I am a new nurse having terrible problems starting IVs! Please don't just direct me to search this site for info, I have spent hours reading all the IV Tips & Tricks pages (all 15!) here on Allnurses, as well as following all the links posted in that thread and any other sites that I can find. I have a handle on the theory, it's just in practice, I can't seem to get it.
I started out my first experience on the floor (ER in a big busy hospital!) missing most of my IVs for several weeks...finally I started getting about 90% of them, (I still don't know what I did differently) then all of a sudden, I'm back to missing 90%!
So I have specific questions:
1. Often I'll go into the skin, and at some point (sometimes before I get flash, sometimes after) I'll end up seeing a nice big bleb of blood under the skin start to appear...have I gone THROUGH the vein? Or is that what it means when "the vein blows"?
2. What exactly DOES it mean to "blow a vein"? I see that phrase all the time, but don't know what it means!
3. OFTEN, most of the time, I'll get a flash, but the catheter won't advance. Yes, I KNOW, most people have told me to get flash, go in a little bit MORE, then advance the catheter. I TRY, I really do...but there are so many times when I just can't get that catheter to advance...so I'll go in a little more, try to advance, then more, etc etc...then I end up with that big bubble of subq blood appearing. I HAD FLASH, I KNOW I was in...why wont' it advance?
4. What if I can see or feel a small a portion of nice spongy, elastic vein...do I insert the needle at that point, and assume that the catheter, when it is threaded off, will just follow the vein wherever it happens to go...(even if it turns?) or do I insert well below that visible part, hoping to enter the vein at that point that I can actually see/feel the vein? Is that clear? I mean, is that visible part of the vein the place where I want the catheter to END, once it's fully advanced? Or is that the place to start?
5. And finally, could speed of advancing the catheter have anything to do with my problem of not getting it to advance? My preceptor goes SO FAST, he gets flash, and BOOM he advances very quickly and it's done. I am so nervous, I know I advance very slowly (praying all the while that it'll go in!)...if I really am in the vein, but maybe my angle is off so I'm not perfectly pointing in the direction that the vein is running, would it help the catheter to follow the vein by advancing quickly? Or is that just totally unrelated?
Thanks for any advice...please believe me, I have read for HOURS on this site and others, about finding veins, techniques for all of this...I can find them, but I just can't seem to get them in successfully!
I also have better luck with a 20g or bigger (usually I go with a 20 though)...it seems that whenever I go out the the floors to start and IV after multiple attempts by others, they have been using 22 or 24 g caths...
I can usually get the IV with a 20g first attempt...I find that when I use a 22 or smaller, I have a more difficult time too- they are just to bendy or something...I figure that 1 stick with a 20g is better than 2 or more with a smaller gage.
Also, I hate hand veins. I think they are uncomfortable for the patient, they get in the way, etc. I prefer a nice forearm vein- I try to go lower forearm first...but usually I go where I know that I can get the stick on the first try (don't forget to look on the inner aspect of the arm if there is nothing on the outer portion). Look at your own forearm or a picture to know where the different veins are located. If there is nothing to be found and I need an IV, i go AC (but try to start it a little lower than the bend of the arm so it dosen't occlude everytime the patient moves). I also use the upper arm on occassion-the vein is deeper but can hold a large gage.
As for insertion, I usually don the tourniquet or bp cuff (which sometimes works better for those with delicate veins), search around and find my point of entry. Prep the site, anchor the vein (everything else is set up already)...I usually go with a fairly low angle of insertion otherwise I find that I blow the vein- especially if the vein is very prominent. If it is deeper, I will of course adjust the angle of insertion as I need to (something else that just comes with practice). Once I get into the vein (I usually do a fairly quick stab in), I advance just a little bit more after I have leveled out the angle. I undo my tourniquet and then advance the rest of the way (before I started undoing the tournquet prior to advancing, I found that I blew more veins).
Last but not least- practice is what makes you better. Go in to the patients room with confidence. Don't be afraid to look at both arms, take your time looking for the right vein if need be. If the patient does use IV drugs or is a frequent patient- ask them where to (or where not to) start the IV. Some patients will just be more difficult than others. And some days you won't be able to hit the broadside of a barn...but after practice, all of that will even out. Everyone is going to have a system that works for them. I watch other RNs who start IVs totally different than I do but have good results too. When I first started with IVs, I was so scared that I would shake...but I made sure that I tried every IV I could. I also watched when others started...if there was another RN that I knew was a good start, I would watch them start a few and then try their technique to see if I liked it better. It took some time to find something that worked for me.
Last edit by zambezi on Sep 4, '05