[Djuna]

I must be a weirdo because I have no problems with the 18g and I miss them with the 22g. 20g is a no brainer so I usually go for that size unless I really need a bigger cannula.

[NurseCutie]

I used to have the same problem with the 18 gauge. I found that it really was a simple solution once I figured out what the problem was, another nurse pointed it out to me...
For some reason when they manufacture the 18g the cath seems to be stuck and won't advance and will blow the vein. When you first open up the package twist the cath around the base of the needle and then insert into the vein. It works everytime.

[mustanggirl]

I've found that often once I get the catheter in, sometimes it helps to turn the IV fluid on wide open and float the catheter in the rest of the way with the fluid pressure once you have pulled the needle out.

[MimisMomLVN]

Hey guys I have trouble getting any gauge in (IV starts) that is. I am just plain scared. I work med surg but have not done one for about 9 months or so. I am so overwhelmed with work (LVN on team nursing) I just don't have time to go try and can't find anyone usually who will go with me to make sure it is done right. I have even been trying to practice on my daughter's cabbage patch dolls, sad huh. I'm getting ready to go into the RN bridge in June and need to get over this phobia. Any suggestions!!! I guess I'm scared to hit a valve, blow a vein, etc. etc.

[groh2009]

The 18 gauge catheters that we use in our ER do not show a flashback. The catheter is also longer than the usual 20 gauge (1.6 mm compared to 1.0 mm) which may make a difference when you are threading it.

[LeesieBug]

Make sure you are looking at the actual flash chamber when starting an 18. Maybe I am the only dork that had this problem..... When I was new I thought I sucked at 18's because I never could even get a flash, then realized that you can't see the blood travel into the cannula like you can in the smaller gauge, and I actually WAS getting a flash! (At least with the style we use.)


I also agree that I have to float in my 18's more often than the smaller gauge.


And, pretty much like anything else IV related, it's all about practice and getting the feel for it. Just start an 18 on anyone who has the veins for it and needs a bolus.

[zamboni]

Originally Posted by MimisMomLVN

Any suggestions!!! I guess I'm scared to hit a valve, blow a vein, etc. etc.

Here ya go...you WILL hit valves and you WILL blow veins...no matter how long you do this, it'll still happen to you, just not as frequently with time. But just when you think you're golden, BAM! You'll blow a vein on a healthy 20 year old athlete with veins the size of radiator hoses! So you can just put that fear to rest.

One common problem I see with new people is that they do the initial stick too fast, because they don't want to hurt the patient. Sometimes it sucks for the patient, but you gotta take your time, especially on fragile veins.

[MimisMomLVN]

Thanks Zamboni, I am just plain scared of IVs I guess. I know I need to force myself to do them and get over this phobia if I am going to be an RN. I think I have just been so overwhelmed at this hospital where I work for the past two years and going to school and not having the time to learn what I need to learn sometimes. I need to push myself. I feel like I don't know what to do, but I do, just lack confidence. What's the worst thing that can happen with IVs if you do them wrong? There I go, more fear!!!

[ZippyGBR]

'any hole is a goal' ... sometimes has to be the maxim with vascular access

practice practice practice is the successful way to get good at IV insertion - assuming your technique is reasonable

[Knoodsen]

Originally Posted by groh2009

The 18 gauge catheters that we use in our ER do not show a flashback. The catheter is also longer than the usual 20 gauge (1.6 mm compared to 1.0 mm) which may make a difference when you are threading it.

The amount of fluid that can flow through a tube is a function of both diameter and length. That means that your long 18s may not flow any faster than the shorter 20s.