Starting IVs

Specialties Med-Surg

Published

I actually don't mind the craziness of the floor I work on. But, there is one thing that brings me so much terror and it is starting IVs. I only started 3 so far and I have almost worked as a new nurse for a year. Two of those IV starts were under the supervision of another nurse. I only successfully started one last week on my own and it was the smallest gauge possible (24!). Though, she was a hard stick.

We never practiced starting IVs in nursing school. I am the type of person who needs to practice, practice, practice my clinical skills.

Does anyone have any tips or pointers? Any basic tip would be helpful! A number of times I was able to get some blood return but then it was infiltrated.

Specializes in LTC, med/surg, hospice.

There are tons of threads on here with IV start tips if you do a search.

The best way to learn is practice. Practice and practice. Watch the technique of a nurse who is good at IVs also. You will develop your own technique.

Look at your own arm and find the veins. Feel them. Do this with your spouse, family or friends. Finding a suitable vein is a huge part of your success.

Be confident when you attempt.

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Specializes in ICU.

Thanks for the suggestions! I am still not great at IVs. But, since this post I started two more (22 g) and hopefully with time and practice I will get better.

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Specializes in ICU / PCU / Telemetry / Oncology.

Your confidence really takes a boost the first time you put in an 18g ... :D I am still waiting for the chance to put in my first 16. Sometimes I feel like a vampire lol.

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First don't let yourself get worked up about doing it starts.

Gather your supplies. Decide where you're going to access. Don't spend all day looking. If they are a hard stick I'll only try once then I fetch someone who is more experienced than I am. More experienced nurses use touch almost more than looking, but I still look more than I feel.

Pick your spot and do it. Don't beat yourself up if you a have trouble. Give yourself permission to seek help after you have made a sincere effort.

I'm fairly new and have found that most patients are very understanding as long as you don't make them a practice pin cushion, if you know what I mean.

You can do it! Seek some education and get to sticking!

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14 months in and I'm starting to hit more than I'm missing. I like forearms and wrists and hate hands (but will do them) and I can't find an Antecubital to save my soul. For me, I can hit them if I can visualize the shadow of the vein under the skin (for deeper veins) and can feel them (more superficial). Practice, practice and more practice will get you used to them. I even got a lady that PICC team couldn't get!

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Specializes in ICU / PCU / Telemetry / Oncology.

I'm more of a feeler for veins than a looker. I don't do well visualizing veins so I go with feeling for them and that works better for me. My favorite spots are the forearms and I despise the hands because I know they hurt, so I go there only as a last resort. I will only put in an AC if I'm only establishing access and heplocking, never if a person is on continuous IV. I have no time to shut off a screaming IV pump or constantly remind a patient to keep their arm unbent. I hate the ER for putting IVs there. Blood draws for me are easiest from the AC. I can often find a juicy pipe there in most people.

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5 iv starts in year is just not enough practice. You need more live sticks to gain confidence. Are you changing outdated iv's? That is one way to get some more practice on your floor & ask other nurses for their iv starts. But I might ask to go to pre-op, endo, or er for a few hours and just start iv's. I think iv starts is just a skill you need to do a lot to become competent with it.

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As others have said, practice makes perfect (Or at least pretty damn good in this case).

When I first started doing IVs my hands would visibly shake, so it was definitely embarrassing and did not instill much confidence.

Tip

1) Do not get discouraged, you'll start getting far more 'hits' then 'misses' as you practice more. Don't get psyched out by patients that get mad at you for missing either.... It happens, even anesthesiologists that have 20+ years of experience miss.

2) Always flush with saline, even if you get some blood drawback.

3) Patience is key, put the tourniquet on and have the patient lower their arm, then wait a little... you'll be surprised when veins on the hand, that you really couldn't see or palpate before, pop out.

4) For slightly 'crooked/wobbly' veins, straighten them out! Pull the skin taut...

5) Apply pressure above your insertion so when you pull the needle out to secure the heplock, you don't get a bloody mess.

6) Observe others that are proficient at doing IVs and see what their techniques are.

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If you have trouble relaxing, it will b harder. Set yourself up for success. Announce to the secretary, charge, or another nurse you're going to attempt an iv, and will be tied up for a little while. They will often answer your other call lights for you, knowing your busy. Take in double supplies, keep in pocket. I am often slow getting j lock to vein, so I bring in a towel too, and lay under the pt arm. All blood will be absorbed, one less thing to worry about. Don't be afraid to manipulate pt. Push, pull skin, twist arm... They'd rather this than being stuck again! Look in unusual places. One of our nurses always gets hers in the thumb vein. My favorite spot is the back of the forearm, most people tend to go for the palm side of the arm, but there's a vein there in the back that you can feel all the way to the elbow in some people. That suckers huge and PTs love it when I use it because it doesn't impede movement as much as some others do. Also, Ask the pt! Often, at least 50% of the time, they will tell me exactly which veins people have the most success with and which ones to avoid. They are usually right!

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Ask your manager if you can spend a few hours working with same day surgery. In my hospital that's a normal part of orientation because they start a lot of IVs there so you get a lot of practice. Other than that offer to try every time a patient needs one even if it's not your patient. The best IV nurse I know said once that the people who are most successful try the most!

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I'm happy, I'm not the only new nurse that has problems with IV starts. I've been on my own since mid-November, and find starting IVs the most daunting part of my job. Granting I'm sure there are many things I can get better at, but starting IVs is the most frustrating. I cringe when I know I have to try to put one in. After I try twice without success, I dread the thought of having to find someone to help because this is something I should be able to do myself! I did get one without supervision, which built my confidence a bit, but it was knocked back down in the last two shifts. I'm wondering if its just practice, practice, practice, or if there is something I'm doing wrong. I think I'm going to try the book recommended by iluvivt. Rachel10609, how have your IV skills developed so far?

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Hopefully the facility you start your career with will offer a.continuing education course on IV and central lines. Watching a seasoned nurse insert an IV a few times and having them let you feel the veins, the where and why's of that site and telling you how to start the IV from start to finish is key. Next, take advantage of every insertion you can.

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