when i learned how to start IV's in paramedic school, i couldn't hit the broad side of a barn, and being left handed didnt help. the best way to be an awesome IV starter is to have your own technique (its just like an art form, i think) and lots of practice of different kinds of patients. now i am the go-to person when anesthesia cannot get an IV and am super awesome at them.
here are some tips to keep in mind:
1. BE CONFIDENT. if you walk over to the patient and you have sweat on your hands already, they are going to be anxious. anxiety makes veins disappear. and your own nervousness will cause your hand to be less steady, making it more difficult to get an IV in. if you act like you know what you are doing, no one is going to know its your first IV but you, and that will put the pt at ease greatly.
2. have everything ready. fumbling for tape when you are trying to secure a catheter is not easy. have your skin prep open, your tegaderm and/or tape ready, and your J-loop or port already primed.
3. take your time scoping out veins. dont go for the ones you can see right on the surface all the time. those are the rollers. feel for that nice, fluffy, spongy vein that is nice and strong. check both arms. sometimes tying the tourniquet lower and/or lowering the arm will help you find a hand/wrist vein better. you can even keep the tourniquet tied while you prep your stuff to get the blood pooling better. what i used to do when i was still learning was close my eyes and feel for the spongy vein. relying on your touch is actually much more reliable than sight in starting IV's sometimes. also, dont be afraid to go for a vein in a weird place. if you cant feel an anything anywhere else, but can feel a big squishy one in the thumb, go for it!
4. for pts with very small veins, warm their arms up! you can rub them with your hands, put a warm towel or compress, or (i know this is a no-no) put a tiny tiny little dab of Nitro-bid where you feel a vein and it will puff it up really nice. also, dont slap people. again, the anxiety thing. the best way to to dilate the vein is to thump it gently and rub in the direction of the vein. that way you can also scope it out for valves, improve the flow and not freak the patient out by getting their arm whacked. and sometimes, a BP cuff works better than a tournquet.
5. ANCHOR! anchor, anchor and anchor! pull that vein as tight as you can when you select your site and straighten it out. my technique, which may not work for everyone, is to anchor the vein until i almost cant see it anymore, and go almost flat on the pts skin at an angle, and then catch the vein and straighten it out.
6. dont go fishing or diving. if you dont get a flash back, you make be in over the vein, under the vein, or out the side of the vein. if you pull back and redirect the needle and still cannot get a flash, you are probably not where you need to be, and the patient is probably starting to have alot of discomfort.
7. one you insert the needle and get a nice flash of blood in the IV hub, gently flick the catheter as you are retracting the needle and flush the catheter into the vein. if your flow of blood stops when the needle is retracted, gently pull back on the IV catheter, and if the blood begins to flow, flush the catheter in while carefully observing for infiltration.
8. distraction is great tool for squirmy patients. engage them in conversation or give them a focal point on the wall or TV.
9. remember everyone has days where we couldnt hit the broad side of a barn, and thats ok. being good at IV's is fun, but doesnt make you the best nurse in the world. its OK to ask for help. if you stick once or twice and cant get it, ask a senior nurse and observe her technique. know your limits. if right off the bat, you cant find anything, ask for help. remember the pt doesnt want to be a pin cushion as much as you want to get an IV in them.
10. PRACTICE! spend the day in the ER, outpt or same day, or on a floor where you know there are a ton of IV sticks to be had. watch different people and their techqniues, and then work on your own. once you start a bunch of IV's, you will get better with each stick and more confident in your skills and development of your own successful technique.
thats all i can think of for now. good luck!!!
ETA: i thought of another tip for you. this is one i still use if its a very deep vein or a pedi patient. once you locate your vein, anchor it and palpate again. then, take the your pen, clean the tip with alcohol and just make a small indent with it (dont click the writing part out and draw on them) so you have a little circle left on the arm. that should be your point of insertion.