New Nurse IV Struggles

Nurses New Nurse

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Hi guys,

I am a relatively new nurse, less than 6 months, and one thing I noticed that I am still really struggling with is IV insertion. I was looking into taking a course offered for nurses at a local university. The summary of the program stated that it was incorporating information from the Infusion Nurses Society 2010 Standards of Practice, instead of the 2016 edition. Does it matter? Does anyone happen to know the differences between the two editions?

I would also appreciate any tips :)

Thank you so much for your time!

Farawyn

12,646 Posts

Practice as much as possible, on young veins, but always phone a friend if you cannot get it after 2 tries.

If you are drawing blood, I like the antecub.

Hands bruise and blow up quicker in the elderly.

Be aware of all blood thinners, steroids, etc. Also, with elderly, osteo. I saw colleague break a LOL's arm once just from starting an IV. I was in the room, and there was no manhandling done at all.

You have to feel it rather than see it. There is a bounce. :) I one glove it, but I don't recommend you do. That's just how I learned from my COB preceptor.

brownbook

3,413 Posts

I've been putting in IV's consistently for the past 15 years in out patient surgery. (Well...the consistently part came has been the past 4 - 5 years.) I have no specific knowledge of the Infusion Nurses Society Standards of Practice for any year? I am sure any recent year would be fine. The basics of putting in "just" a regular IV are pretty much standardized over the past 15 years? As opposed to a PICC or other more advanced catheter options.

You Tube is great for educational teaching videos, there are many about inserting IV's.

I was not a natural born IV starter. I've went through years of tears. I've learned several of tricks, variations of techniques,that work for me. Don't give up. The number one, kind of duh trick, is take the time to pick a good vein, that means warm up the patient as much as you can.

You can see in your own hands. Stand in a cold shower, look at your veins, put the water on hot, see what your veins do.

Boomer MS, RN

511 Posts

Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.

Practice, practice, practice. It just takes time. If possible, see if you can get some time in the ED, where IV queens reside b/c of the need for so many IVs here. I found it enjoyable to help other RNs learn IV skills. Watch closely as others do them. The more exposure the better. Take your time with each vein. And Farawyn's advice is wise. Two tries and then ask someone else. Good luck. It will come with time if you keep at it.

Everline

901 Posts

Specializes in public health, women's health, reproductive health.

I have been in my current job for a few months. I am required to start IVs often for sedation. When I first started this job I didn't have a lot of practice at it. A few months later and I have started a lot of them and can generally do it without problems if the person has "good" veins. I keep practicing to get better at more difficult sticks. As has been mentioned, I generally ask someone else if I try 2 times and cannot get it. If a person is a past or present IV drug user, I find it difficult. I also find it difficult on obese patients. But I strive to keep an open mind with every try and not get psyched out when I miss. Confidence does matter.

I've attended a couple of classes on starting IVs, but they were not ultimately very helpful to me, perhaps because they did not include practice on actual people. The thing that has helped me the most is actual practice on patients, but I sure would have liked to be able to practice before I practiced! The class you are going to take could be different, of course. At any rate, hang in there and take any opportunity presented to you to try. It gets easier but takes time. I'd love to be one of those nurses who is expert at it. The only way to get there is keep trying/practicing. You will find that as time goes on you are able to be more successful. You will get better at locating optimal veins and you will get a feeling for what will probably work.

Good luck!

Boomer MS, RN

511 Posts

Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.

I think someone else recommended warming the extremity. Other ideas are "slapping" the vein to get it to pop up. Also hanging the extremity over the side of the bed/gurney. Now I know one has to be gentle when trying these tactics. And IV drug users would often tell me which vein worked the best!

Bobjohnny

99 Posts

Specializes in ER.

Another suggestion that our facility occasionally uses, if available, see if you can spend a day in Pre-op or the ED. Just spend the day starting IVs. If that could be available to you, ask your manager if you can. I know we've done this with a couple of our new grads when they were hired into the ED. I know one of them got about 35-40 sticks in a 12 hour shift.

Farawyn

12,646 Posts

I think someone else recommended warming the extremity. Other ideas are "slapping" the vein to get it to pop up. Also hanging the extremity over the side of the bed/gurney. Now I know one has to be gentle when trying these tactics. And IV drug users would often tell me which vein worked the best!

THIS!

I slap the you know what outta veins.

And yes on the IV drug users being experts.

Also, I love me some butterflies.

FloatRN19

126 Posts

Starting IV's is all about getting a comfortable routine that you can replicate. Getting comfortable with almost perfect conditions to get to the point where you'll be successful in less-than-perfect situations.

Know your landmarks, finding a vein is easier when you're looking in the right area.

Get as many attempts as you can, 2 per patient, but as many patients as you can. Working in a trauma hospital it is a little easier to get opportunities. Follow facility guidelines but rotating iv sites(don't remove old access until new access is in). Starting a second IV on patient going down for surgery, procedures, or patients on multiple iv meds. Also if I'm in the icu/ccu etc I'll discuss starting a second IV with them as a precaution. Kind of rare for them too only have one. But I feels it's unsafe.

Try and anchor the vein a little lower and to the left or right depending upon which handed you are. When you do this watch how the vein moves to account for the slight variation. Gives you a little clearer point of entry.

Just random thoughts.

I typed a few thousand words on the matter for a nursing student budy of mine and orientee that are with me.

Specializes in Physical Medicine & Rehabilitation.

I'm 4 months on my own, but I'm meh at IV's. Practice makes perfect like most people say! I try twice, then get a friend. If the patient says they have bad veins, I MAY try once, if not, I save my patient the poke and get the good IV nurse. I'm better on hand veins, they're easier to get, but I they hurt more and are easier to blow/lose throughout the shift (especially at at night since patient moves around when they sleep). I tried the warming of the veins/arms and it works, but be prepared to clean up a spill! I'm terrible at getting AC veins, I can NEVER get them :(.

Also, I noticed that I tend to get IV's better with a 22g. With 20's, I go straight through them and it's more convenient to have a 20g (especially for blood and procedures), but I guess I'll need more practice.

Boomer MS, RN

511 Posts

Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
I'm 4 months on my own, but I'm meh at IV's. Practice makes perfect like most people say! I try twice, then get a friend. If the patient says they have bad veins, I MAY try once, if not, I save my patient the poke and get the good IV nurse. I'm better on hand veins, they're easier to get, but I they hurt more and are easier to blow/lose throughout the shift (especially at at night since patient moves around when they sleep). I tried the warming of the veins/arms and it works, but be prepared to clean up a spill! I'm terrible at getting AC veins, I can NEVER get them :(.

Also, I noticed that I tend to get IV's better with a 22g. With 20's, I go straight through them and it's more convenient to have a 20g (especially for blood and procedures), but I guess I'll need more practice.

Good start! In the ED we loved AC veins, but floor nurses, not so much for various reasons. My mantra was to go where I could get one quickly in the ED. (Oh, the places we put IVs!) The most common mistake I made when learning way back when was to go thru the vein, as you described above. So take your time and go very slowly; you can always go deeper. There are several techniques how to "stick" the vein. I went over it; some people go from the side. You'll find what suits you. I learned tricks from other RNs, and one was to rub lots of alcohol over the vein b/c it made it stand out more. Such a useful tip. Try that for AC veins. If a patient was a bit uncooperative, I would say that I had a "sharp in my hand" and didn't want anyone to get stuck. I would tell those learning that, "You get confidence from the easier ones, but you get better and more skilled from the difficult ones." You're not terrible; you're learning. Carry on!

beccap

59 Posts

Maybe you can get some experience in your ER. I too felt very weak in the IV area before I started working in the ER and most days I am successful with every IV attempt. It takes a lot of practice!

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