Trouble with starting IV's

[Katniss88]

I am in fourth semester and have had six attempts to start an IV, but I have yet to successfully start one. My first attempt was the only time I have come close, I got flashback so I was in the vein, but the catheter wouldn't advance, my instructor even tried to push the catheter in the vein and it wouldn't go. It was my first try so I didn't think much of it and I was really excited about it and couldn't wait for another attempt. But each attempt I get I find myself getting more and more disappointed in myself. This semester I had two attempts with one instructor and then I got two attempts with another. When I got a second attempt with each of those instructors and when I was unsuccessful I couldn't help but feel like I was letting them down, like you let me try a second time and I still can't get it. The last time the instructor even suggested practicing on the practice arms like we did learning the skill. I just don't feel that would help because they are nothing like a human arm. I don't need remediation because I know the skill, but I just can't get the needle in the vein. Each time, I get the needle next to the vein but when I try to stick the vein it moves away from the needle. I am probably the only student in my class that has had this many opportunities, but I still can't get it. I am so frustrated with myself.

[Lev, MSN, RN, NP]

I use two tourniquets. Let the arm drop so blood flows down. Apply heat if needed. Once you apply the tourniquet, palpate the radial pulse to make sure it is not obliterated. Practice on someone with good veins. Make sure you have good lighting. Take your time looking for veins. Feel them. Stabilize the vein. I feel it is easiest to stabilize only above the insertion sight. Don't ask me why. Have someone else hold it for you, if you want. Also, use the smallest possible needle, such as #22. If you have a needle with a butterfly, use it. I find they offer more control. Officially, you are supposed to pierce the skin next to the vein and then puncture the vein. I think it's easier to do it in one movement. Try a 30-40 degree angle at first. Go in slowly, until you get a flashback. Then, straighten the needle to about 10 degrees and push it in while advancing the catheter.

[charli_appleRN]

I've only had one try, too. I had to work backwards because I'm right-handed but I did get a flashback. Then my instructor told me to advance the needle. I advanced it a little and she said to keep going. I really didnt feel comfortable with that but I did anyway. Long story short, it didnt work and I've been thinking about how to do it differently ever since. She said I had a very good techique but the bottom line is my technique didnt work. I feel like I shouldnt have advanced the needle at all, just the cath. It seems like advancing the needle will puncture the vein. I'd appreciate any input from the pros............after the flashback, do I advance the cath or the needle?

[Sun0408, ASN, RN]

After the flashback you advance the needle just a bit further to get the cath in the vein, then you just advance the cath.. Open a new IV and look at the tip. The needle sticks out further than the cath, thats why you have to advance the needle just a little bit more to get the cath in the vein.. If you go too far you will go right through the vein.. It does take practice, getting flashback is a good start :)

[Sand_Dollar, BSN]

The IV arms we get to use in school are a joke! I wanted an arm that belonged to a dehydrated 80 yo with tiny veins rather than the one that looked like it belonged to a body builder - a blind person could poke that vein!

I work in the pre-op as a student and get to do IVs pretty regularly. There is definitely an art to it! Here are a couple of things I have gleaned from watching the pros and doing my own:

• always use a chux pad underneath your work area (better to not need it, than make a mess....trust me on this! lol)
  
• Quite often you have two limbs available, don't forget to check the other it might be better
  
• After you put on the tourniquet let the arm hang, it may help bring them up
  
• If you see some potential veins, smack them lightly...it helps bring them up
  
• I hear warmth helps, but I have never had to do this, doesn't hurt to try
  
• Use your fingers, not just your eyes. Feel for the rebound
  
• When inserting the needle, go low. You aren't giving a subQ injection, pretend you're landing an airplane
  
• If I'm doing one on the hand I pull it downward, if in the arm I pull the skin toward the hand and press down to help stabilize the vein
  
• Feel for valves...the little bumps in a vein, insert after these
  
• If you hit a value and the catheter doesn't want to go in easy, you can hook up the fluid and open the value then insert all the way (I haven't gotten this good yet)
  
• relax! Either raise the bed or sit down to do the poke
  
• Remember, even the veterans miss IV sticks on occasion, there will be more opportunities
  

I hope you find one or two of these tips useful. I still get nervous starting IVs, but if I miss I try not to worry, after all it's a learning opportunity.

[KJM-RN, BSN]

If this makes any of you feel any better... I live in NY, where students are not allowed to start IV's until we graduate, same goes for drawing blood from a patient or giving an IV push med.

[Katniss88]

If this makes any of you feel any better... I live in NY, where students are not allowed to start IV's until we graduate, same goes for drawing blood from a patient or giving an IV push med.

Well, I shouldn't be complaining then. That doesn't seem fair, after all clinicals are meant to give you experience and opportunities to practice the skills you have learned. It's not like your doing it by yourself, we have to have an instructor present when doing IV sticks or an IV push.

[NICU:)]

I had my clinical today! I was only able to start one, as the rest of the patients were not comfortable with a student. I did get the vein the first time. But something that the nurse taught me was a "scoop" technique. You go in and then scoop back to the skin, kind of like a spoon. This helps to make sure that you do not go all the way through the vein. Idk if this helps you as much as it did me, but I thought I would share!

[Tarabara]

Just a few tips:

In school I was taught to anchor below the vein and go at an angle, I always failed that way. I find it much better to anchor above the vein and go at a very shallow angle.

Make sure once you get a flash do not let go of your anchor! Hold your anchor while you advance the needle and catheter.

If the vein moves after you puncture, its ok. If you can feel that you're right next to the vein just pull back slightly (but not completely out of the skin) move over a bit and advance again. I know that I personally hated the idea of "fishing" around with the needle when I was a student. But you're not doing it blindly, I only do it when I can feel that i'm right next to the vein and only need to move slightly.

Take your time finding veins. I will sometimes feel arms for 20 min trying to find the best vein that I am most comfortable with. I would rather take extra long feeling than poke several times. And as much as I hated hearing this as a student, its true that you really have to get used to the feel of veins instead of sight. Feel your friends and families veins all the time. The best ones are usually felt not seen.