Pretty bad at starting IV's

[NurseJessie2]

I am a new RN, just out of school, and have been off orientation for a few weeks. I am having trouble with starting IV's and find that I need help with about half of them. It is very frustrating because it is bringing my confidence down and making me feel like I am a burdon to other nurses. When did you begin to feel like you needed less help with nursing skills from other nurses? I have only been a nurse for 4 1/2 months and Im wishing I could fast forward to a time where I felt more competent!

[NotReady4PrimeTime, RN]

Some questions/tips:

* Some mentioned using nitro paste to numb the site first -- is an order needed?

Nitropaste (nitroglycerin in ointment form) doesn't numb the site. It dilates the veins. Not to be trifled with because it's absorbed through the skin and can have significant systemic effects. It's an antianginal with similar effects to sublingual nitro, but because it's used topically it has a longer duration of action. We use it very occasionally on kids who have had septic emboli or extreme vasoconstriction from the alpha effects of inotropic meds used to treat shock states, whose perfusion to digits has been severely compromised. The local peripheral vasodilation it produces can often eliminate the risk of eventual amputation. I can't say that I've ever seen it used for IV starts... seems a bit radical and mildly dangerous! So I'd say an order would be imperative.

[eatmysoxRN, ASN, RN]

A big tip that hasn't been mentioned or that I overlooked is asking the patient where they usually have IVs. It saves a search of good veins are limited. I tend to find a good vein in the wrist under the thumb often. Upper arms are decent. Remember to adjust your tourniquet so veins aren't popping too much or they'll blow. Putting pressure above your site before pulling out the needle does a good job of preventing the bloody mess that patients freak over. Stay close to the skin (angle wise). I float by pulling back on my flush until I get blood then slowly advancing back in. I always chevron with tape. I usually try to get a 20. I prefer a 22 over nothing though. Haven't used a 24 on anyone but a baby. Oh and taking the lock off the extension tubing and just using that instead of that plus the short tube can keep your site from blowing so easily as well. Scrubbing with chloroprep or whatever you use to clean can really pop veins out some too.

[whichone'spink, BSN, RN]

I actually find I lose veins after I scrub with chloroprep.

[Jenn1229]

I have been a nurse for 20 years and I've never been good at peripheral IV sticks! But I've always worked as a team player and willing to help my fellow nurses. In return,I've never had a problem finding another nurse to help me out.

[jagged777]

good tips and thx for the info

[Anoetos, BSN, RN]

IVs are hard. Many of my patients are regularly dialysed, and/ or elderly. Their veins are like tiny pencil drawings that disappear as soon as the skin is pierced. It's like a game of hide and seek.

Luckily enough, about half of our patients come from the ICU with central lines...

But yeah, I think IV starts might be the most challenging common procedure nurses perform.

[babysteps25]

I am about 8 mos. into my first year and have a few questions for those who have more experience or are just good with IV's. I tried finding answers in books, articles and can't find any mention of these topics (maybe means they're not important lol but I'm still curious)

1. I had a patient that arrived from the ER with an IV in the foot, I was told many people who are good at IV's tried and eventually they placed it there. So if someone is really really difficult is it okay to put one on the foot? Do you typically need to clear this with an MD?

2. If a patient had a stroke and is paralyzed on one side of their body (whole left side or whole right side), can you not start an IV on the side they are paralyzed on?

Thanks In Advance

[Sun0408, ASN, RN]

I am about 8 mos. into my first year and have a few questions for those who have more experience or are just good with IV's. I tried finding answers in books, articles and can't find any mention of these topics (maybe means they're not important lol but I'm still curious)

1. I had a patient that arrived from the ER with an IV in the foot, I was told many people who are good at IV's tried and eventually they placed it there. So if someone is really really difficult is it okay to put one on the foot? Do you typically need to clear this with an MD?

2. If a patient had a stroke and is paralyzed on one side of their body (whole left side or whole right side), can you not start an IV on the side they are paralyzed on?

Thanks In Advance

#1 will depend on your policy. Many do require an MD order for the foot d/t the high risk of infection.

#2 will also depend on your policy, we are not allowed to place a line on the affected side. Many pts have sensation issues and wouldn't be able to tell if the site is hurting etc...

[IVRUS, BSN, RN]

1.IV catheters in the foot or leg veins are never a good idea... However, if it is necessary, and it rarely is, Get a MD order. The patient must be non-ambulatory as well.. Remember the occurance of DVT is much more prevelant when cannulating LE.

2. In order to get adequate venous return from the peripherals to the central vasculature it requires the use of the muscle pump. If one is flaccid, that is impaired. So, no, Do NOT start an IV one the stroke affected side. That along with the fact that they do have impaired sensations, as do many elderly, stay away from that side.

[anggelRN]

Yes there is a chance of hitting a valve if you go for a "Y" vein. Usually you have less change if you go right below the bifurcation. Also, I understand there are endless do's and don't when it comes to IV therapy, but when trying to learn a new skill, you need confidence builders. The "Y" is one that is fairly easy to insert, and I think the more options you're aware of, the better. I tend to avoid IVs in the hands (not the best spot for laboring mothers) but a quick hand IV insertion can be a life saver in an emergency situation.

[RNEMT-P]

One more piece of advice not already mentioned: Don't put the tourniquet on too tight with elderly patients. You only need enough pressure to make the vein pop up; too much will cause the vein to burst when you puncture it if it is at all fragile.

Also, don't put the tourniquet around the neck to try a scalp vein; it usually doesn't work out so well.