I Stink at IV's.

  1. Hi!
    I am an RN 2 years out of school but new to L&D, and I just recently found this site. Yay! What a wonderful resource!
    I am currently experiencing a very long, bad run on IV starts. I used to think I was fairly talented at them; used to do Mom/Baby and Peds at my old job and seldom had a problem, even on the kids. But since starting a new job in May I don't think I've gotten one on the first try yet! Not only do I feel bad for my poor patients who have to endure all my poking, but it makes me feel so incompetent having to always be asking other nurses for help!
    I'm wondering if it's due to the size of the angio's we're using? At the old hospital we were pretty lax about that and mainly used 20's on adults. At the new place (as well as at most other normal hospitals I suspect), 18's are the hard-and-fast rule. I don't know really how much difference that makes, but it's the only thing I can think of that's changed!
    I've talked to some of my new co-workers about it, and they each seem to have their own special trick, none of which has worked very consistently for me. (even had one very experienced nurse simply say "no *****-footing around.") I have no problem getting into the vessel and getting that return, but then I either can't thread the catheter, or it immediately swells up like a little purple balloon, or just won't flush for heaven knows what reason.
    Anybody have any suggestions I maybe haven't tried yet? My confidence is really shaken!
    •  
  2. 13 Comments

  3. by   amy7902
    Doing IV's is about confidence. I have had some bad days. Getting enough sleep and not feeling rushed help alot. 18 G is that really necessary? They are larger and harder to put in. It helps to heat up the site. Maybe a warm wash cloth? I also found with bigger catheters I had to be right on top of the vein couldn't access from the side. Hope this helps. PS you could also try visualizing it going well. Playing that movie in your head of the steps you would go through to perform the IV when you are calm and feeling good.




    Quote from Mrs.S
    Hi!
    I am an RN 2 years out of school but new to L&D, and I just recently found this site. Yay! What a wonderful resource!
    I am currently experiencing a very long, bad run on IV starts. I used to think I was fairly talented at them; used to do Mom/Baby and Peds at my old job and seldom had a problem, even on the kids. But since starting a new job in May I don't think I've gotten one on the first try yet! Not only do I feel bad for my poor patients who have to endure all my poking, but it makes me feel so incompetent having to always be asking other nurses for help!
    I'm wondering if it's due to the size of the angio's we're using? At the old hospital we were pretty lax about that and mainly used 20's on adults. At the new place (as well as at most other normal hospitals I suspect), 18's are the hard-and-fast rule. I don't know really how much difference that makes, but it's the only thing I can think of that's changed!
    I've talked to some of my new co-workers about it, and they each seem to have their own special trick, none of which has worked very consistently for me. (even had one very experienced nurse simply say "no *****-footing around.") I have no problem getting into the vessel and getting that return, but then I either can't thread the catheter, or it immediately swells up like a little purple balloon, or just won't flush for heaven knows what reason.
    Anybody have any suggestions I maybe haven't tried yet? My confidence is really shaken!
  4. by   Someday-C.R.N.A.
    First off, WELCOME to allnurses.com!!

    Now I'm not a nurse (yet), but I do know what it feels like to be in a new environment and have my confidence rattled a bit.

    It sounds like you're having a confidence problem. ........And the more you worry about it, the worse it gets.

    This may not be much help, but try not to worry about it. YOU KNOW HOW TO DO THIS. All you need to do is to DO IT. Don't over-think this. I know it's easier said than done, but this is what I think you need to do. Find a way to boost your confidence in yourself, and do the job. You'll get over this "hump" and, soon enough, you'll be wondering why you were ever having troubles to begin with. (Old Pro).

    Believe in yourself.

    You can do it.
  5. by   yoga crna
    Sometimes starting IVs can be the most frustrating procedure you do--take this from someone who has been starting them for over 45 years in anesthesia. But, there are a few tricks.

    1. 18 gauge are important in OB cases for the rare emergency that you need for fast infusion. They are no harder than 20 gauge, if you select a large enough vein. Veins are usually distended in pregnant patients and should usually accommodate an 18 gauge.

    2. Make sure the tourniquet is tight and fairly close to the vein you are going to use.

    3. Keep the arm below the level of the heart prior to tightening the tourniquet.

    4. Find the strightest vein you can. It is hard to advance a straight catheter in a crooked vein.

    5. Veins on the dorsum of the hand are usually superficial--don't go too deep.

    6. Advance the needle about 1 cm into the vein before advancing the catheter, keep tourniquet on until catheter is advanced.

    7. In anesthesia, I almost always use a skin wheal of local anesthesia with a 30 ga needle prior to insertion of the angiocath. You can argue about this, but a 30 gauge needle hurts less than an 18. But I am an anesthetist and hate pain and my patients love me for it. In California, the BON has ruled it acceptable for RNs to do this without an order.

    8. If you miss after two times, get someone else to try. You will have good and bad days with IVs and that's that.

    yoga crna
  6. by   PegRNBSN
    Biggest helpful hint I ever got was go low and slow. After you initially get in the vein (going very slowly) lower the angle of the needle before you advance. This helps to prevent going through the vein.
  7. by   NurseNora
    Do as many as possible. Ask your coworkers to get you every time they have an IV to start, especially if the woman has really good, big veins. Nothing beats practive.
  8. by   ARLadyRN
    Stabilize your vein by holding it down with your thumb on your non-dominate hand and go right on top of the vein with a slight angle. A lot of people go in at too much of an angle and go thru it and it blows.
  9. by   mstigerlily
    I am a new grad and went right into postpartum where I hardly ever get any practice doing IVs and rarely even catheters so a WONDERFUL L&D nurse was floated over to our side one night and I told her about it, so whenever she and I are working, she calls me over for a little practice and she gave me some good tips.

    First, they use lidocaine. This makes things nicer because the poor mom isn't wincing in pain and jerking her arm when you are sticking her. You feel more free to root around a little when trying to get the vein. I had the same problem you did where I could find the vein and get it in but couldn't advance. This L&D nurse told me she advanced the catheter a little, retracted the needle (keeping pressure on) and hooked up a running fluid line (wide open) then it was easy to advance the catheter and it just "floated" right in. I tried it and she was right.

    The tip she gave me for inserting catheters were great too, I had trouble finding the urethra sometimes since our patients were swollen and bloody by the time we got them (postpartum). Instead of just pulling the labia apart to the sides, she taught me to do this "hook" maneuver where you hook your fingers on each side and pull apart and then BACK and the urethra is separated and pulled up, there it is clear as a bell, even on the most swollen mom. Kind of hard to envision without showing you the hook maneuver but I've had no problem getting them in first try, quickly and one handed.

    Melissa

    Quote from Mrs.S
    Hi!
    I am an RN 2 years out of school but new to L&D, and I just recently found this site. Yay! What a wonderful resource!
    I am currently experiencing a very long, bad run on IV starts. I used to think I was fairly talented at them; used to do Mom/Baby and Peds at my old job and seldom had a problem, even on the kids. But since starting a new job in May I don't think I've gotten one on the first try yet! Not only do I feel bad for my poor patients who have to endure all my poking, but it makes me feel so incompetent having to always be asking other nurses for help!
    I'm wondering if it's due to the size of the angio's we're using? At the old hospital we were pretty lax about that and mainly used 20's on adults. At the new place (as well as at most other normal hospitals I suspect), 18's are the hard-and-fast rule. I don't know really how much difference that makes, but it's the only thing I can think of that's changed!
    I've talked to some of my new co-workers about it, and they each seem to have their own special trick, none of which has worked very consistently for me. (even had one very experienced nurse simply say "no *****-footing around.") I have no problem getting into the vessel and getting that return, but then I either can't thread the catheter, or it immediately swells up like a little purple balloon, or just won't flush for heaven knows what reason.
    Anybody have any suggestions I maybe haven't tried yet? My confidence is really shaken!
  10. by   lionkore
    Quote from Mrs.S
    Hi!
    I am an RN 2 years out of school but new to L&D, and I just recently found this site. Yay! What a wonderful resource!
    I am currently experiencing a very long, bad run on IV starts. I used to think I was fairly talented at them; used to do Mom/Baby and Peds at my old job and seldom had a problem, even on the kids. But since starting a new job in May I don't think I've gotten one on the first try yet! Not only do I feel bad for my poor patients who have to endure all my poking, but it makes me feel so incompetent having to always be asking other nurses for help!
    I'm wondering if it's due to the size of the angio's we're using? At the old hospital we were pretty lax about that and mainly used 20's on adults. At the new place (as well as at most other normal hospitals I suspect), 18's are the hard-and-fast rule. I don't know really how much difference that makes, but it's the only thing I can think of that's changed!
    I've talked to some of my new co-workers about it, and they each seem to have their own special trick, none of which has worked very consistently for me. (even had one very experienced nurse simply say "no *****-footing around.") I have no problem getting into the vessel and getting that return, but then I either can't thread the catheter, or it immediately swells up like a little purple balloon, or just won't flush for heaven knows what reason.
    Anybody have any suggestions I maybe haven't tried yet? My confidence is really shaken!
    Hi,

    I'm about a year and a half out of school myself, and also new to L&D. I came from a CCU at a different hospital, where we used Introcans all the time (basically just the cathlon without an extension set). I was pretty decent, not the gold standard, but not too bad. Now, here on L&D, we're using Intimas (with "butterfly" wings and a mini extension). I found in the first few weeks of orientation, I was so flustered about doing things well and giving a good impression to my preceptor, that I couldn't hit the broad side of a barn, even when she and I went hunting for Introcans in the supply room for me to use. We finally figured out that I was having stage fright, and she left me alone for my IV starts after that - guess what, I've hit them on the first try ever since, and am even starting to get used to the Intimas.

    If I have any suggestions, it would be to clear the room of unnecessary folk, take a deep breath before you start, and remember: This is something you can do. You know that you can do it because you have done it before. No wait I do have one more suggestion. and it is a practical one. When you get your flash, advance the needle just a l-i-t-t-l-e more, like 1/8 inch. This will ensure that the entire bevel of the needle is actually in the vein. as opposed to being halfway in the vein, giving you a good return, and then blowing when you try to advance. that was what helped me make the transition from 20s to 18s a little easier.

    good luck to you!
    kori
  11. by   Mimi2RN
    Quote from lionkore
    Hi,

    When you get your flash, advance the needle just a l-i-t-t-l-e more, like 1/8 inch. This will ensure that the entire bevel of the needle is actually in the vein. as opposed to being halfway in the vein, giving you a good return, and then blowing when you try to advance. that was what helped me make the transition from 20s to 18s a little easier.

    good luck to you!
    kori
    I agree with Kori. Advance the needle just a little bit further in, before you advance the catheter. It sounds like you are not quite far enough in. Veins in the moms on L&D are usually big, so the needle has further to go. Also, a 5 or 10 ml syringe of NS can be useful to help "float" a catheter in a difficult vein.

    Good luck!
    mimi
  12. by   Mrs.S
    Thanks for all your tips, everyone! I started an IV on a patient with skinny little veins this morning at work, with no trouble at all. This time I tried advancing the needle just a little farther than I thought I needed to before advancing the catheter.
    Anyhow, thanks so much! I can't get over how handy this site is! I could spend hours and hours on here, reading through all the threads...
  13. by   Mimi2RN
    Yeah!! Knew you could do it!

    mimi
  14. by   SmilingBluEyes
    Quote from yoga crna
    Sometimes starting IVs can be the most frustrating procedure you do--take this from someone who has been starting them for over 45 years in anesthesia. But, there are a few tricks.

    1. 18 gauge are important in OB cases for the rare emergency that you need for fast infusion. They are no harder than 20 gauge, if you select a large enough vein. Veins are usually distended in pregnant patients and should usually accommodate an 18 gauge.

    2. Make sure the tourniquet is tight and fairly close to the vein you are going to use.

    3. Keep the arm below the level of the heart prior to tightening the tourniquet.

    4. Find the strightest vein you can. It is hard to advance a straight catheter in a crooked vein.

    5. Veins on the dorsum of the hand are usually superficial--don't go too deep.

    6. Advance the needle about 1 cm into the vein before advancing the catheter, keep tourniquet on until catheter is advanced.

    7. In anesthesia, I almost always use a skin wheal of local anesthesia with a 30 ga needle prior to insertion of the angiocath. You can argue about this, but a 30 gauge needle hurts less than an 18. But I am an anesthetist and hate pain and my patients love me for it. In California, the BON has ruled it acceptable for RNs to do this without an order.

    8. If you miss after two times, get someone else to try. You will have good and bad days with IVs and that's that.

    yoga crna
    excellent and helpful post.

    WELCOME To ALLNURSES!

close