I need HELP!! with IV starts

Specialties Infusion

Published

I find that IV starts are the most frustrating thing that I've ever had to do in nursing, perhaps the most frustrating thing I've ever had to do in my life. I could be, and very likely am, the worst of the worst, the baddest of the bad, at doing IV starts.

You could give me a juicy vein and I could miss it or blow it. You could give me the most cooperative patients, the best lighting, the narrowest needle and a bedside coach and I could still manage to screw it up.

I know basically what I'm supposed to do, and the procedure to do it and well, I could explain it to someone else so that they could give it a try, but hell could freeze over before I could get an IV start.

On the bright side, I'm really good at keeping IV sites. I watch that tubing like a hawk and snatch it up before it snags. I've contorted my patients into pretzels just to keep the lines flowing.

I know it's probably already been discussed ad nauseum, but could anyone help me out? What I need is a straight forward approach, that not only sounds good, but actually works. I mean I'm getting nada here.

Well, hmm... It's not really up to me how long I spend in day surgery pre-op, but the institution itself. I asked for the extra 4 hours - I guess 4 hours is all they give most. And sadly, no, IV nurses have been eliminated right across the province, leaving us to do our own IVs or beg the emerg. nurses for help. Hmmm... maybe they could be bribed... although really, I should try to do my own starts, I just wish I had some idea of what I'm doing wrong - I wish it were a more straightforward skill.

My favourite position for IV starts :) -----> :chair:

It is a straightforward skill. Has someone been directly with you, or have they left you to your own to learn how. Sounds like you need someone at the bedside actually talking you thru the process. This is what I used to do when training other nurses, as well as physicians. It is not see one, do one. There is a knack that needs to be learned, and it is easier if you are directly one on one with someone for a few hours.

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It just takes time and lots & lots of practice. I was also one who believed she was bad at IV's... and now I'm an IV nurse. Some advice - confidence - it's easy to believe that you will again not get the IV, but try to believe instead that you will. Go slow, when you get a little flash, wait for a second and make sure that your chamber continues to fill, then lower your angle, slowly advance a little more and gently side your catheter into the vein. If you meet resistance when you try to advance the catheter, STOP! Wait for 10 seconds or so and try again. Veins spasm when they are poked (go figure!) and you have to sometimes let that pass before you can thread a catheter. My other advice is try to use hand veins if they are large and straight. Even though you sometimes see those big ropy arm veins that tempt you, they tend to roll and get away.

If you are friends with a nurse that is good at IV's maybe you could practice a couple on them and get direct feedback. I would let someone do that on me!

Don't give up!!

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Specializes in Emergency.

I'm an ED nurse and have to do alot of IV starts. Looking back, it seems like success depends on three factors. First, there is technique. I'd guess that yours is pretty good, from all the coaching you've gotten. Still, is there one step that you have trouble with? Finding a vein? Getting a flash? Advancing the cath? If there's one step that's the problem, you can focus on that one. If its all the steps, then the issue might be the second factor - Mental. I know its impossible to instantly start believing you can do it. However, if you go in thinking you'll fail, you will. The way out of this dilemma is to learn to "take a deep breath". When you start getting nervous, take a deep breath and blow out everything so that you are concentrating on only one thing - this start. Like the previous writer said, visualize succeeding. Then there's the third factor - Luck. There will be days when you just can't miss. You'll be sliding catheters into tiny, tiny veins like they are garden hoses. Then there will be times when you can't hit the side of a building. It won't be your fault. It won't be the patient's fault. You just missed. Happens to us all. Take a deep breath. Reset your gear and either you or another nurse do it again. .... I know its hard, but you'll get it.

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I'm an ED nurse and have to do alot of IV starts. Looking back, it seems like success depends on three factors. First, there is technique. I'd guess that yours is pretty good, from all the coaching you've gotten. Still, is there one step that you have trouble with? Finding a vein? Getting a flash? Advancing the cath? If there's one step that's the problem, you can focus on that one. If its all the steps, then the issue might be the second factor - Mental. I know its impossible to instantly start believing you can do it. However, if you go in thinking you'll fail, you will. The way out of this dilemma is to learn to "take a deep breath". When you start getting nervous, take a deep breath and blow out everything so that you are concentrating on only one thing - this start. Like the previous writer said, visualize succeeding. Then there's the third factor - Luck. There will be days when you just can't miss. You'll be sliding catheters into tiny, tiny veins like they are garden hoses. Then there will be times when you can't hit the side of a building. It won't be your fault. It won't be the patient's fault. You just missed. Happens to us all. Take a deep breath. Reset your gear and either you or another nurse do it again. .... I know its hard, but you'll get it.

Thanks! You've all been very supportive... almost nurse-like :). I still don't know what I'm doing wrong, but I just have to keep at it I guess. The deep breath thing is a good idea. I think I probably subconsciously hold my breath while making the attempt.

I really don't get the sense that it's a straightforward skill though, if it was, you wouldn't find 10 people each with their own style of doing it and, you could follow a step by step process that either always worked or worked at least most of the time - so no, I don't see IVs as being straightforward. Nonetheless, I just have to keep trying.

Sometimes I get flashback and screw it up - too far? Other times I must miss completely - no flashback. I do find it distressing though, and it's difficult to remain confident after 3 or 4 failures in a row and just keep going. I feel bad for the patient and I feel like an idiot who should have studied harder - when in fact, if I studied the process any more, I'd need bifocal lenses. So it's not a good feeling.

It should really be a part of the basic nursing program in my view. Anyway, when I do figure it out, I'll post all the specifics I can for the other poor sods out there who were thrown to the wolves with IVs and try to identify as much as possible, what I was doing wrong, so that someone else can have a better time of it than I've had.:roll

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One more thing... on our IV team we have a policy: 2 sticks per nurse. After 2 sticks with no luck you're going to start to have confidence issues, no matter how good you are, and the patient will too. I just say "2 pokes is my limit, your veins are tougher than me! I'm going to have another nurse come and see you though!" The patients seem to appreciate it.

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Specializes in Everything.

Hi Jasano

Wow it sounded like me many years ago, now I'm a resourse and teaching link in IV work insertion and development. Reading the posts it sounds like you know the rountine down pack but need to work on the practical side. Which part do you find you have more trouble with,going through the vein more often and blow it that way, or is it getting the flash back let me know so I might be able to help more, don't worry some people pick it up very quickly others take more time. In the mean time if you can get some cannulas from work (clean ones of course) if your boss is ok with that, then go to the local butcher and get a nice cut of red meat with lots of juicey veins/arteries and play, get to feel the way the needle works as it moves through the different layers, and stuff it up on purpose from time to time and talk your way through it, people my think you strange but it helps. Oh if you are not into red meat, see if your work educator has a practise arm to play with (the rubber kind). Last thing start with the smaller cannulas on the biggest veins first sounds simple but not everyone follows that, and go for what you feel not what you see..... hope this helps alittle

Knightlycomic RCpN, BA (Adv Nursing Practice), ENB 100, ENB998 Blah Blah Blah Blah and all that stuff.

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Specializes in NICU,ICU,PACU,IV Therapy.

All I can say is PRACTICE, PRACTICE, PRACTICE!!!

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i was there. then i was sent to endoscopy for a day to start i.v.'s there. then they sent me to every room to start a new iv or site change. i was petrified to start an i.v. but they wouldn't let me run away and hide. as much as i wanted to, they caught me and threw me into the room that needed the i.v. started.

now, a year later, i can start my own, and start anyone else's. i also go to other floors to start the difficult i.v.'s hang in there. you'll get it. i think it's the experience. you just have to get experience.

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Hi Jasano

Wow it sounded like me many years ago, now I'm a resourse and teaching link in IV work insertion and development. Reading the posts it sounds like you know the rountine down pack but need to work on the practical side. Which part do you find you have more trouble with,going through the vein more often and blow it that way, or is it getting the flash back let me know so I might be able to help more, don't worry some people pick it up very quickly others take more time. In the mean time if you can get some cannulas from work (clean ones of course) if your boss is ok with that, then go to the local butcher and get a nice cut of red meat with lots of juicey veins/arteries and play, get to feel the way the needle works as it moves through the different layers, and stuff it up on purpose from time to time and talk your way through it, people my think you strange but it helps. Oh if you are not into red meat, see if your work educator has a practise arm to play with (the rubber kind). Last thing start with the smaller cannulas on the biggest veins first sounds simple but not everyone follows that, and go for what you feel not what you see..... hope this helps alittle

Knightlycomic RCpN, BA (Adv Nursing Practice), ENB 100, ENB998 Blah Blah Blah Blah and all that stuff.

Wow, you really are sick :) Are you single perchance? LOL. Anyway, I will maybe give that red meat idea a try, although explaining what I need to the butcher may cause some hard looks.

I sometimes just feel that more practice isn't really going to help me unless I have someone explaining what I'm doing wrong while I'm screwing it up. Since I'm never successful at getting an IV, I really don't feel that I'm learning anything, and of course it's extremely frustrating, for both my patient and myself. More often when someone needs an IV, I try to hide in a corner somewhere, which is admittedly quite difficult when you're a male nurse of 6'2 in height.

I'm hoping to find a course in IV therapy initiation here in Ontario, but finding one has not been easy - such courses/workshops seem to be on a province-wide "discontinue" list. This of course just adds to the frustration, because I was never taught IV therapy as part of my Nursing Degree. I'm pretty sure that I'm not an idiot and that if I did have a coach at my side while doing IVs, that I would pick it up much more quickly.

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Wow, you really are sick :) Are you single perchance? LOL. Anyway, I will maybe give that red meat idea a try, although explaining what I need to the butcher may cause some hard looks.

This of course just adds to the frustration, because I was never taught IV therapy as part of my Nursing Degree. I'm pretty sure that I'm not an idiot and that if I did have a coach at my side while doing IVs, that I would pick it up much more quickly.

Ok, I'll join you in the whining.

I recently started working med-srug as a new grad and I stink at IVs. I tell the other nurses to let me know when they have a stick, so I can get as much practice as I can. (Though I do feel uncomfortable "practicing" on pts who are A/O and see and feel everything...) More often than not I miss the vein. Funny thing is I've been more successful with little old ladies than with the big young guys!

My only encouragement to keep practicing is that last week another nurse tried twice to get an IV on her pt and missed. Then the resident tried and missed, claiming the lady was too much of a hard stick. So she came and asked other experienced nurses if they were willing to try and help her. I volunteered to try just to get the experience but my success rate is more of a failure than a success! When I got flashback, advanced, and then flushed easily, I had the biggest smile in the entire world. It was what I call beginners luck! =)

Just today I came in the AM and saw my pt's IV was infiltrated. Since he had no impt fluids to run, I figured I'd finish passing everyone else's meds and then I'd go into his room calm and relaxed and try my best. Lucky for me (or maybe not so lucky), before I had a chance to try sticking him, transport came to take him for an endoscopy. He came back up to the floor with a brand new functioning heplock. =) So there went my chance to practice an IV today.

Oh well, I'm looking forward to the time when I can just go in and do it!

Hang in there Jasano, we'll get there one day...

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Specializes in Emergency, Family Practice, Occ. Health.

Here's my suggestion:

Go to the nearest ambulance station and ask them if they can let you use their practice arm. This way you can start 20 of them in a half of an hour and nobody will say "ow". The Paramedics will me more than happy to let you practice and will probably be able to critique your technique. Be sure to tell them you are a nurse. Paramedics as a group tend to love thinking they have something to show a nurse. They will be very nice to you and may even offer up their own arms for you to practice on.

Each IV is a new experience. We all have days when we suck at them, don't let this define you "Good morning Mr. Smith, I'm the nurse that will put an 18 gauge hole in your arm before I get another nurse to fix this for you."

You will get good at this, just keep at it.

Good Luck!!

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I took an all day course in starting iv's. It was a great class and helped me alot. I think the company is called "Peripheral Vascular Nurses" or something like that. It is owned and the class is taught by the RN that founded the company. I think they are located in PA. I took the class in Hagerstown, MD. Practice and technique. You will get it, I'm sure.

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