Re: Humiliating IV questions

Try flushing the Insyte with saline before the IV start. That may give you a better clue that you are in the vein. Another idea, go in over the vein, instead of to the side. Have another nurse that usually gets them hold and tape. It helps to have someone who is willing to teach, not just to jump in to do it for you.

Sounds like you need practice, ask other nurses if you can do their IV starts. I like to work with our new nurses, unless I know it's going to be a difficult stick on a baby with no veins left.

Good luck!

Re: Humiliating IV questions

With the BD's it is somewhat helpful to twist the angiocath(take the wing and spin completely around) around the needle to loosen it up a little. When we went to those years ago the company rep recommended that. Also, stick just below where you see the vein well, and just off to either side of the vein. I am a newbie in NICU, but those tricks have helped. The twisting the angiocath part I learned in adult nursing.

Re: Humiliating IV questions

I use the old Jelcos ONLY! Can't get the hang of the safety caths. I really hate the ones w/the clip on the end--got one in a 500 gram kid, went to pull the stylet out, the whole thing came out!

Lately, I've had a hard time hitting anything, my hands shake a bit too much. But, here are my tips: Go in slowly, when you get a flash, push the catheter forward a little (maybe 1-2 mm), then pull the stylet back slowly as you advance the catheter. Don't pull the stylet all the way out till you have more of the catheter in--there's not enough strength in the catheter, it'll kink, and then it's pretty much over. If you miss, pull back slowly, if you see blood, pull the stylet out, and try and "float" it in w/your flush--someone else gently flushes while you try to advance. Works once in a while.

If you have a big NB fighting you, have someone start feeding him/her/it, or use Sweetease. Swaddle (tightly!) all but the desired extremity. Use a rubber band for a tourniquet (or non latex type rubber band).

Need I mention appropriate prayers to the holy person of your choice never hurt!!

Re: Humiliating IV questions

We don't have any choice in what angiocath we use. They don't stock anything else. We did have the BBraun's with the clip on the end, and it only took about 2 months and the whole corporation quit using them because they were so hard to deal with. It wasn't a neonatal only problem, nurses couldn't get IV's in adults with those things! I like the ones we use now better,the BD's, they are what we used prior to the BBrauns. Sometimes the old way IS the better way!

Re: Humiliating IV questions

Of the ones I have tried, the "ProtectIV" catheters is better than the clippie one. Problems are that it's hard to get catheter off the stylet, and there is so much weight @ the back end of the device, it pulls its own self out by itself.

What a pain.

Re: Humiliating IV questions

I miss the "unsafe" angios! We've been using Jelco ACUVANCE catheters for awhile now though, and I like them (once I got the hang of them!) much better than the BD push-button ones. Sometimes the Jelco ADVANTIV catheters will show up on the unit (I guess if whoever does ordering isn't paying close enough attention) and they are terrible! They're the ones that you almost have to screw off, and I can never do it without at least 2 other people helping! The problem is, they look very, very similar in packaging.

Re: Humiliating IV questions

I liked those--not so much weight on the back end.

Re: Humiliating IV questions

Originally Posted by cshell1964

I take out the stylet as soon as I get a flash of blood, flush the catheter, then advance.

It's interesting to hear you describe this procedure. I'd read that you could "float" the catheter in as you flush, but can't seem to do it properly.

I'm a tactile learner and also seem to have some kind of spatial disability going on with the catheter. Give me a butterfly and I can get as many tubes as you like, but ask me to leave a line in and I start sweating.

This past week, I decided to pretend I'm just getting blood, and it's helped in terms of confidence, but I've had a couple of those where you can hit the vein, get your tubes filled just fine, but then when you try to flush - NO thank you.

We use the angiocath to go in, attach a 12mL syringe to it when you get your flashback, fill it for the tubes, remove it (getting blood all over the place unless you can maneuver your finger to clamp off the catheter just right), attach the saline lock thingy, flush and you're done.

What gets me as well is advancing. Many times, I've been left with a catheter that will flush only if it's pulled out about 1/2 inch, which of course is a no go, so I have to stick the pt. again... No fun.

I keep thinking it's a matter of practice, but I find myself scoping out pt.'s arms as soon as I see them. Never thought I'd like bulging veins as much as I do now. I find myself staring at people's arms everywhere and thinking "Oh, you'd be an easy stick" or "Oh my G-d, I hope you never need an IV!".

Thanks for the advise everyone.

Re: Humiliating IV questions

Ha! I remember being horrified at the amount of blood I was drawing when I'd work the ED or have a teenager in PICU. Seriously though, 12 mls is like 50% of some babies total blood volume.

Re: Humiliating IV questions

I once had a mom ask me recently how much training I have had on getting IV's on Neonates. I replyed to her "15 years of training, I'm always learning." She seemed very impressed with that answer.