Pretty bad at starting IV's

  1. 0 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!
  2. Visit  NurseJessie2 profile page

    About NurseJessie2

    From 'Bear, DE, US'; Joined Nov '12; Posts: 19; Likes: 4.

    46 Comments so far...

  3. Visit  J&B-RN profile page
    1
    Don't be so hard on yourself. Nursing is hard work and skills take time! Lots of time. Everyone struggles in the beinging. I only get about half the IV's I try and guess what, if the other nurses don't like it so what! We are a healthcare team and all need to work together. Keep trying and keep your chin up.
    gigglestarsRN likes this.
  4. Visit  scb7620 profile page
    2
    Keep trying! I still struggle too, but if my podmates have patients who need IVs, I always ask if I can help to gain more experience. Practice makes perfect.
    SCSTxRN and JessiekRN like this.
  5. Visit  SaoirseRN profile page
    1
    Some people have a knack for them and some don't, and really it isn't an easy skill! My advice is to keep trying, but also to seek out those nurses who "have the knack" and ask them for tips, and if possible watch how they do it. Generally the nurses who are really good at IV starts also love doing them, and will be more than happy to give you some pointers.
    DawnJ likes this.
  6. Visit  GinaCat profile page
    0
    is it finding the vein that's the problem, or physically starting the IV? maybe we can give you some advice
  7. Visit  TheCommuter profile page
    2
    After being a nurse for 7 years, I am still terrible at starting IVs. I can insert a Foley catheter into any 95-year-old lady after several nurses with 30+ years of experience fail to locate the urethra, but starting IVs is not my forte.

    We all have things we're good at. Practice makes perfect. In order to become good at starting IVs, you have to practice this skill repeatedly. Good luck to you!
    anggelRN and amoLucia like this.
  8. Visit  akulahawkRN profile page
    1
    Hardest thing about starting IV's is believing you can start the IV. I've had days where I couldn't get a line on my first or second attempt to save my life. It can be difficult to find a good vein. I first looked and felt for them. Not only did I feel for them where I could see them, I would try to follow their path by feel even if I couldn't see it. Later I could just see the landmarks and use my fingers to "see" the location and size of those veins. As far as actually cannulating the vein, I found it easiest to visualize the vein as if it were a hollow pasta and I'm aiming for the middle of that pasta. However, I can't perf the other side... so I get through the skin at a relatively steep angle and then shallow the angle so that the cath is almost parallel to the skin, but at an angle where can advance right into the vein. My fingers and cath follow a "J" shape, with the letter on it's side. Kind of put your mind's eye right at the bevel and "see" it go right into the lumen, get the flash, advance an itch more to ensure you're really in, then advance the hub to skin. It's really not that hard.... but it's one of those skills that are devilish to perfect.

    Just take a deep breath, find your calm place, believe you can do it in one stick, and get through the skin fast. While fishing for a vein can be uncomfortable, it's the first penetration through the skin that hurts the most. Never hurry. It's the old saying: slow is smooth, smooth is fast. And remember to breathe. Your patients will greatly appreciate the fact that their nurse isn't turning a nice shade of blue.
    biggirl11 likes this.
  9. Visit  NurseJessie2 profile page
    0
    I get the opportunity to start a few every day, plus some blood draws. I get a flash and then cannot advance the catheter, I guess because I went through the vein. Occasionally I will get one that I miss altogether because the vein rolled. I know that I will get better with time, I just hate being that new nurse that everyone has to help!
  10. Visit  itsnowornever profile page
    1
    Without reading everything- I rocked IVs in the ER for preceptorship. Get to L&D and these huge IVs kicked my butt. I was depressed!!!!! Not to mention I could only stick hands not the AC like in the ER. My husband told me to focus, don't let it get to me. I tell each IV (in my head) "I got you. You won't fail me. I know how to do this" and now I'm good. Silently focus. Take your time. You can get it.
    gigglestarsRN likes this.
  11. Visit  One1 profile page
    0
    Quote from itsnowornever
    Without reading everything- I rocked IVs in the ER for preceptorship. Get to L&D and these huge IVs kicked my butt. I was depressed!!!!! Not to mention I could only stick hands not the AC like in the ER. My husband told me to focus, don't let it get to me. I tell each IV (in my head) "I got you. You won't fail me. I know how to do this" and now I'm good. Silently focus. Take your time. You can get it.
    You used bigger gages in L&D than in the ED?!
  12. Visit  flyingchange profile page
    2
    Quote from NurseJessie2
    I get the opportunity to start a few every day, plus some blood draws. I get a flash and then cannot advance the catheter, I guess because I went through the vein. Occasionally I will get one that I miss altogether because the vein rolled.
    Based on what you said, I will provide 2 points of advice that helped me tremendously. I am a new nurse working in emergency and place at least 5 IVs q shift. Often more.

    1. Don't forget to drop your angle and advance the needle 1/4" after you get flash. The actual cannula that you are threading is shorter than the needle tip - you need to get that inside the vein too! If it won't thread, you are probably butting it up against the outside of the vein.

    2. Anchor those veins! Veins don't roll, they move when they don't have enough traction. Pin those suckers down and you will never have one "roll". Manipulate their hands to get the best traction.

    Hope this helps. Once I mastered the above, I had a LOT more successes and now I usually get them first try. Knock on wood. lol
    joanna73 and gigglestarsRN like this.
  13. Visit  SaoirseRN profile page
    3
    Quote from equestriRN
    1. Don't forget to drop your angle and advance the needle 1/4" after you get flash. The actual cannula that you are threading is shorter than the needle tip - you need to get that inside the vein too! If it won't thread, you are probably butting it up against the outside of the vein../
    I know they teach you in school to go in at 45 degrees or something ridiculous like that, then drop your angle. I swear this causes more punctured veins than anything! I prefer to start out with as small an angle as possible, not precisely flush with the skin but pretty close.

    Also, when you get flash back, pause and don't get excited. Advance just a teeny bit more, then advance the cath slowly. Doing this step quickly or too hastily can be the downfall of many an IV start.

    And my two biggest pieces of IV wisdom:

    1) Have some one show you the tricks and specifics of whichever IV product you are using at your workplace. We switched from Insyte to Nexiva and there was a big difference in technique between the two.

    2) Try using a manual BP cuff (inflated to around 90mmHg) instead of a tourniquet. I always use the BP cuff, both for comfort of the patient, and the fact that I've seen a dramatic decrease in veins blowing since I started doing that, oh, five years or so ago.
  14. Visit  needshaldol profile page
    2
    I have started IV's almost everywhere. Thumbs, toes, etc. The trick is not to rush. I will find one of those thin gabage can liners (sneak into the cleaning room) from a box and take about 3-4 wash cloths. I take the cloths, wet them, wring them out and put them in the microwave (oops) and heat 40 sec. They are hot as heck so I move them about, then when not scolding, I wrap around the arm/hand and put the plastic bag over it and keep it there for at least 5 min. I tell them it is their "spa" treatment. Then (with arm still in bag) I hang their arm down for about 20 sec. and take bag/damp cloths out and usually a vein is there.
    joanna73 and anggelRN like this.

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