About to take the IV insertion class...

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Specializes in ACNP-BC.

Hi! I'm a fairly new RN & I'll be taking the IV insertion class soon. I've watched several nurses put in IVs. But I'm still nervous I won't get them in, or will cause the patient a lot of pain as I'm trying to put them in. Any tips or advice from all you experienced nurses? Thanks! :)

BD Healthcare systems have several videos you can download for venous puncture technique. Although it is illustrating their product, I found it extremely helpful. Also, check out the IV therapy nurse websites, they have great tips and they do work.

Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.
Hi! I'm a fairly new RN & I'll be taking the IV insertion class soon. I've watched several nurses put in IVs. But I'm still nervous I won't get them in, or will cause the patient a lot of pain as I'm trying to put them in. Any tips or advice from all you experienced nurses? Thanks! :)

Hi! I'm a fairly new RN & I'll be taking the IV insertion class soon. I've watched several nurses put in IVs. But I'm still nervous I won't get them in, or will cause the patient a lot of pain as I'm trying to put them in. Any tips or advice from all you experienced nurses? Thanks! :)

Good morning..first off, I'm not a nurse, but I've got some tips for you.

1. It's all about PRACTICE. GET AS much as you can.

2. Remember to explain what you're doing and why you're doing it. Patients and family members appreciate that.

3. Be SMOOTH when inserting IVs. It's not necessary to be "quick", just smooth...no jerking. The patient will probably do that on their own.

4. Put an appropriate sized catheter in your patient. An 80 year old with spider veins probably won't tolerate 3 attempts with an 18 gauge. Use good judgement.

5. Ask for help if you need it.

6. Once you've found the IV site you like, pull the skin taut prior to sticking your patient. It straightens out the vein.

7. If you miss or the vein "blows"...apologize to the patient that they're going to have to be stuck again. It may not have been your fault, but that helps to put a patient at ease, and that is something they deserve.

8. Of course, assemble all your equipment prior to starting your IV. I can't tell you how many times I've had to ask someone to go get me a...tegaderm, or an armboard. Don't I look stupid!!

9. Don't stick the patient in their dominant hand unless it's all you can find!! It's bad enough they're in the hospital, do you have to take their hand away along with their mobility??

10. I prefer the wrist and forearm for IV starts, especially on peds. Generally no need for an armboard (in the forearm anyway) and not really close to a joint.

11. As others have said - go for the AC if you're just starting out. Then work more distal.

12. Be aware of patients you may have to have help with. An 80 year old fist can hurt awfully bad when it hits you square in the head.

PRACTICE PRACTICE PRACTICE

And don't worry...it's not brain surgery - you can do it!!!!

Hope this helps!!

John

vamedic4

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The rest may be similar to what's written up top...I posted it awhile ago -

As I've started IVs here in Dallas for the better part of twelve years and probably over 1000 IVs, here's what I know.

1. If the baby's asleep and wakes when you flush the IV...it's probably bad.

2. If the left arm has an IV infusing and it's twice the size of the right arm (assuming no preexisting conditions)...it's probably bad. But check the TAPE JOB. Too tight on the tape will send an IV south very quickly.

3. If you're having trouble with an IV, break it down - take the tape off CAREFULLY and try to find out if the catheter is still in the vein - or in the skin for that matter. Sometimes over time the catheter can kink, especially with active children. Reflush, retape.

4. Flush your IVs frequently when establishing them. Both right when you hook up your tubing, and during the taping/securing process. You have no idea how strong little arms and hands can be and they can wiggle that catheter out of that vein like nobody's business.

5. During an attempt at an IV on a little one, the most important person in the room are the patients (*for obvious reasons) and the person HOLDING the baby still. An ineffective helper is the one who doesn't hold on tight enough. You have to pretty well immobilize little ones - and that can be difficult. Swaddle the baby and leave out only the extremity you're working on, if possible.

6. CHECK YOUR IVs FREQUENTLY!! "It looked fine this morning but I didn't flush it..." Duh...and you graduated from nursing school??

7. Try your best not to "overtape" your site. It is a royal PITA to tear down all that tape 20 minutes / 2 days after you started it. Less is more...as long as it's secure.

8. Use a padded board to immobizilize the extremity. Tape securely but not tight enough to occlude circulation - it's easy to do (taping too tightly, that is).

9. Double side your tape for patients with sensitive skin (babies) / patients with tons of hair. In this instance, use your tape mostly on the skin directly around the insertion site, if you need it at all. We use a Tegaderm and silk tape for a chevron, if necessary.

10. Discretion is necessary when establishing an IV. Don't put a 24 gauge in a kid who's 10 years old, has great veins, and is gonna get gentamycin for a week. Use common sense. If he can tolerate a 22, or even a 20, give it to him.

11. Use whatever pre IV anesthetics your institution allows. We have cold spray and EMLA cream. Both work well, but be advised EMLA has a tendency to make veins disappear -and it gives the skin a "waxy" feel, which can make palpating a vein you found 1 hour earlier a very tricky ordeal.

12. IF THE SITE IS COLD, YOU'RE GONNA BE HARD PRESSED TO FIND AN IV. Warm the area up with a warm pack first if necessary. Cold extremities = no veins.

13. Start distally. Look for IVs in the patients hands before moving up the arm. Try to avoid the AC if at all possible, unless it's critical and you need fast access, or if the child just doesn't have anything else...it happens more often than you know.

14. Don't put an IV in a 16 year old girl's right hand IF SHE'S RIGHT HANDED unless you just can't find anything anywhere else. This goes for ALL children/ adults who are at the age where the dominant hand does most of the work. Also true of infants who suck "that thumb". Again, unless you have no other options.

15. DON'T EVER walk in and introduce yourself as the IV EXPERT. Kharma has a way of biting your ass. Let someone else build you up - that way your performance speaks for itself.

16. Be aware that some infusions, like Potassium, sting when infusing, especially to small veins. Antibiotics like gentamycin are caustic to veins as well. Keep this in mind when assessing your patient's response to therapy.

17. Look everywhere for the best access. A large vein in the saph is better than a small vein in the hand, at least for the purposes of the attempt. It's far easier to his a large target with a small needle than to push a catheter thru a tiny vein.

18. If your patient may require fast acting meds (Adenosine), establish an IV as close to the heart as possible. With infants it's not such a big deal, since there's maybe 12 inches the med has to travel, but with adults and older teens it becomes very important. When you've got a med with a half life of 12 seconds...it matters bigtime.

19. If you're going to be the one starting the IVs and you don't have much experience...practice on your coworkers before you come in and stick my child. Also, if you have the option - start small...work with the healthier kids before moving on to attempts on the truly sick ones. That way I don't have to worry about you blowing 2 veins I could have used for access.

20. Last but not least, know your limits!!! I can't stress this enough! If you stick twice and aren't successful - FIND SOMEONE ELSE. Preferably someone with more experience/ or someone you trust.

You can do it...PRACTICE PRACTICE PRACTICE

John Cork

Licensed Paramedic/Clinical Technician

E8 Cardiology

Children's Medical Center Dallas

Practice is the key! Have no fear. :) Even if the person is a "hard stick" (and don't always believe that) try once! Look for veins in places that are often overlooked - back of forearms, thumb/wrist area, under watches and name bands, upper arms if necessary. Spend three times as long looking as you do starting the IV. Think of things like "how straight is the vein? How large is the vein? Does it bifurcate? Does it feel like it has a lot of valves?" You will gain valuable experience by feeling a lot of veins.

Always walk into the room thinking you can do it. Don't tell the patient "I'm going to try to start an IV" Say instead "I'm going to start your IV so we can give you fluid/medicine". Distract your patient by talking about other things while you work. Explain that you like to spend a lot of time picking out the best possible vein. Many times on elderly patients with fragile veins, a BP cuff pumped to about 40 or 50 is more effective than a tourniquet - less pressure and less apt to blow the vein. Or no tourniquet at all! If you have the catheter in the vein but can't thread it - don't try to "force" it at all - gently hook your flush to it and try to gently "float" the catheter into the vein - sometimes this will open a valve or carry the catheter with the flow of blood through a fork in the vein. Try to visualize in your mind what is going on under the skin with your needle. I know in nursing school they tell you that you will feel a "popping" sensation when you enter the vein - often this is faint or non-existent. Watch that flash chamber - if you get a flash, make sure it continues to fill before you try to thread. Practice makes perfect, and even people with lots of experience will have a bad IV day occasionally. It just happens. Oh, and make sure your not hungry/shaky or having to go pee - nothing to blow your concentration or steadiness! My crowning moment was the night I got an IV that anesthesia missed! It was just because I had the courage to try and I took my time! Good luck to you - starting IV's is one of my favorite things, because I love the feeling when I get one easily and the patient says "I'm going to ask for you next time, that wasn't bad at all!" Don't be afraid to ask good IV starters what their secrets are - most will share!

BD Healthcare systems have several videos you can download for venous puncture technique. Although it is illustrating their product, I found it extremely helpful. Also, check out the IV therapy nurse websites, they have great tips and they do work.

Could you provide some direction as to where on their site? I've been all over and can't seem to find the videos.

Thanks so much.

Specializes in med/surg, telemetry, IV therapy, mgmt.

https://allnurses.com/forums/f18/iv-tips-tricks-3793.html

http://www.nursingcenter.com/prodev/ce_article.asp?tid=582125 - "on the road to successful i.v. starts", a ce offering from nursing 2005, may 2005. a beautiful article with explanations and good photographs of what the author is explaining.

if you are really serious about learning as much as you can and becoming a kind of expert on ivs you might want to invest in purchasing a copy of the current standards of iv therapy published by the intravenous nurses society for reference.

Seeif you can do some phlebotomy. I worked in a small office where the nurses did everything, including drawing all labs. I probably drew 3-10 people a day; it really helped my IV insertion skills.

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