[Lady_Bing]

Hi everyone,

I am a new nurse on a busy medical floor and I am just two weeks off orientation. I am having a really hard time starting IVs, I did not get an opportunity to start many IVs in nursing school and now when I am on the floor I find myself feeling handicapped in that department. I read a number of posts on the boards and found really useful tips, and I am now able to see and touch the vein, but I am having a hard time finding the vein with my needle/catheter. And even when I get the blood return, I am having a hard time advancing the catheter into the vein without blowing it. I realize that there is an art/techinique/ to starting IVs and I need experience, but I am feeling very frustrated because despite getting practice, I am not really improving. Please help.

[jodi_cmsrn]

Our facility offers new nurses the opportunity to spend a day in our ambulatory surgery unit to have exposure to starting a large number of IV's in a short period of time. Perhaps you could ask if this could be done in your facility. These nurses are often able to provide tips and tricks and maybe even identify what you could do diffferent/better to improve your skills and your confidence.

Hope this helps.

[Anagray]

Hey. I am very proud of you for wanting to improve. Usually people just ask others to do their job. You are very new and it takes time to get good at it.
I don't know if this helps, but there are many components to good IV techniques and I find the the most important are location, ancoring (sorry this is probably spelled wrong) and angle at which you insert needles.

I'd say that if the vein is blowing you probably went right through it with the needle and incidence of this can be reduced if you pick a straight vein, ancor it (i usually stretch it veritcally, and then go approx 1 cm below where you see a good vein popping up at 10 degree angle. You can always go deeper, but it is difficult to come back up after you dug your way in already.

You may want to speak with your manager and set up some shadowing with IV team (if you have this in your hospital). My best experience was on a tele floor because most patients there require blood draws q 6 hrs if they are on heparin or if they need cardiac enzymes.
Drawing blood with a small need is another good way to get used to fingin veins and aiming. It is much easier than starting IVs.

Good luck, keep trying.

Nat

[Lady_Bing]

Thank you, guys! I will be taking your advice and asking management if I can spend a day just doing IVs and improving my technique.

[julesAR]

I worked on same day sx for 17 years and it is a great place to get practice. Couple of hints: if possible, tie the touniquet tight- makes a huge difference. Also, if it is an elderly patient with very small veins, try to use the smallest gauge catheter possible b/c sometimes the vein just won't hold even a 22 g- and it will do fine with a 24 g. I learned early on that if I advance the cath. just a little more than when you get a blood return, the vein doesn't blow as much- I think the cath is sometimes not all the way in. Don't feel badly about your ability- I work with many long-time RN's who cannot start IV's and I think it is entirely due to lack of practice. When you only have one or two a wk compared to ODS having 20/day, you just don't get practice. One more thing- do not fall into the trap of leaving the iv in after it is sore and/or infiltrated b/c you feel inadequate in restarting. For the patient's sake, try once or twice and then get the best iv nurse on your unit and don't feel badly about it. Hang in there, it will get better!

[Lady_Bing]

quote=julesAR;2638149]I worked on same day sx for 17 years and it is a great place to get practice. Couple of hints: if possible, tie the touniquet tight- makes a huge difference. Also, if it is an elderly patient with very small veins, try to use the smallest gauge catheter possible b/c sometimes the vein just won't hold even a 22 g- and it will do fine with a 24 g. I learned early on that if I advance the cath. just a little more than when you get a blood return, the vein doesn't blow as much- I think the cath is sometimes not all the way in. Don't feel badly about your ability- I work with many long-time RN's who cannot start IV's and I think it is entirely due to lack of practice. When you only have one or two a wk compared to ODS having 20/day, you just don't get practice. One more thing- do not fall into the trap of leaving the iv in after it is sore and/or infiltrated b/c you feel inadequate in restarting. For the patient's sake, try once or twice and then get the best iv nurse on your unit and don't feel badly about it. Hang in there, it will get better![/quote]

Thank you for all the encouragement and advice. IV is such a sensitive topic to me - I end up being sort of fixated on them and if I see any sign of phlebitis and/or the pt complains - that sucker is out of there in a sec. I can't imagine someone ignoring a bad/infiltrated IV for any reason, that's just goes against every principle of good nursing.

I always try to start an IV myself - and if I don't get it on a second try - I ask another nurse to help me (and I try to do something for her/him later in the day to kind of make up for the time they spend on helping me). But I feel bad for the patient that they are getting poked multiple times on account of my incompetence. Then again if I see someone has really bad veins, I call a STAT nurse - there's no need to torture someone just for practice. For example, if I know that a senior nurse (who is really good at IVs) couldn't get an IV into my pt yesterday and had to poke her 2 times, I call the stat nurse for help.

The thing is we only have two size catheters #20 and #22. And of course smaller veins would call for a #22, but if I know that my pts hgb is dropping and he had transfusions yesterday - makes me realize that the next logical step for this pt would be having a #20 in case he will need more blood.

[julesAR]

You're entirely right about the falling H and H- you do have to use the 20 g- that's when you have to do your best and pray! The other thing that really helped me was to watch the same day sx nurses- I know that sounds dumb, but I know I picked up their smooth motions many years ago from just watching them do it over and over. (you might try to go there and shadow one on your own time) You sound like you're on top of things in assessing the site- I have been suprised at my facility of how many so-called "seasoned" nurses have an apathetic attitude about iv sites - maybe it's laziness, but I hate it! Once you begin to get confident, just know that there are days that everyone has trouble and don't be too hard on yourself.

[RealNurseWitch]

I'm TERRIBLE, TERRIBLE at starting IV's, always have been, and it is very, very frustrating. And, I have almost 4 years experience in Med/Surge! Where I worked before, we used these little-bitty IV needles/catheters, and I did much better than I do now. Where I am now, we use these GREAT BIG things with needles that retract by pushing this little white button. Many nurses at my facility have trouble with these new angiocaths, and I am no exception.

Practice is definately what you need... it's what I need to but I'm just so terrified of going somewhere, anywhere, where I have to start a lot of IV's. I'd love to work in ambulatory surgery one of these days, but I have to get over this fear of IV's first!

[Daytonite]

There are lots of helpful hints on starting IVs on this thread:

• http://allnurses.com/forums/f18/iv-tips-tricks-3793.html - IV Tips and Tricks

[sharrie]

Starting IV's is not something that nurses in the UK do routinely, when I started as a NP I was very expereinced in critical care, surgical nursing and emergency care I was a competent and very confident nurse. The one thing I struggled with for months was starting IV's in fact in the 15 years I had been nursing before I started it was the one thing that managed to reduce me to tears because I felt so inadequate.

It all comes down to practice, I have spent 5 years perfecting my technique and now I am called to start the most difficult IV's and even ones that anaethatists have failed on. There is lots of good advice about techniques and little tricks that help but at the end of the day it comes down to practice

Don't get too disheartened you will improve with expereince