Good at placing IV's?

Pheebz777, BSN, RN · Sep 28, 2006

I explain (truthfully) that many women handle IVs alot better than men. That almost always gets a chuckle and relaxes the patient alittle......

Everything you had to say is very true except for the above quote. For the short term goal you have achieved what you needed. Long term, you've caused a lot of problems. This patient will have that general concept in mind that women are better than men. Then she'll talk about it and this just goes on an on. What you could have said is "Some nurses are better experienced than others at placing IV catheters. We all have to start somewhere."

In the ICU where I once worked at, there was this male nurse who can insert catheters in places you never thought you would find a vein. Edematous? Dark skin? unpalpable and unviewable veins? nevermind, this guy can work wonders. And not only did he do it in the most diffucult areas, he always used a gauge 18 or 20, nothing smaller than that. And in my 2 years working with him he never missed. All one shot entries. Out of maybe over 100 hard sticks, I've had maybe 3-4 patients where I couldn't get an entry. This guy did it for me.

In other words, if your patient had been admitted to his care, she would have probably requested a female nurse instead to insert the cannula because of your promising words.

P_RN, ADN, RN · Sep 28, 2006

Another thing I forgot. My dear friend and former Assistant Head Nurse told me this:

If it's difficult to find a vein, get down on your knees-and always use a #20.

Mary passed away shortly thereafter, but she lives on in hundreds of nurses she taught.

flashpoint · Sep 28, 2006

You are going to have days when you can slip a 16 gauge into the hand veins on a diabetic, dialysis, chemo patient...you are also going to have days when you can't pop a helium balloon with a steak knife.

Don't lose confidence...don't be too hard on yourself when you miss...don't get psyched out by patients who say things like "I'm a really tough stick," or "You get one chance and then you're done...If you miss I'll knock you flat on your ***." Always make your first attempt your best attempt...don't go for the first vein you see...take a minute or two to look around and find the best vein. Think about what size catheter you really need...not everyone needs and 18 gauge, but a 20 gauge won't work for everyone either.

Something that helps me when I get in a slump...I don't make any plans for Friday or Saturday nights. When the bars are packed and tempers flare, people get hit..sometimes they fall down on their own and someone always calls 911. Drunks have huge confidence boosting veins. I don't start an IV if I don't think I need one, but drunks almost always get fluids.

:)

Daytonite, BSN, RN · Sep 29, 2006

i was very bad at iv's. it took months and taking the lvn iv course before i started showing any improvement. at the suggestion of the person teaching the lvn course i started looking and taking every opportunity to start an iv. and, most nurses were willing to let me do it. after about 6 months i started to feel like maybe i was catching on. i eventually got better and better. it became something that i just kept pursuing. i eventually got onto an iv team. i worked on iv teams for a total of 6 years over my career.

a lot of people have contributed information they have picked up in their careers to this thread. you might want to read it:

https://allnurses.com/forums/f18/iv-tips-tricks-3793.html - iv tips and tricks

augigi, CNS · Sep 29, 2006

Can only agree that it's confidence! The more you get, the more you think you'll get in future. If you miss one, you drop back in confidence.

What helped me was really learning the anatomy of the hand and arm veins. With regard to your wheal (which I've never heard of doing, by the way - it really isn't painful enough to need a premed stick!), what may help you is to visualize where the vein is going after the wheal. It's easy to stick the needle in if you know which direction to aim. Another skill you'll get from practice, practice, practice is the angle to stick the needle in. It can be such a small difference which means you get it or not.

One other thing was not giving up if you stick the needle in and don't get a flash immediately. If you know the vein is there, relax, pull back a little, change the angle of entry a little etc. I often get it in at this stage without having to take it out and do another stick.

OBSFlightRN · Sep 29, 2006

We also use the "wheal" method but we use 1% lidocaine. It makes a huge difference for the pt and it's actually a positive for a novice IV starter too because you can move the needle around a lot more without causing the pt a lot of pain. The key is to palpate the vein above where you've put the wheal. So as I'm inserting the needle through the wheal with my right hand, I'm palpating the vein with my left hand about a cm or so above the insertion site. That way I can aim the tip of the needle in the direction or my fingers. Does that make sense? It's hard to explain, I wish I could draw a picture.

ETA- to the PPs who have said that an IV start isn't painful enough to warrant using freezing, I work in L&D and all of our pts get 18Gs. An 18G is big and really friggin' hurts. When I use freezing I always get happy comments from my pt's that they didn't even feel the IV go in. So freezing gets a huge thumbs up from me and my pt's.

nursejohio, ASN, RN · Sep 29, 2006

When I use freezing I always get happy comments from my pt's that they didn't even feel the IV go in. So freezing gets a huge thumbs up from me and my pt's.

What do you use for the freezing? I'm in L&D too and we use an 18 unless we can't find a single vein that will hold one. I love the lido idea, even asked my preceptor about it. We aren't allowed, because at my hospital it's out of our scope. I'd definately try freezing if I could though, especially on our really *really* young primips that are terrified of everything.

heartbeat2 · Sep 29, 2006

One thing my instructor told us....sounds weird....but you can increase your touch sensitivity. Take a hair from your head. place it under a page in the yellow pages of a phone book,,,and see if you can trace the hair. She had us up to 20 pages and able to trace it...NEVER thought i could do this. It helped tons with little veins, or deep veins.

scrmblr · Sep 29, 2006

How long did it take you to become proficient with placing IV's? I just started a new job in pre-op, and I'm sucking royally at getting these placed. So far I've had one successful attempt within about 10 tries. My preceptor is very sweet and patient, and tells me it takes repetition and practice. But right now I can't see myself EVER being good at this.
Has anyone gone from being terrible with placing IV's, and then somehow gotten really good? Or, do you know of anyone who never got the hang of it, no matter how much practice?

I swore I would NEVER be good at iv starts! I started in the ER and couldn't hit anything to save my life! I was seriously thinking about quiting! For my entire first three months I swear I only hit every 5th IV. It was pure hell:( BUT! I have been in the ER a year and a half and I seriously don't miss very often anymore. It is really repetition and practice and learning the "tricks" of the trade. I will miss on occasion and have to have someone else try...I hate that! But, my IV skills have gone waaay up and my confidence has too. I swear it was like a light went on one day and I was finally able to put in those IV's. I had to start an 18gauge on a hospital administrator yesterday...I was still nervous, but it went right in!

I'm sure everyone has given you their tips and tricks, but for me, saying a little "prayer" prior to EVERY stick has helped. I also make sure everything is in arms reach and ready. One really important thing is to STABILIZE that vien. DON'T let it roll...That was tripping me up often. I hold the pt's skin really tight as I am getting ready to poke. That vien ain't goin' nowheres:lol

Relax. Practice.

scrmblr · Sep 29, 2006

Everything you had to say is very true except for the above quote. For the short term goal you have achieved what you needed. Long term, you've caused a lot of problems. This patient will have that general concept in mind that women are better than men. Then she'll talk about it and this just goes on an on. What you could have said is "Some nurses are better experienced than others at placing IV catheters. We all have to start somewhere."
In the ICU where I once worked at, there was this male nurse who can insert catheters in places you never thought you would find a vein. Edematous? Dark skin? unpalpable and unviewable veins? nevermind, this guy can work wonders. And not only did he do it in the most diffucult areas, he always used a gauge 18 or 20, nothing smaller than that. And in my 2 years working with him he never missed. All one shot entries. Out of maybe over 100 hard sticks, I've had maybe 3-4 patients where I couldn't get an entry. This guy did it for me.
In other words, if your patient had been admitted to his care, she would have probably requested a female nurse instead to insert the cannula because of your promising words.

I'm pretty sure she meant that women as PATIENTS are better able to handle the pain of GETTING an IV.

nrsang97, BSN, RN · Sep 29, 2006

I had a terrible first year to start IV's. A few of the nurses I worked with would take me to a pt with awesome veins and let me try them. I also went twice with the IV team. I had a terrible day the first time. I couldn't hit a vein no matter how hard I tried. The second time I went with the IV team (and a much more patinet nurse), I started 6 IV's in one night. After that I gained some confidence. I am now one of the "go to" nurses on my floor for hard to get IV's and there are still ones I cannot get and others I wonder how I did that. So it takes lots of practice. You will be able to do it. Good luck