guy to go to
    I know that this may sound crazy but could the fact that I have some colorblindness make it harder for me to find those hidden veins? I will be searching and my partner on the medic will be like "Don't you see that one right there?" and I won't, it is becoming a concern for me because I want to work at a trauma center when I finish my RN.
    I have scheduled myself for clinical time at our local ED and some of the nurses there said thay would try to help me out.
    Any info would be appreciated.
    Thanks
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  2. 19 Comments

  3. by   nursenatalie
    I can't imagine that being color blind should affect your ability to start IV's. I think you are looking with your eyes for a vein and that may be the problem. Feel with your hand and finger. The veins you see, unless the person has ropes aren't always the best veins. Make sure your technique is good and practice, it is the only way to get better. See if you can go to day surgery and start IV's.
  4. by   jojotoo
    Quote from nursenatalie
    I can't imagine that being color blind should affect your ability to start IV's. I think you are looking with your eyes for a vein and that may be the problem. Feel with your hand and finger. The veins you see, unless the person has ropes aren't always the best veins. Make sure your technique is good and practice, it is the only way to get better. See if you can go to day surgery and start IV's.


    This is good advice. Stop looking and start feeling for veins. And if you can't get some time in Day Surgery for practice, you should already have an "in" at the ERs that you service. WE are always glad to have an extra pair of hands!
  5. by   Larry77
    Sounds like you are on the right track scheduling some clinical time at the ED you are familiar with. I agree with the posts about feel rather than looking...always the way to go.

    Plus I wouldn't stress about IV's your technique will get better over time and if you end up working in ED you will do so many IV's you will become a pro. Us ED nurses are spoiled with our good lighting and roomy rooms (compared to an ambulance anyway), I had a hard time in the back of an ambulance too.
  6. by   RunnerRN
    I was an awful IV stick at first. A few things that helped me....
    -close your eyes when palpating for a vein. For some reason, decreasing my stimuli like that really helps.
    -don't use glove while palpating - if you're a medic, I'm sure you're a die hard gloves wearer (before any patient contact). I couldn't feel anything through gloves at first, and it drove me insane
    -when you have the time, go for the harder to stick veins. My comfort zone is the AC, but I'm very uncomfortable with hands. So I forced myself to start hand IVs even when I could see a big juicy AC beckoning me. I also forced myself to forearms - they hurt going in, but I think are a lot more comfortable for inpt stays.
    -Dont' run away when people ask you to try a hard stick. Those are the best ones to learn on!
    Good luck! You will eventually be able to start lines south of the elbow without breaking a sweat!
  7. by   lauralassie
    wounderful advice. I use an etoh pad to wet the area, makes it easier to feel the integrity of the vein. Many times I won't look at the area that I'm trying to find the vein in, feel seems to do better for me. Of course when I am ready to stick I look at the area but, I try to visulize where the vien is when I place the hub of the needle. When patients say I'v's make me nervous, I try to ease their anxiety by having them wiggel their toes , I tell them to start wiggeling as fast as they can (just as I'm ready to stick) and not to stop until I tell them to. (when I'm done with the actual puncture of the skin) . When the patient is thinking about something else , it makes the stick a little easier. I'v had a lot of patients say, that really helps. Guess it's the old mind of matter thing.
  8. by   elizabeth321
    Ya don't lose your confidence.....

    Wrap arms in a warm flannel blanket while you assemble your equipment....dangle the limb if you can....palpate and feel for that "bounce"....I got good at IV's working on a medical floor....alot of ill, elderly patients....difficult but a great base....now in ER I rarely miss....

    Hang in there.

    Liz
  9. by   Medic/Nurse
    Hey there firemedic7 -

    You are not alone in the "IV" problem. Others have been there - remember it is a technical skill - one that can be learned. I am a bit confused that you admit 15 years experience and you are still having a problem.

    I was in serious danger of "failing" out of my degreed medic program some 14 years ago, because my IV skills just kinda sucked. I mean I'd get maybe 1 out of 5. My FD medic preceptors just held my feet to the fire (not literally) but, you bet, by golly I got pretty good - failure was not an option. For me it was reviewing the technique and getting in the numbers.

    Day surgery is an excellent "training ground". Lots of IV's - most patients pretty healthy (or else they would not be OP surgery candidates). I do not go on sight alone, I go by feel (and the alcohol prep to "wet" the area does enhance it for some). Sometimes I see, nor feel - but those are desperate times. Never go the no glove route for a stick - just not worth the risk!

    Practice feeling around on everyone. Feel the hand, forearm, upper arm. As for assistance with your "technique". For me-
    1. Find site.
    2. Prep site.
    3. Traction skin at site.
    4. Stick to flash, advance 1/4 inch, off thread cath with other hand.
    5. Apply pressure above site (to reduce free flow blood out cath - BIG MESS)
    6. Collect samples, secure lock or line.
    7. Secure site.

    This is a numbers game. More attempts is the only thing that will make you better - after correcting any "errors" in your technique.

    Honestly, I found that after a few hundred I was pretty good. I've placed probably thousands at this point in my career. I tend to avoid the hand (bad place for infusions). I chose the forearm or non-dominate wrist most of the time. I'll go for a clean AC in a desperate case or a good EJ in an even more desperate case. But I have placed femoral lines without any problems as well.

    CONFIDENCE can be the key!
    Get the numbers up and GOOD LUCK! You can do it!

  10. by   EricJRN
    Sometimes if you place a BP cuff upside-down on the arm and blow it up to 80-100 or so, you'll see some veins you might have missed with a tourniquet.

    Kudos for recognizing a potential weakness and taking steps to deal with it.
  11. by   EmerNurse
    If learning to "feel" veins is a problem, find your own. I can make my hand veins pop when I want to, and I'd sit around just feeling them and following them up my arm by feel, as far as I could. My husband used to look at me like I was nuts, but I learned the feel of a nice bouncy vein that way, so now if I can't see it but I know it's there (and it has to be or else the patient's hand/arm would fall off, right?), I close my eyes and feel for it.

    Ya look funny palping your own hand/arm, but after a while you can follow those veins a good distance without looking.

  12. by   danh3190
    Quote from EricEnfermero
    Sometimes if you place a BP cuff upside-down on the arm and blow it up to 80-100 or so, you'll see some veins you might have missed with a tourniquet.

    Kudos for recognizing a potential weakness and taking steps to deal with it.
    Just wondering, why upside-down on the arm?
  13. by   Mr. Grumpy
    Besides all of these comments, review your vessel anatomy. If your working in trauma, especially level I, don't worry to much. There are so many people willing to stab a pt. that you don't need to. This will free you up for other more important tasks such as assisting with advanced airway placement, or applying oxygen. Finally, remember there are more ways to access than from elbow down. You could ask for central line placement or take a stab in the neck. If you miss those, then you may want to go into telephone triage or comm.
  14. by   ERheart
    The key to IV starts is feeling. Take a hot shower, when you get out feel your arms. Feel where the veins are. Remember them. Many times when I set down to start an IV line. I close my eyes and feel the pts arm. 9 times out 10 I get a line.
    Also listen to the pt. They know there body.
    Hopefully that helps

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