Re: Humiliating IV questions

It takes time to get good at them and to develop tricks that work for you. I have tough a lot of nurses but never on line so I will just list a few things to try on difficult starts. Some times I will use a tourniquet some times I will not, If the vein blows when I first puncture the vein with it on my next try I will not use it. I always use a 1ml syringe to guide the cath in if it will not easily advance, I have even had success spinning it around like a corkscrew as I advance to get passed a valve or bifurcation. I will also us the trans illuminator if I cant find a vein in the first place. Try to get to all the new admits you can before all the veins are blown to gt practice and build up your confidence. I hope I helped, Joker.

Re: Humiliating IV questions

While new admits are usually wonderful to practice getting IVs on - they can be the hardest as well. But when they're volume depleted (especially sick term kids) getting an IV is usually horrible. You'll get great flashbacks, but then won't be able to advance / flush the IV for the life of you. So frustrating!

Re: Humiliating IV questions

We use those in our NICU and I have found that lately we have had a bad batch where they are so flimsy they kink really bad, and to make matters worse, the hub is very difficult to dislodge. The catheters with wings makes it a little easier. When you are having the luck (or skill) to get your IV in and it is in good shape, wrestling with the hub makes me want to swear! Once the catheters came with the needle protection devices they became much harder to insert. For some of us older nurses it was a difficult adjustment to make. I know it is better for us but it sure is harder.

Re: Humiliating IV questions

elizabells, I have the same issues you have. I've been working at my job for many years and can always get the labs, but threading in the catheter totally eludes me most of the time. Funny though that the ones I DO get are the ones where three other people have already tried, the kid is screaming and cartwheeling across the bed and OMG there it is - in! I'm going to take the tips I've just read here and put them into practice the next time I try one. Then I'll report back.

Re: Humiliating IV questions

Originally Posted by elizabells

Hey, y'all.

I have an embarassing confession to make. I've been in the NICU, student and RN, since March of 06. In that time, I have successfully started ONE IV. One. Now, I'm really good at venipuncture. Good enough that I help out other nurses when they can't get their labs. But I have some kind of psychomotor disconnect when it comes to advancing the catheter and flushing. It's truly pathetic. I know that it's hard to say what I'm doing wrong when you haven't seen me do it, but does anyone have tips? I just can't advance that d(&* catheter properly! It bends, it kinks, and if by some miracle I get it in all the way, it's gone straight through the vein and it blows, or it just won't flush.

thanks

One thing you may try is this: Once you obtain that initial flashback of blood into your flashback chamber, lower your angle then advance a mm or so more. Then using the two handed technique, advance only the IV catheter while your dominant hand holds steadfast onto the flashback chamber, thus dissallowing the needle from moving with the catheter.
Then remove the needle and hook your extension set or IV fluids directly to the IV catheter.
Holding traction below the VP site is important to aide in stabilizing the vein and keeping it from rolling, and it aides catheter advancement.
Hope this helps. DD

Re: Humiliating IV questions

That technique will work well on cooperative adults but no so much with toddlers who really don't want to be touched at all, never mind have an IV put in. To do something like you've suggested, the person doing the VP will need at least one extra pair of hands, maybe two! Don't let kids fool you, when they don't want to cooperate, they're stronger than Hercules and more determined than a mama bear.

Re: Humiliating IV questions

Originally Posted by elizabells

We only have BD Insyte angiocaths, 24g. We do have 0.56 and 0.75 lengths, but if I'm not getting the 0.56's in, I'm certainly not going to get the 0.75, KWIM?

Only 24g??? How in the world do you get a 24 in a micro?? We use the Insyte angiocaths 24g, I think they are the .75, and I don't remember the brand on our 26g, but the needle doesn't retract, (its still exposed ) but the catheter is much shorter. I'm not fond of our 26g and usually don't get it. But there are some kids I don't even think about using a 24g on!

Re: Humiliating IV questions

Our educator uses a 1ml to flush with instead of a 3ml.

Re: Humiliating IV questions

I am TERRIBLE at them. Granted I only have 9 months experience but it never fails that when a kid has one go out on me they are ALWAYS a tough stick. I have started ONE myself. But, we always do them in teams....so 1 person is the stick person and another is the hold them down/cut the tape/etc etc person. So I have no tips....just know you are not alone...whenever I have a new stick to do or an IV go out my stomach starts doing bubblies.

Re: Humiliating IV questions

Originally Posted by nursecave

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.

Oh man! Always do this, you will be really mad the one time you don't do it if it gets stuck. Trust me I know.