Pretty bad at starting IV's - page 3
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
- 0Nov 21, '12 by m1ckeyPractice makes perfect! I'm also a new grad with 2 1/2 months of experience on a med-surg floor and my IV starts are always a hit or miss. Don't be discouraged and just do your best to find a vein. You have two chances, so why not use it, right? The ones that I don't always get are the elderly population. The one thing that my co-workers told me is to bend their arm and use the side of the forearm. Also, I read on this thread that they went to the surgery center to practice.. That is also a great way to boost the confidence. Our new grad residency program gave us a chance to practice our IV starts at the peri-op for 2 hours. It was definitely a fun experience.
- 0Nov 22, '12 by One1Quote from itsnoworneverDifferent ED, different culture I guess . We use 18s and 20s as standard (preferrably 18s though) and 22/24 only on children or the patient that is impossible to stick (eg a 22 in the thumb).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!!!!!
- 0Nov 22, '12 by needshaldol22 works just fine with blood. I prefer 22 unless the vein is very large; then I go for 20. Or if the person has thick skin a 20 is best.
I worked in a clinic where I would put in maybe 6-8/day so I got good fast. Had no choice if I wanted the job. We did thinks there that are not used elsewhere from what I know. We would put on nitropaste over the vein area and put very warm/wet clothes. As said earlier, take your time and have everything you need all ready.
- 1Nov 22, '12 by akulahawkRN, ASN, RN, EMT-PMy "go to" size is/was an 18. I rarely had to go larger than that. I consider that size more of a mid-size. Small-bore is 22-24 ga, mid-bore is 20 and 18, large bore is 16 and 14 ga. I generally do 20 ga in hands, 18's everywhere proximal to the hands. It's easy to control the flow with those, run-away lines don't dump fluid in that fast, and you can easily saline-lock them. As to "large bore" lines, I can count on one hand the number of times I've had to do a truly "large bore" peripheral line... and I have never missed one of those.
If you're starting a line in a vein that will roll and there's no bifurcation that you can use, pull traction on one side of the vein to anchor it (can't go any further that way), enter the skin on the opposite side of that traction, then the only way the vein can roll is right into the cath. Once I've placed the cath inside the vein and I'm ready to remove the needle, that's when I release the tourniquet. Done smoothly (and remember, smooth is fast), it kind of goes: anchor the vein, enter the skin, flatten out the angle to the skin, point cath at the final spot inside the lumen, advance to that spot, see the flash, advance another 1/4 inch, advance the hub to the skin, release the tourniquet, place a 2x2 under the hub, tamponade the cath tip as I remove the needle, safe the needle, grab the IV tubing and attach it using aseptic technique to the hub, release cath tip tamponade pressure, open the roller clamp and verify flow... secure the site, regulate the flow to ordered rate. Total blood loss, 2 drops.
All that is from the moment I'm ready to actually puncture the skin. From "flash" to secure takes about 20-30 seconds, if I've gotten everything prepped and ready for me to grab. It's all just smooth, deliberate movement that doesn't cease until the procedure is done. I do it the same way every time, rushed or not.
- 0Nov 22, '12 by akulahawkRN, ASN, RN, EMT-PQuote from coriaa1As many have said, perfect practice makes perfect. What also helps could be a visualization technique were you visualize yourself doing the task perfectly. This way you prime yourself for doing perfect practice perfectly.practice makes perfect
I hope that was not too confusing.
- 0Nov 22, '12 by Racer15I'm doing my practicum in the ER, and after 7 days, I'm getting to the point where I can visualize the veins better in my head just through feel. It just takes practice! A trick my ER nurses have taught me is floating an IV in. Sometimes I get a flash but advancing the cath just does not work, it either won't go in any further, or the blood return stops. I pull it out slowly until I get blood return so I can draw a rainbow, and once I'm done, I attach my normal saline and just slowly push it into the line while slooowly advancing the cath forward. Works about 75% of the time for me. if I didn't learn that trick, I'd be missing a lot more IVs!