Pretty bad at starting IV's - page 2

by NurseJessie2 8,863 Views | 46 Comments

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... Read More


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    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.
  2. 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.
    Rizz, joanna73, and redhead_NURSE98! like this.
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    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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    Thank you guys so much for the advice. I know that I need to take my time looking for a good vein, but because Im working in the ER I feel like I need to be quick because most patients need fluids/ meds quickly. It seems the only ones I can get are the easy ones that pop right out at you lol. I am working again on friday and Im going to try to take my time with each one and have a little more confidence in myself. I am really trying not to get to upset because I really want this first year of nursing to be a big learning experience with my skills. Thanks guys!
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    You are correct; being in the ER may mean you have to act fast. Just keep at it and let the pros give you advice while you are doing it.
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    In my L&D we did 18 guages...all the time.

    I really like all the advice.Hereis the only thing I have to add. If you see a bifurcation in a vein(there's usually that hand one that comes straight down the ring finger and then forks into a "V"), always go in the middle of the "V", it''ll stabilize the vein and I have never missed that one.
    m1ckey likes this.
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    AnggelRN you are 100% correct. I teach all nurses to "look for the Y". I forgot to add that earlier post.
    m1ckey likes this.
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    Quote from NurseJessie2
    Thank you guys so much for the advice. I know that I need to take my time looking for a good vein, but because Im working in the ER I feel like I need to be quick because most patients need fluids/ meds quickly.!
    Think about it this way -- it's likely actually quicker for you to take some extra time, than it is to miss twice and have to go hunting for another nurse. As for the patients, I tell them "I like to look twice and poke once." This prevents them from taking my diligence for a lack of confidence.
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    One thing that really helped me when I was a new grad was to go to our hospital's ambulatory surgery center and start IV's for 1/2 a shift for a few days. Our ambulatory surgery center sees 40-50 patient's a day so I had a LOT of practice, it improved my confidence level quite a bit.
    m1ckey likes this.
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    Quote from One1
    You used bigger gages in L&D than in the ED?!
    Yes! 18 in l&d and unless we suspected blood products a 20 or 22.... Sometimes I think we are using something larger in l&d I swear I'm sticking people with blood donation straws!!!!!


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