IVs

rn-jane · Oct 17, 2008

First of all relax! Iv's for some people come easy for others it takes time to acquire the skill. The best advice is l know your anatomy and your vein placement. There are countless other tips but until you actually get into the field and doing iv's, practicing on dummys is different. I started out as the worst iv nurse. Now I'm probally one of the better iv nurses in the hospital. I am on an iv team as well as being a ccu nurse.

The key is practice, practice practice. Try every patient of yours, (even the hard ones} before you ask another nurse and if there is someone good on the floor follow her when she does her sticks if she does not mind. It will come to you in time.

emtb2rn, BSN, RN, EMT-B · Oct 17, 2008

:yeahthat:

patwil73 · Oct 18, 2008

As mentioned earlier, I am a first year student. In lab this week, we started on IVs. This scares me a little. It seems somewhat complicated. Can anyone give me any advice to maybe what can make it seem a little easier? I know that I need a lot of practice. Right now the math even seems confusing.

One of the differences between school and the nursing world is that in school you are expected to know every step the teacher wants you to know - in the real world you will develop your own steps as you become more proficient.

Since I don't know what steps your teacher wants, here are mine:

1) Wash my hands upon entering the room.

2) Take a quick look at both arms to determine which site I will access.

3) Find a chair and raise the bed to a comfortable height for starting IV's (I don't like bending over)

4) Place a tourniquet above the insertion site.

5) Lay out all my supplies in easy reach. (If I need blood I attach a 10 ml syringe to the J-loop tubing otherwise I attach a 10ml saline flush)

6) Cleanse the site. If using lidocaine inject 0.1ml just to the side of the vein I want to access (at times lidocaine can form a small bubble which will obscure the vein,so if you go to the side your chances of obscuring are less)

7) With my non-dominant hand I stretch the skin above the vein (usually sometimes I need to hold below) and press on the vein to "lock it down" so it doesn't wiggle. This is most important! Most people miss IV starts because they don't lock the vein down.

8) Usually I approach slightly from the side if the vein is big or from the top if small. Hold the needle with the bevel facing up at about a 40 degree angle. Insert into the skin (through the lidocaine if you used it) until you see a flash of blood back into the needle.

9) Drop the needle from a 40 degree down to a 20 degree and push forward just a bit more (this makes sure the needle is all the way into the vein.

10) Advance the catheter (not the needle) all the way into the vein.

11) Withdraw the needle and attach the tubing. Place the tegaderm over the IV.

12) Flush or draw blood out then flush.

13) Tape it down and initial.

Hope this helps.

Finally - practice with someone who knows what they are doing. A lot of practice done incorrectly will not help. Finally, remember this is a skill. It takes practice, but it gets much easier with time.

Pat

ANH_RN · Oct 18, 2008

I never got a chance to start an IV in school and they gave us a literally 15 minute instruction on how to do it and we had to do it ourselves. The first few times I started an IV I was shaking real bad and was petrified! I made sure I had my preceptor with me who was a great coach and I got it on the first try each time. I have only been out of orientation for a week or so and I have already started 2 IV's on my own with any cuing and have gotten them on the first tries. It looks a LOT worse than it really is! I promise. My only downfall is I get sloppy with it comes to putting on the dressing and keeping the IV in without pulling it out. That's the hard part.

RedhairedNurse, BSN, RN · Oct 18, 2008

As mentioned earlier, I am a first year student. In lab this week, we started on IVs. This scares me a little. It seems somewhat complicated. Can anyone give me any advice to maybe what can make it seem a little easier? I know that I need a lot of practice. Right now the math even seems confusing.

I got a smile out of this post. I graduated 6 months ago. I remember I use to feel just like you now, but now for me it just comes second nature. You'll learn, don't be worried or scared. You will soon see, as I did, when you learn, it's just like learning to ride a bicycle.

Daytonite, BSN, RN · Oct 19, 2008

there are all kinds of weblinks to help you with ivs on post #6 of the any good iv therapy or nursing procedure web sites sticky thread in nursing student assistant forum. https://allnurses.com/forums/1458776-post6.html.

Megsd, BSN, RN · Oct 19, 2008

One other tip, take the tourniquet off the arm before you flush the IV, otherwise you might blow the vein. Been there done that.

loricatus · Oct 19, 2008

Here's a website that may help you

http://enw.org/IVStarts.htm

TX_TeleRN · Oct 23, 2008

You have received (as have I!) many good technique advices with your post.

My advice is more for your self confidence: Don't let your failures get you down. Bring in RNs who are good with IVs and have then help you as you KEEP TRYING!

I recall my orientation. My first month, I did very well with IV starts. Then??? I had maybe 2-3 months of always hitting the vein but could not advance or would blow the vein. I was scared, but my preceptor kept pushing me to try. After each failures, she would recap what I did right and what I did wrong. Then one day, I started getting them as if all the advices I'd received finally sunk in. You may not get it every time, but that's OK. Don't get nervous and stay positive. Don't let yourself be your worst enemy. Good luck!

GrumpyRN63, ADN, RN · Oct 24, 2008

See if you can start a couple on some willing coworkers with good veins. I always let the newbies stick me. I have great veins and will talk them thru it as they go, plus you'll get that " first time" jitters out of the way, good luck !

tigers11 · Dec 2, 2008

Remember to release the tourniquet. This wasn't in the steps and is a big one to remember! Our hospital had to develop an action plan because staff were forgetting to release the tourniquet.