IV insertion techniques!!

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    Hello everyone!!! I am a nursing student currently enrolled in my program's IV therapy class. I was just wondering if any of you experienced nurses out there can give some tips and trick for inserting an IV. We practice on each other, (OUCH!) and so far I have had one successful out of 4 attepmts. It is so frustrating not to be able to get the vein, or when it rolls, etc. I could use some great advice!!! What angle do you usually go in at? How do you put traction on the vein? Do you really feel or hear a pop when you get in?? Do you use one hand to thread the catheter in?? Any other tips or tricks would be greatly appreciated!!! Thanks in advance!!!

    Erika Ann
  2. 20 Comments so far...

  3. 1
    Have you gotten any feedback from your instructors? Hard to know what you are doing wrong without watching. When I started, I tended to go in at too high of an angle. You should be almost parallel with the skin, bevel up. I have never heard or felt a 'pop'. You are in the vein when you get blood return. It takes practice, and some people don't have a knack for it, and that's fine. Being a good nurse is more than being able to slap an IV in someone.

    I would talk to your instructor, get their take on what you are doing wrong.
    NewlyGradBSN likes this.
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    In my IV class my instructor told us it was like landing an airplane. Fly it in she'd say So in other words you start out at a higher angle and then lessen your angle once you are under the skin and in the vein. She would show us the arm/hand movement-lost here. :icon_roll She also said not to go too slow. It hurts more and I did notice that students had trouble if they were hesitant. We practiced on dummy arms first and then each other. When my fellow student started an IV on me one time I did hear the pop and so did she. I never heard the pop when I started them however.

    Do a search here. There was a great thread on this and some experienced nurses replied giving very detailed directions. Always meant to print that. Do you get to pick and choose your partner? Perhaps getting someone with veins that pop out? Our first one was just inserting a butterfly at the antecubital space. Cheating the instructor called it. But good to get our confidence up. One local college here does not even allow students to stick each other I think for insurance reasons. They have to start their first on a pt. in clinicals. :uhoh21: Can you imagine?

    Gosh can't wait to read the more experienced nurses replies. Good luck and keep sticking!
  5. 1
    Quote from Faeriewand
    One local college here does not even allow students to stick each other I think for insurance reasons. They have to start their first on a pt. in clinicals. :uhoh21: Can you imagine?
    Yep, I sure can. Our college was the same way. First real stick I did was on a pt in the ER with kidney stones. He was as tense as could be, jerked when I stuck him. I missed, and was crushed. After that, my momma (an LPN) brought all the IV stuff home with her, and I put an IV in her and my dad.
    NewlyGradBSN likes this.
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    We did not practice on eachother thank goodness! We went up to SDS in school and started IV's on pre-op pts. The OR director showed us how to do it and I know the one thing he told me was that I would go in at too much of an angle I needed to be more perpendicular w/ the vein. Also as someone mentioned above try to go in quickly it's the best chance of hitting those rolling veins. I have also found that you need to get yourself into a good comfortable position and have everything set up and ready to go. Also watching others and seeing their techniques or having someone explain it to you while you do it is helpful as well.
    I still have trouble to this day starting IV's. Some days are better than others, I have the most trouble getting 18's in. I do feel a pop when I get into the vein then the blood flows. I have had quite a bit of practice but some days I can't hit the broad side of a barn. We also use Lido to numb the vein up and that usually gives me trouble because it blocks my view of the vein, but we have to use per policy. The more you practice the more confident you will feel. Good luck hope it gets better for you.
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    'Pops' seem to be done, LOL. The old IV's (3 different brands) used to have that "pop" feel but since we switched to the safety needles we haven't felt it. We discussed that alot when we were making the switch... it was a big part of the learning curve. We trialed a few brands of safetys, too. For the life of me I don't know why it makes a difference but I haven't felt a pop for years.
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    I have no idea why, but at my school we were NOT allowed to start IV on each other or patients. The hospital where I work and as far as I know all the other hospitals in the surrounding areas do not let any one who is not licensed start IVs. So I was not able to start my 1st IV till I had RN behind my name.

    Lucky for me, the 1st patient I attempted was not only sedated but in restraints and he was 35, so he had nice healthy veins!!!! That boosted my confidence because I was able to start it!!

    I have no problem getting them started now, but I still make a bloody mess, because I am not too coordinated in getting the flush on there before a bunch of blood pours out, my mentor nurses tell me to apply firm pressure at the catheter site and elevate that arm at the same time. Getting better but I am still kind of fumbly.

    Since I am still new, and believe practice makes perfect, all the nurses I work with know if they have a new admit and or need another IV site started to call me. I am my own little "messy" IV team!!!
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    Quote from racing-mom4
    Lucky for me, the 1st patient I attempted was not only sedated but in restraints and he was 35, so he had nice healthy veins!!!! That boosted my confidence because I was able to start it!!
    My first IV was on a 19 year-old football player with mono...hardly needed a tourniquet, could see those veins from the doorway in the dark!
    We were not allowed to start IV's until training was completed (eg, at very least, as a grad nurse) but learned all the theory, etc. behind it. If you're lucky your site of employment has a clinical education coordinator that can provide a small inservice or education "refresher" periodically with dummy arms and pumps and all that fun stuff. Practice makes......well, it helps!
  10. 7
    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.
    Last edit by flightnurse2b on Mar 7, '08
  11. 0
    http://allnurses.com/forums/f205/any...es-127657.html

    This thread should give you much more info! Great info here and lots of great advice!


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