by elizabells Premium Member

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

Re: Humiliating IV questions

Don't worry, I've been in NICU for almost 18 years and IV's are not my thing. i can do an art stick fairly easily for labs, but i have trouble with coordinating IVs with advancing, etc. too. If I look at a baby and can tell i couldn't get the IV, I will get the "Expert" nurse to do it...I've had nurses be shocked that I won't do an IV if I KNOW I won't get it...why hurt the baby more than is necessary? It doesn't help when the IV caths are changed frequently on the unit...always a new one to get used to! I always have another nurse helping me, or I help the other nurse because IMO it is not a one-person job.
Some nurses use the vein viewers to help with starting the IV.
I don't have much advice, but to just keep trying and get advice from the "experts" in your unit.

Re: Humiliating IV questions

It really depends on the type of catheter you're using. We use those safety clicking angiocaths (not the kind with the button). I used to have trouble advancing those. The key for me was to go in VERY slowly. Then after I felt the pop I would advance with the needle just a smidgen more. Then I advance just the catheter while keeping the needle completely still. It sounds wierd maybe, but after practicing it with an angio I just took from the unit, the motion becomes much more fluid.

Re: Humiliating IV questions

I can only use a certain type of catheter we have (we have 2 different ones on the unit). I've actually gotten quite a few IVs and I LOVE doing it ...... I try to start as many as I can. I do like fergus described and just go slowly, once I see that flashback I keep the needle completely still and then advance the catheter.

But we're totally opposite because you said you are great with venipuncture ..... and I never can get lab draws, usually always have to have someone else help me.

Do they have only one type of catheter on the unit? Have you tried different kinds? Once you find a type you like, it could help.

Re: Humiliating IV questions

Thank you so much for the tips and encouragement, guys!

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?

The way we do lab draws on my unit is either with an angiocath, inserted just until you get backflow, then you pop out the needle and let it drip into the microtainer, or (and this is probably totally dangerous in terms of needlesticks, but it's how we do it) cut the tubing off a butterfly and use that. Some people used to snap the needle off a syringe and insert that with a Kelly clamp, but there was an incident and now that's not allowed...

Re: Humiliating IV questions

I am pretty good at IV starts. (one of the "experts" people call). I take out the stylet as soon as I get a flash of blood, flush the catheter, then advance. Good luck!

Re: Humiliating IV questions

Originally Posted by elizabells

Some people used to snap the needle off a syringe and insert that with a Kelly clamp, but there was an incident and now that's not allowed...

Re: Humiliating IV questions

I am pretty good at IV's but suck at drawing labs via butterfly.

My trick to a good IV start is when you see flash use your nail to Gentley dislodge the hub off the needle just enough to cover the sharp point of the needle then advance the cath. If you are using a tourniquet remove that before you attempt to flush.

Re: Humiliating IV questions

Originally Posted by dawngloves

Yeah, guess who got stuck with a needle someone had left in a bed??



And I know *I* didn't leave it there, seeing as it was my second day on the job and I'd never drawn labs...

Re: Humiliating IV questions

Luckily I am pretty good at IV's. Being said I think that for whatever reason some people just aren't and should feel no shame in asking someone else to help them out. Everybody has different strengths and weaknesses. I do know that I prefer to be sitting in a chair at the bedside when I start an IV because I feel I have more control. I am not leaning over them, I can have the bedside table right next to me, with everything ready to go and more easily rest the pt extremity on the bed or table in front of me. Also I have found that when using the sterile surg gloves they are thinner and fit more snugly giving me better control. And finally, when you are ready to advance the cath, go slowly, you can feel where it's going and you have control. Many time just by taking my time to feel it and insert it slowly, I am told, oh wow that didn't even hurt. There is also like a chain of command goig on in my unit, I know if I can't get this stick I go to either this person or that one.