IV starts - anyone get better?

  1. I have been in the NICU for about 16 months now and I just haven't gotten the hang of starting IVs. Not sure what the problem is! Possibilities: 1) the catheters - definitely not the whole problem but all the nurses complain about them. 2) We just don't start them enough for me to get proficient. Of course we start them on virtually all our admissions, but we are a fairly small level 2 NICU and often run with a very low census. The most I've seen in our NICU are 10. We've been down to zero babies once since I've been there. Of course the 3rd option is that I just suck at it . I try as often as I get the chance but after the admission the babies often already have a bunch of blown veins from the first IV start so it only gets harder to find a decent vein. And I am feeling guilty for blowing the veins by practicing, which makes it harder on my co-workers who have to get it after I've tried.

    What I'm wondering is - should I just accept that I'm bad at it? I really *want* to get good at it. Would it help if I practiced on other populations? I'm sure L&D would let me try on their patients, all of them get IVs. But I'm not sure practicing on adults would help me with the neonates.

    As far as technique, I often (but don't always) get the flash, it's advancing that kills me. I try to advance the entire unit after getting the flash but I always, always blow the vein. If I try advancing just the catheter, well, it won't advance, the catheter is too flimsy. And sometimes it seems like I get the flash so quickly, the needle is barely in, so I have to try to advance with the needle.

    Any encouragement? Anyone start off bad but actually got good at starting them?

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    About krenee

    Joined: Nov '05; Posts: 522; Likes: 161


  3. by   Bortaz, RN
    Something like 32 months in and I still suck at it too. I always try twice, then pass it on to someone else. I'm not willing to "practice" on the baby, and like you I feel bad wasting veins that a more proficient nurse might be able to use.

    Sent from my iPhone using allnurses.com
  4. by   HazelLPN
    Its all about technique which takes practice. Cooking is technique,Sports are technique, music is technique. Want to learn to cook? Watch Julia Child's reruns and practice on your family. Learn to play tennis? Find a tennis club, get a coach, and practice. Start an IV on a premie? Find your BEST IV nurse and ask for a lesson. Look, feel, listen, and ask questions. Next time, have her/him watch you stick and coach you through it.

    I was great with IV starts on adults and peds, but had to train my nerves a bit when I started doing NICU and took my own advice. Our IV queen was a veteran old school diploma educated nurse named Donna. She could throw the angiocath across the NICU blindfolded and it would insert perfectly into a scalp vein of a 23 weeker for good return and easy flushing.

    Perhaps I exagerate a bit, but I never saw Donna miss...and on more than one occasion the nursing supervisor called her to the floor or ER for a difficult stick.

    Practice makes perfect.

    Happy sticking,
    Mrs H.
  5. by   sugarmagnoliaRN
    Are you leveling out and advancing the catheter & the needle a tad further after you get flashback? If not, do that before trying to advance just the catheter.
  6. by   krenee
    Quote from sugarmagnolia018
    Are you leveling out and advancing the catheter & the needle a tad further after you get flashback? If not, do that before trying to advance just the catheter.
    Yeah, I've tried it both ways. When I advance the needle at all, I blow the vein. If I try to advance just the catheter, it won't advance. So either way hasn't worked for me so far. I was precepted by the best IV nurse in the department so I've had coaching. It's not that I've never gotten one, but I get maybe 5% of the ones I try, and it's been months since I have gotten one. So frustrated. Thanks for the input, though!
  7. by   missnurse01
    altho i don't work nicu, I would think that getting confidence and a feel even in an older population would definetely be helpful. I would talk to whomever was your preceptor or your manager about the feasibility of this...and if it would be helpful!

    much of iv starting in any population seems to be confidence-have seen it through many new nurses over the years...and in myself of course! always know you can do it!
  8. by   LaughingRN
    Just some encouraging words

    I work in the ER where we have a peds "ER" with limits (since we don't have in-patient peds)

    Since my main population is adults in an inner city level one, it took a year to become good at adult IV's

    When I rotate to peds, I find that the skills I learned definitely transfered to that population. To date, I've only missed one on the first attempt in the under the age of 1 population. (4 week old preemie)

    Go and practice in L&D. I think it will be priceless. Gain some comfort with how IV's feel when you thread the catheter...

    You would be surprised with how many adults have really bad veins which makes for comparable practice to peds.

    In fact, I got a 20g beautifully working IV last night in a 20 year IVDA patient.....made me feel great! (in the shoulder of course)
  9. by   karnicurnc
    Have you tried advancing the catheter while gently flushing? It kind if floats in that way. I tell all my orientees to watch other people start IVs. Take every opportunity to observe technique, troubleshooting, taping and securement, etc. Gradually it will come to you.
  10. by   ToughingItOut
    I'm currently in an IV slump. :/ I hope reviewing some of this advice will help. I blew the most gorgeous saph last night...Any positive IV thoughts and energy greatly appreciated
  11. by   NICU_babyRN
    I have found that most people blow veins when their tourniquets are on WAY too tight. Loosen it up. For the "fresh" babies, I don't use a tourniquet often at all! And, don't rely on a transilluminator as you are learning. Try going without it until you have the hang of it without it! Take your time, take a breath and tell yourself, "I am going to start this IV" rather than I'm going to TRY this IV. You'd be amazed at how your own mind plays tricks!
  12. by   nicubabies4me
    I'd love any advice as well. I've been in the nicu for 6 months and I feel like I'll never get one. I get a flash almost every time, but when I flush, the vein always blows. I've tried so many things. Question - do you go right on the vein, or try to go below it and advance up to it. Also, advice for jaundiced veins. Why are they so tough anyways??
  13. by   prmenrs
    Juandiced kids are tough because they are frequently very dehydrated! If they can tolerate it, feed them 1st. If not, sometimes it's easier to put in a UVC, give some fluids, remove it, and THEN put in an IV. jmo, but docs don't really want to.

    If you have a "rolly" vein, try stabilizing it w/one finger above and your thumb below it. After you get your flash, advance the catheter a tiny bit before removing the stylus. Sort of "catheter in, stylus out", if you will.

    Even very experienced nurses go thru dry spells when you can't hit the proverbial broad side of the barn. Keep trying!
  14. by   CoraBeth RNC-NIC
    Are you using the pre-filled syringes? Those require more pressure to flush and often cause more veins to blow.
    Also, do you have a posi-flow on your IV extension tubing? That also causes you to need to use more pressure to flush. Can you flush without a posi-flow, and once the IV is taped and secured, add the posi-flow?
    Another tip (which someone already posted) is to not push the catheter all the way in, but rather "float" it in the vein as you flush.
    Try not to get discouraged. Even the best IV start nurses go into slumps.
    You'll get it!!