HOW TO PUT IN A IV: ANY TIPS

janine3&5 · Sep 5, 2001

BP cuffs are a great tip, esp with the older pts.

They never told us this in school, but if you get a good flashback, but can't advance the catheter, try floating it in with your saline. Sometimes the catheter will get stuck up against a valve, and the flush will push it out of your way.

And if your pt tells you they're a hard stick, that nurses can never find their veins, ask them where they are usually able to get the IV. I've been surprised at the number of times a pt can say, "oh they usually go right here or have better luck in this arm, etc." And they're right.

Practice, practice, practice!

P_RN, ADN, RN · Sep 5, 2001

I see this topic is fairly old, but it's a goodie. First advice..just do it....2nd advice Always use a #20.

I haven't seen it mentioned, but I'd bet most if not all of us here notice other folks "great veins" while standing in lines, riding the elevator or going out to supper. I know my husband HATES when I casually palpate his hand....subconsciously even now.

While you ar watchingtv notice your own veins and how they feel.

Next time you have your blood drawn watch and see if you can pick out when the needle hits home.

And NEVER use a tourniquet on those old ladies with the tissuepaper skin. You can usually get them using the finger stop method mentioned earlier.

I'm a pretty good sticker, only because I never let a stick go undone. It takes awhile but once you figure our how it's supposed to feel....you have got it!!

PS as a dear head nurse told me....."I'm never be too proud to get down on your knees and ask for help from above. Oh and always use a 20"

egmillard · Sep 5, 2001

Yeah, I look at peoples veins all the time, funny how we do that.............

denikarn · Sep 5, 2001

Originally posted by hollykate
Hi there,
Starting IV's is the one thing I CAN do as a new grad. By now, even some of the more experienced RN's come get me when they can't get anything. The way I learned was by working in an emergency veterinary clinic for years. I was initially a very bad stick, but got to where I could put an IV in a 16 yr old dehydrated cat. The point here is to practice, a lot. Let people know you want to start their IV's, the more times you do it, the better you will get, but there will always be those days when you hand acts like 5 thumbs... I think just doing it over and over is the key. If you want to numb the skin up some and you cant use emla or lidocaine, try using some ice for a few minutes if the vein is good. I don't actually do that, but I have seen it done iwth good results. If the vein is not so hot, avoid the ice, as it may cause the vein to shrink up to nothing. Now, you know, I feel a little ocncieted posting about how I can start IV's. I'll admit, I have the worst trouble with NG tubes, even on unconcious non-objecting pts, the tube still comes out the mouth, curls up or does strange knots...I'm still practicing that one, and I'll bet you're great with those (any hints?)! Good Luck.

denikarn · Sep 5, 2001

As far as Nasogastric tubes go I do pretty well with them. I always elevate the head of the bed for all patients, 90 degrees if possible, flex the neck forward, go slow, try and advance when pt swallows and it should go in fairly easily. I don't think everyone flexes the neck but I find that it makes things easier. Our Nurse Manager Neurosurgery taught me that and she could get an NG IN ANYBODY! I just put one in a trached patient the other day. Some nurses like to put the NG TUBE IN THE FREEZER prior to insertion but I never do. Hope this helps you...

mary-grace · Sep 5, 2001

I have been starting Ivs for a long time. Find the vein you want first, before you put a torniquet on, alot of cases dont even need a torniquet. Take a big deep breath and blow it out and say to yourself I can do this. You'll be surprised what having confidence in yourself will do for you. Always choose a Iv needle,cathlon to fit the vein. I prefer a 20 ga myself, cause it's usually small enough for most veins and is large enough to draw blood through if you have to and to give blood through if you have to although, and 18 is preferred for blood. There is no need to hurt your patient by putting in a nail when a tack will do the job. Lots of hospitals dont allow the use of lidocaine as a pre anesthetic for nurses anymore but you can use sterile water for injection. It works. I've had it used on myself. Keep telling yourself you can do it and you will become a great starter of IVs.

rowbucks · Sep 5, 2001

The best advice i was given when i first started iv's was, if you can't find a vein with a tourniquet, use a blood pressure cuff. pump it up and leave it at 70 or 80. works every time.:)

Over-the-hill-Nurse · Sep 6, 2001

Inserting IV's can be tricking. I have used all of the methods used here. First you need to be comfortable with your self, the patient comfortable, let him/her know what you are going to do and I also raise the bed or sit in a chair if it is not possible to raise the bed up. When I first started in nursing, I started in peds. Learning to do IV's on the infants was definately a challenge! One of the things that the hospital where I work does is have the new orientee spend a day in same day surgery doing nothing but starting IV's. This was a big help. It may be a suggestion you can mention to your DON or Head/Charge Nurse who ever is in charge of your floor. NG tubes I also raise the patient in a sitting position, have them flex their head and also give them a drink while putting the NG tube in. This gives them something to focus on when I have them swallow, swallow, swallow... ( I have them drink from a straw) I haven't missed an NG tube yet. But before I do any of that, I try to allay any fear the patient may have by explaining the entire procedure on what I am going to do and ask them for their assistance and what they can do to help facilitate the procedure. I have had a NG tube myself and when mine was put in, it took more than 2 trys. Believe me, I learned first hand how hard it is when the patient doesn't know what to expect and how they can help you. Good Luck in your IV and NG skills... and practice...practice...practice... is the best teacher in knowing what suits you best in putting IV's in.....

Huganurse · Sep 6, 2001

I just had to add my two cents to this thread! The previous posters have already given all my tips except for this one: Always have the patient look away before the stick. I tell them what I am doing but ask them to look away.

icombs · Sep 10, 2001

No one is born knowing how to start IV's, lucky for me I was a paramedic prior to becoming a nurse so I got plenty of practice. Besides practice, a rule of thumb ; tight constricition, and if you got to see and feel it ..thats number one, second if its a rolly- vein start at the side rather than the top of the vein, with your thumb pull the vein tight and if it moves when u penetrate, just slowly chase it until it can't go any where. I start IVs in an Outpatient Oncology treatment center, so having a good IV is important. About pain we use EMLA cream which is a topical anesthetic(did I spell that right?) :confused:

. Smaller sometimes is not better

sometimes u need a bigger cath, dont wimp out and start a 24g that is going to clot or kink.. on average you want at least a 20g for blood products. The person that said numb the skin incase you have to hunt (ouch)..Heat packs make the veins stand up...My motto "If you cant' see it or feel it, wait unitl u see it or feel it:o GOOD LUCK remeber Practice, practice practice

KC CHICK · Sep 10, 2001

if i've learned anything, it's don't listen to anyone else!!!!

everytime i ever had an instructor "assist" me with an iv start, they'd say "ok, you're in...thread it!" i was never in and it never threaded.

recently even had an anesthesiologist try to "help". couldn't get it w/his assistance but got it in as soon as he left the room.

(oh yeah, i work w/ the unconscious....that helps too. )

sgtmedic · Sep 18, 2001

Hey,

Liked the responses to putting in an IV. I know when I went to school our training was terrible. I'm also a medic in the National guard. We put IV's in all the time in some of the best of conditions. My latest accomplishments being in the back of a four wheel drive Hummvee ambulance on a gravel road at 25 miles an hour with dim lights. First time, should've seen the guy's eyes when I did it. Personally, I like to go straight on top at a 30 degree angle while holding the skin and vein tight with my thumb. when I get a flash I drop to a 15 degree angle and advance the length of the needle that projects from the catheter. Works most of the time even on the hard liver patients. Hope it helps.

D.