HOW TO PUT IN A IV: ANY TIPS

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    I have just started my orientation on a telemetry unit, and have just been taught to put in IV's, sometimes I get it and sometimes I dont. How long does it take to be successful. I know that we all have times when we can't do it, but I want to be 80% successul. Any tips and ideas about the best way to do it would be most welcome, thanks Emma...........
  2. 51 Comments so far...

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    I find that I have the best luck if I heat up the arm with either a heating pack or other warm towels etc... I also use lidocaine so that I can fish around a little without causing additional pain to my patient. Good luckand keep practicing!
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    Hi egmillard. Best wishes on your training. As profjan indicated, it will take practice for you to reach your goals. I once took a phlebotomy class for simulated practice. I had also offered to start IVs as often as I could when I was employed with a hospital that did not have an IV team. You will want to check with your hospital or unit policy or your preceptor on what supplies or meds you can use to start an IV. Some hospitals require a person to contact the doctor for use of even a small amount of Lidocaine if it's not included in standing orders. Facilities may limit you in this area due to cost consideration.
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    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.
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    Everything tha everyone has said are good tricks. I used to be horrible at inserting IVs when I first started. Now, I am confident and usually get them on the first try. One little piece of advice I have i got from an anesthesiologist. He advocates approching the vein from the side. This way if it rolls away from you you know where it is in relation to your catheter. Hope this helps. Just keep plugging along..practice really is the key.
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    Holly and other experts!!

    I had to reply when I saw this post. I am a hideous sticker!! I've attempted maybe 10 so far in my new vocation, and the only two I've got in were veins that a garden hose would go in.

    What I really want to know is angle- what angle is best? In my cert. class, we were taught to go low and slow. I seem to ride the top of the vein each time I do this, causing me to have to 'fish' and this is so painful for the patient. Then, if I go at a 45, I poke through everytime. Also, patients with tough skin pose even more of a problem for me. Any hints on softening it up?

    Also, when you steady the vein and hold it taught, are you using your thumb directly over the vein or pulling from the side?

    I dread starting IVs but know that it's a skill I need to master and the sooner the better.

    keep the tips coming, folks.
    Thanks!
    Julie
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    Get yourself in a comfortable position i.e. pull up a chair at the pt's bedside, elevate the bed so that it is at your elbow level. Close the door and concentrate on what you have to do, don't let anything distract you (yea, I know it can be hard but do it !). If it's an elderly pt with fragile veins try not to use a tourniquet, instead stretch and hold the skin over the vein with your non-dominant hand. For those hard to find veins wrap a warm towel around the extremity for a few minutes.
    Choose your vein carefully. It should be one that is visible, straight, large and ideally one that will be able to tolerate and maintain a line. For veinipunctures on those elderly fragile/tissue paper thin skinned pts, to prevent eckymosis and hematomas: Immediately after removing the needle, apply pressure and elevate the arm so that the hand is above their heads, hold in that position for 2-3 minutes. That always worked for me and I loved hearing from my pts': "So and so always gives me bruises but with you that never happens"
    OLD ONC nurse here!
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    A lot of it is confidence. I've been a R.N. for 5 years, and I'm finally getting I.V. starts nearly everytime.

    What helped me, is moving the bed up to me. And making sure the rooms quiet. And I learned it often takes a while to find a good vein, especially in the elderly or very ill patients. Take your time! Good luck!
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    Originally posted by egmillard:
    I have just started my orientation on a telemetry unit, and have just been taught to put in IV's, sometimes I get it and sometimes I dont. How long does it take to be successful. I know that we all have times when we can't do it, but I want to be 80% successul. Any tips and ideas about the best way to do it would be most welcome, thanks Emma...........
    Emma,
    Time, practice and patience will do it. My two biggest suggestions: 1) Try everyone, no matter how difficult...2)The tourniquet does NOT need to be stretched its entire length before application..You are trying to compress superficial veins...Having it very tight does NOT make a difference. Re. suggestion 1, my preceptor told me 14 years ago when I started that if I learn to start babies and the very old, I could start anyone...And how right he was...
    Good luck
    Ted
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    I agre with everyone above, especially the pull up a chair part and confidence. One thing I did early one was to evaluate all the veins, because some days there are no veins you can visualize- you gotta go on feel- on that note, Julie, about the angle. It really depends on what I want to hit. If I am doing a cath in the hadna dn the vein is sort of "shallow"- visible, etc, I go at a pretty low angle, but when I move up into the brachial area (I know a bad spot, but on my paralyzed/sedated patients, it is a good spot comfared to the foot). The veins may be a little "deeper" and so I do go in at maybe a 45 degree angle, pierce the skin, and sort of dip back down to a 30-35 angle, at least thats what it seemed like to me.
    Use the warm towel to soften up the skin.
    And I will admit to this, and then "dont try it at home. If I have a really rolly vein, I will sometimes pull the skin down with my thumb on my left hand and put my left index finger up alongside the vein, using my right hand on the other side to place the catheter...in effect squeezing the roller between the two. This is risky in that if the pt moves, you could potentially jab yourself with a very contaminated hollow bore needle, so while thats what I do, it is surely pretty stupid when I think on it! Now, the ng tube? WHy is it that everyone else can pop them in and mine just crul right up? and why is it when I put in the nasal trumpet I feel as if I am cramminghte thing into the pt's brain (it always goes in, but....
    Thanks everyone, these tips are great.


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