Really bad at Starting IVs

barefootlady, ADN, RN · Feb 9, 2008

If a day with the IV team is not available, then shadow the best IV nurse on your floor. Ask that nurse what they do to make it easier for themselves and the patient. In the end, practice is what counts. So practice and do not feel so badly when you miss one stick or even 6 sticks. After all of these years, I still have bad days and miss a stick. Keep a positive attitude, you will get there.

Lady_Bing · Feb 9, 2008

To update everyone who has been so helpful and encouraging :)

I am slowly getting better with practice. Yesterday another nurse had a patient who had really bad veins, she asked a senior nurse whom I was following to help her out. The senior nurse grabbed me and we looked together for veins, when we found a good one, she said - go ahead, you can't do it and I did it :) Thank you all once again for the positive feedback.

Daytonite, BSN, RN · Feb 10, 2008

lady_bing. . .it took me years to become an expert at ivs and i was nationally certified in it with the intravenous nurses society! this is a very delicate skill that takes time to learn. it will take you many, many iv starts over a long period of time to become proficient in this skill. the reason is because patient's veins and anatomy come in all shapes and sizes. you just have to be patient and practice, practice, practice.

hajer · Feb 10, 2008

am still resident in ccu & am feeling very shame of my self cose am alwayse asked my frinds to do iv insted of me.....thats realy bad feeling to have when all people around u know what to do while u still learn & seak help

barefootlady, ADN, RN · Feb 10, 2008

Hajer,

Read the posts, you will see that no one learns without practice. So get the mind set to start practicing the skills you need. I am sure you will do a good job. Good luck.

medsurgrnco, BSN, RN · Feb 14, 2008

Figure out which type of IV catheters work best for you and stay with that style when possible. Don't attempt to start an IV when feeling rushed. Get prepared before going into the room - use the restroom and then get supplies. I always take in 1-2 #20's and 2 #22's, several NS syringes, tape, 2x2's, alcohol pads, chloroprep cleansers, etc. Keep the extra catheters hidden in your pocket so the patient doesn't think you are going to have to stick them several times to get an IV in. Get everything ready while talking to the patient to put them at ease. Turn all the lights on so that is it easier to see viens. Ask the patient if they have a preference for which arm, and tell them you will look there first but may have to use the other arm if that's the best bet for getting an IV in.

Start keeping track of your success rate and vow to increase it. Don't have preconceived notions of which arm or vien to use. Look for whatever pops up or is clearly visible. Don't attempt an IV start in an iffy vien - look around all over on both arms if needed, from the fingers to the upper arm. Moving the tourniquet lower on the arm often helps viens pop up more. Having the patient dangle the arm, and squeeze the fist also helps. Another technique is gently tapping on the vien, and stroking back and forth with the alcohol pad. For patients with rolling, ropey viens, I find the upper arm or upper forearm are the best places to start an IV. If you miss on the first try, take your time looking for a better vien and use a #22. When you get blood return, advance the needle only slightly to decrease the likelihood of blowing the vien.

Getting good at IVs takes experience, as well as learning tricks to find the best viens to use and for dealing with hard stick patients. There's a lot of other good information on starting IVs on other threads. Do a search on "IV Tips Tricks". You also might want to look at a color chart of hand/arm viens to have a better idea of where to look for viens.

bluefabian · Mar 2, 2008

Working in ER gave me lots of experience in starting IVs. Like it or not, doctors present or not, I just have to do it. Understaffed most of the time, either me or the other nurse.

My experience: pop (what a word) the vein just far enough to penetrate it. Do not advance further with the (metal) needle still sticking in. Withdraw the needle part bit by bit until you are confident that the plastic part will hold it strong enough to be inserted fully inside. Withdrawing too much will cause it to flex while going deeper in with the needle still in will blow it through.

Do not assume a straight, bulging vein will be easy to cannulate. Best to stretch the skin to ensure really straight line.

Always use tornique. The blood pool will be there and your vein will be distended. Easier to poke that way.

My experience in dialysis has proved this (though we don't use the usual IVs - metal all the way) all along. Too deep, you miss it. Even with the supposed bigger and stronger vessels due to the anastomosis, some of these line are superbly superficial. And always use torniquet - harder to miss a vessel when it's bigger and protruding (yes, even when we are dealing with really big ones here).

Oh yes, I had my fair share of failures too. Up to these days.

rgroyer1RNBSN, BSN, RN · Mar 5, 2008

Practice makes perfect! Im an ER and SICU sup. Just practice practice practice, shadow the IV team, or crit. care nurses. Oh also a question- You guys dont use #18guages? Especially for blood but ive been in er for along time I always take 4 iv caths in my pocket- 1 #16, #18, #20, and #22. Good luck!

Long Term Care Columnist / Guide · Mar 5, 2008

It took me SIX YEARS to become comfortable with IV starts. I just couldn't get the knack of it, and was actually beginning to think I never would, when all of a sudden I got one in........and another...........and another.........Soon I was starting lines all over the place, and eventually became one of the go-to people for IVs. Even the ICU nurses would call for me when they had hard starts! It was flattering to hear other nurses say, "If Marla can't get one in this patient, I'll have to call anesthesia".

Yes, practice literally does make perfect. And sometimes, even when you've developed considerable expertise, you'll have an "off" day when you can't hit the broad side of a barn, let alone a spindly little vein in a LOL who's dehydrated from three days of vomiting. Be patient with yourself, and keep working at it---you WILL get better, even if you never learn to love it as I did. It's the only thing I miss about med/surg nursing (besides the $$).

rgroyer1RNBSN, BSN, RN · Mar 5, 2008

Yes I agree with Viva, Its also the same with me lol, and its a great feeling. "If Rod cant get it, well have to call anesthesia or the doc." LOL. Im the go to guy for Iv's lol, even the floors call me and so does peds-lol. Guess Im really more usefull then I thought LOL. But I still have my off days.

MedicalLPN, LPN · Mar 7, 2008

To the OP, you are not alone, I've been a nurse for 10 months and though I'm nowhere near being a "good stick" when I first started I was truly terrible at IV sticks. One of the reasons is that I have a fine hand tremor which complicates things, luckily one of my nursing supervisors took me under her wing and really mentored me on starting IV's. Now, I go do my two sticks, sometimes I get them sometimes I don't, it's funny I'll go a few weeks where I'll hit everything I stick then I go a few weeks where I can't hit the broad side of a barn! Oh well, practice makes perfect!

Ruffles 1 · Mar 11, 2008

I agree it takes lots of practice to start IV's. I think the catholons are not made as good. The needles seem to be dull. I have been having trouble with the new "safe" catholons.