Humiliating IV questions

  1. 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
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  2. 36 Comments

  3. by   MA Nurse
    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.
  4. by   fergus51
    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.
  5. by   RainDreamer
    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.
  6. by   elizabells
    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...:smackingf
  7. by   cshell1964
    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!
  8. by   dawngloves
    Quote from 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...:smackingf


  9. by   nurseiam
    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.
  10. by   elizabells
    Quote from 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...
  11. by   Laughs-a-lot, RN
    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.
  12. by   Mimi2RN
    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!
  13. 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.
  14. by   prmenrs
    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! :angryfire:angryfire

    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!!

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