IV starts in the oncology setting

  1. I have worked in oncology for a number of years, but most recently have had to learn how to initiate IVs in an ambulatory setting for chemotherapy.
    I am finding this challenging at the best of times. Any skill suggestions or reading material would be helpful.
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  2. 1 Comments

  3. by   MollyJ
    Greetings: I never worked oncology but was an ED nurse with decent but not spectacular IV skills; some people just really have a touch. I, like most RN's, had the "magic touch" some days; others not. My personal rules were:
    Know your limits. My general rules were no more than 2 to 3 sticks on an individual and I might limit myself to one or no tries if I thought they just couldn't afford the veins and I wasn't having a good day.
    Set yourself up for success. Use well fitting gloves (snug but not too tight) so you can feel what you are doing. DO NOT even try to use gloves that fit you like the lady in the lunch line at school that handed out bread. Implore beg etc your employer to get you appropriately sized gloves.
    If your clients can afford (no fluid restriction) and tolerate the fluid, encourage them to drink "two big glasses of fluid" before they come in for IV therapy. A well hydrated client is easier to stick.
    Take the time to warm your clients extremities with heating lamps or warm moist packs, being careful not to burn them. This ten minute maneuver can be very worth it.
    Take a leaf from Red Cross donation nurses. They select their venipuncture site and mark it with a pen and then prep the site using betadine, which can change the appearnce of the landscape.
    Make sure you are in a comfortable position when you do the stick so you can be relaxed.
    Note your tourniquet technique. Too tight can cause fragile veins to blow so sometimes less is more. Experiment with tourniquets; my favorite was still the old-fashioned penrose drain.
    Listen to clients when they tell you that that little vein over their thumb knuckle is the best one.
    Their may come a time when their peripheral veins are so tortured by chemo and antibiotics that it becomes time to advocate for a central line with the doc in the appropriate way.
    Good luck. Putting your time in will enhance your skills.

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