Took my relative to the ED

Specialties Emergency

Published

Took my family member to the emergency department and the paramedic was able to get the IV on the first try. #20!!!

I told him this person was a hard stick, because typically, people will dig and search so I asked him to be really sure before he sticks. He got it!

Gotta love solid ED staff like this. :)

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I disagree. I am that patient who will tell you I am a hard stick, because I am. I know where you should stick me and I rather you listen than to try to poke me 5 times. And yes, I've worked in the ED and ICU so I did hear the same thing a lot too.

I'm glad you had a good experience. This thread made me smile! It's a great feeling when you get warned within an inch of your life about poking and then slide one in like it's nothing.

Luckily I have this experience many, many times in a day because *everybody* does it, lol!

The reasons patients tell us they are an impossible poke seem to be

1: they have extreme IV anxiety and every poke sticks out in their mind like a major trauma

2: they think that if they make a big deal they will get the unit "sharp shooter" and avoid any mess ups from the young-looking nurse

3: they have had truly awful experiences due to their truly awful veins (your morbidly obese, your IVDUs and your frail LOLs with friable veins)

4: they have had truly awful experiences due to the truly awful skills of the people trying to poke them.

I think the last group is probably the biggest, there are a lot of people performing venipuncture out there who do not get enough practice and do not really know what they are doing (I know because I was one of them).

In our ED we don't have paramedics or techs, it's all RNs all the time and we draw our own labs too so depending which pod we are working in we may start more IVs in one shift than I did in the entire first year of my career, and every one of those a 20g or bigger (except for peds). You get proficient real quick. :)

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Specializes in Emergency.
I disagree. I am that patient who will tell you I am a hard stick because I am. I know where you should stick me and I rather you listen than to try to poke me 5 times. And yes, I've worked in the ED and ICU so I did hear the same thing a lot too. [/quote']

I didn't say there is no such thing as a hard stick, I will add "miscellaneous" to my list of reasons that people are true "hard sticks."

I will take guidance from patients on where to poke within reason, but often the place I plan to poke is where I will get a vein, I rarely miss.

I am, in contrast an easy poke, but you wouldn't know it to look at my arms today. While in the hospital yesterday I had a nurse miss twice, then the "unit sharpshooter" miss once, then give up and stick me in the AC. I could give no guidance because their errors had nothing to do with the veins they chose, but rather the fact that they were going in too steeply and I didn't want to be a jerk.

Like I said, many reasons that a person feels they are a hard stick, if that had been my first experience with venipuncture I might be one of them.

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Specializes in ED, trauma.
I disagree. I am that patient who will tell you I am a hard stick because I am. I know where you should stick me and I rather you listen than to try to poke me 5 times. And yes, I've worked in the ED and ICU so I did hear the same thing a lot too. [/quote']

People do listen. The point of my post was not to bring negativity to this forum.

I have NEVER had a nurse/medic/etc not listen to what the patient was saying. They take it into consideration, but patients must understand that when they come to the hospital sick, their veins may just be dehydrated and become a hard stick.

Give the healthcare worker a chance to at least get the stick. Everyone needs to get experience, it's my all about fat, plump veins. Everyone has to take the time to at least attempt a venipuncture.

If you have experience with people not taking what you have to say into consideration, that's on you, not the staff. Staff always knows that venipuncture is not an easy task, they will take it into consideration, but they will also move on to ensuring you have a line in place.

I have been stuck 9 times in one ED visit and I never once said I wasn't sick enough for the sticks. I said I was a hard stick, they attempted and I was getting more dehydrated by the minute. The staff said they were going to get a PICC team or central line in place. I refused and asked they try over and over. Despite their attempts for me to succumb.

I don't blame the staff for trying, admiring defeat and trying to find alternatives. I just was far more terrified of a PICC or central line at 16 than I am these days now that I know more about them and how then can be used.

I wish you luck in your pursuits but please don't bring negativity to my thread. I'd rather it be deleted than filled with your negativity.

Thank you.

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Specializes in ED, trauma.

I didn't say there is no such thing as a hard stick, I will add "miscellaneous" to my list of reasons that people are true "hard sticks."

I will take guidance from patients on where to poke within reason, but often the place I plan to poke is where I will get a vein, I rarely miss.

I am, in contrast an easy poke, but you wouldn't know it to look at my arms today. While in the hospital yesterday I had a nurse miss twice, then the "unit sharpshooter" miss once, then give up and stick me in the AC. I could give no guidance because their errors had nothing to do with the veins they chose, but rather the fact that they were going in too steeply and I didn't want to be a jerk.

Like I said, many reasons that a person feels they are a hard stick, if that had been my first experience with venipuncture I might be one of them.

Exactly. There are tricks and techniques for successful venipuncture. With experience, most nurses can become proficient. But that means there are going to be bad days, and bad veins from time to time.

Take what the patient says into consideration, but moving forward with treatment will at least consider attempting a venipuncture. It's a part of life. If you are sick enough to need an IV, that's a part of treatment. Can't win them all!

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Specializes in Emergency.

Apologies! No negativity meant, I'm just a bit of an IV nerd so I get a little overexcited.

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Paramedics are great and usually don't get enough credit. Imagine trying to start a line in the back of a bouncy ambulance!

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Specializes in ED, trauma.
Paramedics are great and usually don't get enough credit. Imagine trying to start a line in the back of a bouncy ambulance!

Hahahaha I always think about this and wonder why anyone would want to ride in an ambulance without truly being sick. They've got to be a little trickier than a firmly planted ED stretcher.

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Specializes in ED, trauma.
Apologies! No negativity meant I'm just a bit of an IV nerd so I get a little overexcited.[/quote']

I am too. I think it's fascinating and think we've got to give credit where credit is due. There are some people out there that can restore the faith in our patients. :)

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Specializes in ER, progressive care.

That's great!

I love the feeling of being able to start a difficult IV on the very first try. It's an accomplishment! I had a patient in the ER who stated she was a hard stick, and her veins roll and she hates needles and if I missed she was going to be "really ****** off." That scared me, but I joked and told her she couldn't get mad because I had pain medicine for her once we got it in ;) She eased up, and I got it in on the first try. She then told me "good girl" like I was a dog :sniff:... but she was medicated afterwards and happy as a clam.

I have decent IV skills but I wouldn't say I am "the best." I have some other nurses I will call if I cannot get anything started. I will also ask the patient if they are a difficult stick. I will always attempt to look first but I cannot find a good vein, I call in my reinforcements. No point in me poking them and probably missing when I can call in someone who is better and they are likely to get it started on the first attempt.

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I had a very irritating patient who was a bear towards me and other staff. She insisted very strongly that she was a very hard stick and didn't have good experiences with IV starts. I managed to impress her by getting her on the first stick. Granted it was an AC. Normally, I don't go for the AC unless it's truly necessary. I like to go for a distal vein in the hands or forearm. Using the distal vein was stressed to me during my orientation. But with her, I didn't want to take any more crap from her so I saw the AC and went for it. I'm not ashamed to admit it.[/quote']

Did the jugular cross your mind?

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Did the jugular cross your mind?

At my facility physicians start peripherals in jugular and feet.

To OP: nothing wrong with the AC, just harder to maintain.

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