IV Starts

Bikerchic · Feb 15, 2003

I used to like starting IV's on adults, but after 7 months of trying on the babies and not being successful I am real frustrated. I can get a blood return many times but then it blows when I advance it. I have never tried a scalp vein yet, but I think they work well. We have a transilluminator; I like it but it can be awkward. And I learned from a more experienced nurse that it is easier to start an IV in a bigger baby without it.

Has anyone had problems with their catheters? We have been through 2 different types since I started. One type was sent back to the manufacturer who tested them and found them to be troublesome also. I forgot what happened since I never saw it, but I think it left a small lump under the skin next to the insertion site. What type do you use? I just started back to work 2 days ago after being gone since Nov. but I think we are back to using Jelco, which was discontinued before my orientation, so I never used it myself. We had an angiocath after that.

Any tips on how to get proficient at starting IV's? Or how to advance them without blowing them?

Thanks.

Heather333 · Feb 15, 2003

I had the same trouble with IV's that you did when I first started. I would get a blood return then BOOM there goes the vein. I found out that I was going through the vein because I was aiming too deep. The veins are much more superficial than you think sometimes. I rarely use a transilluminator and have never used one on a big baby.

Heather

KRVRN, BSN, RN · Feb 15, 2003

I rarely try IV's on big babies without a transilluminator. How funny that we all do it different.

Candace · Feb 18, 2003

We do 2 attempts each on our unit, preferably using sucrose prior to the stick. I will occasionally (few&far) leave one catheter in and restick with a new catheter parallel to the first unsuccessful one. It seems to always work if you have a baby that's blowing or rolling. We also use surgilube on the scalp as a base then tape with cloth tape.... it dries like cement and when it's ready to be d/c'd, wet, and WALA!, off it comes with the baby's hair still attached to her scalp! Any other tricks you have to share?

nurseiam · Feb 19, 2003

I think that we are now using InStylet? They retract for safety. We will try three times in our unit.

The best way I have found is to put the catheter in the pull out the needle and try to float the catheter in. Then you dont go through from going in to far. We will also try heparin if the clot easy and if their hct is low there might not be a flash. I like to try the vein on the outside of the foot. We are not allowed to use ANY major veins, they are saved for PICC's

NICU_Nurse, BSN, RN · Feb 19, 2003

Dumb question, but what is surgilube and how do you get it on the NICU? That sounds perfect...I hate seeing their hair come off when we d/c an IV, even if you try and try to keep it intact, it seems like we never quite get it all. :>( We get, technically, three tries per person before moving on, but unfortunately, some people are better at IV's than others, and some babies are horrible sticks...you get where I'm going with this (although technically, since it *is* the rule, we try to stick to it as much as possible). We use the Jelco catheters, and I find that they work well. I always float in because I don't want to go in too far and damage the vein on the other side. We try to save the a/c veins for PICCS, even if the MD hasn't mentioned wanting one, as much possible.

gauge14iv, MSN, APRN, NP · Feb 22, 2003

I use a few drops of mct or corn oil (which we always seem to have hanging around) on the tape on sites when I want the tape to come off but the hair (or skin) to stay! Just moisten the tape or place a few drops under the edgeof a clear type dressing, wait about 10 min and everything should should fall right off. This also works great for taking the very adheseive dots off the cheeks that we use to hold the nasal cannulas.

I usually have to wash the hair afterwards, but at least it all stays on their head!

Mofe'ny · Mar 1, 2003

Wow I just read this thread again for the first time in months. Just wanted to pass on some encouragement to those of you still struggling with IV's. For me it seemed that once I was able to get a few IV start in a row, I haven't really had much trouble with them. I'm not intimidated by IV's anymore!! So it does get easier with practice!!! :)

nell · Mar 2, 2003

Kristi,

surgilube = Ky jelly.

Sure are a lot of good ideas here! Too bad we got "stuck" with catheters that are waaay too long and seem to blow and leak more than any we tried before.....

cindylouwho · Apr 7, 2003

3 times and I'm done...I love scalp veins....parents do freak out...only use them after the hands are gone....love PICC lines even more when appropriate...we've had excellent luck with our PICC lines....

love4neos · Apr 13, 2003

I would definetely be suggesting a PICC line for this baby. Everywhere I have worked has only allowed anyone 2 tries each, it is recommended that you get an NP before there are NO veins left! Any vein that looks good and refills we try, except of course jugular or other major access in case sugery is needed.

NICU_Nurse, BSN, RN · Apr 14, 2003

Okay, forgive me if this sounds stupid, but IV starts remain my poorest skill. I have improved dramatically since I first began working in the NICU (approx. 16 months ago), but I am still disappointed that I still struggle with this. I seem to be hitting the veins but blowing them almost as soon as I get them. My facility is horribly poor when it comes to providing reference materials and inservices/education regarding this issue. I am left to look it up and learn on my own, which is fine, but I don't know where to go! Any suggestions from the pros? I have my basic diagrams of adult venous structure- are these basically applicable to the babies as well? It seems like, after studying these pictures, I go for a vein that I may not be able to visualize well, and it's just not there for the babies (or I'm simply missing it), which increases the number of sticks needed to obtain IV access. I've gone to the bookstore and looked at a couple of phlebotomy books, but they mostly pertain to adults. The sections on infants are very small and have virtually no information. Is there a book('s) about IV therapy for infants? One specifically designed for NICU nurses or neonatal nurses? If anyone knows of such a thing, I'd be grateful if you'd let me know. Anything I can do to continue improving this skill is at the top of my list. ;>)