How did you "get" the skill of starting IV's?

[Roland]

I have a friend who is a new grad working on a med surg floor for about two months. She is really upset because she has missed her first ten IV starts. Although she hasn't gotten in trouble she wants to know what she can do to get this skill down better. I'm not sure what her error is although I think she may be going "through" both lumens of the vein. Any advice? Why don't hospitals have "skill labs" with state of the art simulators (or not so state of the art simulators) so that someone can practice these skills. If Peyton Manning has a bad game he can go down on the field and throw a few hundred passes to Marvin Harrison. Where does a nurse go when they have a "bad game"?

[apaisRN, RN, CRNA]

I work MICU, with most patients grossly edematous, peripheral veins shot, and a central line. A nurse from the IV team told me these were the best patients to learn on. I think she meant because they are hard and most of them are gorked. But I need some confidence on the easy ones first! And if the patient is anything less than fully sedated, I feel like it's cruel to practice my IV technique on them when they already have a central line. The IV team is a great service but for nurses like me, who've never worked without one, it prevents you from ever developing the skill.

[casualjim]

Sometimes a little extra time with the alcohol prep will make the vein a little more visible. The "go deep and level off" is the rule. Also a lot of people get their flashback and dont advance either the catheter OR the needle enough so that when they ease up on the traction on the distal end of the pipe the vein pulls away from the catheter. I usually get my flash and advance the whole works forward just a little , then the catheter alone, then release traction.

Jim

[jeepgirl, LPN, NP]

I have the same prob!

I can get blood out of almost anything... I rule at lab. But actually getting an IV in for me is just tourture. It doesn't help that I'm a peds nurse... and when I try to start, I'm usually trying to hit a moving target!!!! I've started about 5 IV's since I started. However, we haven't been getting a lot of chances to start on my unit lately... ER has been sending up good IV's, and our direct admits usually come in the day, and the day nurses start them.

I"ll be watching this thread for some tips.

[dknunges]

PRACTICE, PRACTICE, PRACTICE. I know this is hard when you miss so many, your confidence level is below gutter level. I was fortunate to be able to spend time with nurses in Out Patient Surgery and GI Lab where the patient usually are relatively healthy with pretty good veins. The key is finding someone to be your mentor, spend time with you and give you guidance in this skill that can only be perfected by practice.

A few tips I live by:

Throughly assess patient and determine if this is a good learning experience, do they only have 1 palpable (not visual) vein. If so I'd seek help.

Insert the smallest size catheter that will accomodate therapy

Take your time, take a deep breath.

Allow time for venous dilitation. Avoid slapping of vein as this could cause venous spasm. Try heat, hanging extremity over side of bed, open and closing of fist etc.

Good lighting is a must and having all your supplies before entering room.

During venipuncture I do the following

Allow skin prep to dry thouroughly this will help prevent a chemical phlebitis

Apply tourniquet 6-8 inches above intended site

Keep skin tight, easier to puncture skin and thread catheter off

Approach vein slowly and at a 15-20 degree angle

Wait for flash, sometimes takes a couple of seconds, esp with newer safety IV catheters

Once you get a flash lower catheter completely flat and advance a little further into vein to make sure the catheter as well as bevel is in vessel

Keeping catheter flat push the catheter forward off of the needle.

Hope this helps a little :)

Donna

[P_RN, ADN, RN]

http://www.mrprotocols.com/sset/iv.html

This is a site aimed at MRI/CT techs BUT when you get about 1/3 down there a number of excellent pictures and instructions.

[Speculating]

I work MICU, with most patients grossly edematous, peripheral veins shot, and a central line. A nurse from the IV team told me these were the best patients to learn on. I think she meant because they are hard and most of them are gorked. But I need some confidence on the easy ones first! And if the patient is anything less than fully sedated, I feel like it's cruel to practice my IV technique on them when they already have a central line. The IV team is a great service but for nurses like me, who've never worked without one, it prevents you from ever developing the skill.

If there gorked then practice away. Quit finding crutches and learn how to stick. What's cruel is not to learn when you have the opportunity.

[apaisRN, RN, CRNA]

If there gorked then practice away. Quit finding crutches and learn how to stick. What's cruel is not to learn when you have the opportunity.

Mmmmm, thanks for the support.

[javanurse2000, BSN, RN]

Maybe the hospital would let her spend a few hours in outpatient surgery starting IV's with a preceptor.

Great idea!

[The Veridican]

I have a rep for being a good IV starter. It's not true. I have to stick twice about 50% of the time. But If I have the time, I always do the other nurses IVs that they never want to do, if they ask me to. So, they think I'm great and I get to practice on their pts.

The Veridican

[jayne109, RN]

When I started as a new grad, I didn't hit many IV's at all. Maybe 1 to 100. Then i did a rotation in our tiny ER (back at the old hospital) and the nurse's told me that I am allowed to go for the AC veins if I can't find anything else. Since then, I look low and then Go for the AC if nothing is found. My skills have grown tremendously in 2 years and I also found that praying before every stick and thanking God at the end of a successful stick helps me.

I learned the rule of get the flash, go 1 more mm with the needle then thread off. Works 95% of the time for me. My learning now is focusing on little kids. I work in a Level I ER now and so I am having to learn the in's and out's of sticking a kiddo.

[dianah, ASN]

I learned after working Radiology for many years, starting ALL the out-pt IVs for CT scans and IVPs -- sometimes 20-40 per day, all varieties of skin, all availabilities of veins (a lot of post-chemo pts for CT f/u = fragile veins).

Time and experience just doing it. It's sight and feel and intuition -- sometimes imaging in your mind just how far down you think the vein is, from palpating. Sometimes all you have to go for is the little blue line, not a big juicy one that pops up.

I always have trouble when I rush, too. Take your time, make yourself comfortable. I can't start 'em when I'm stretched out with my back hurting. The arm has to be stablized, too, for me. Not hanging in the air, it moves too much. I try to stack the deck in my favor. :)