Any advice on IV insertion skills?

livingonadream · Jun 12, 2013

What is happening when you are starting IVs? I was a phlebotomist prior to nursing and good at IV starts. The problem I see a lot is that some nurses can't feel the veins, they expect to see them.

BSNbeauty, BSN, RN · Jun 13, 2013

This is my problem. When I cannot see the vein I miss all the time. I also have a problem with threading the catheter. I suck at IV's period. I've had plenty of time to hone these skills but I just suck at IV's....

s0ad · Jun 13, 2013

During one of my clinicals, there was nothing but IV starts, but on relatively healthy patients, and I got pretty good. Now I might have a chance to start an IV once a week on very sick patients, with very bad veins. And I absolutely suck at it. Its incredibly annoying. I got into what appears to be a good stretch of vein and either nothing, it blows, or I can't advance. And my female foley skills suck. I have always had extremely demented patients or morbidly, morbidly obese ladies. Its very annoying. Everyone told me these skills would come in time, well its been a year and they haven't. I'm very disappointed as well!

stoberto · Jun 13, 2013

Volunteer for every stick you can, hard or easy...and there are no concrete rules with IVs in my opinion...sometimes you see them and can't feel them, sometimes you feel them but can't see them, sometimes you aren't sure if you can feel OR see them, sometimes you should go in at an angle, sometimes right on top. One thing I see many people do wrong is they don't pin those suckers down well enough so they move too much...just keep at it.

Rhi007 · Jun 13, 2013

The technique to starting an IV is similar to that of intubation for docs....visualisation! If you can't see the vein but can feel it visualise the path. Also keeping the skin tought will stabilise the vein preventing it from rolling

SaoirseRN · Jun 13, 2013

If you are having trouble threading, sometimes I find it's a matter of the IV device itself. For example, we use Nexiva, and so many people make the mistake of pulling the needle out before threading the cannula into the vein. I suggest asking someone who is good at IVs to show you (not on a person) exactly what they do with their fingers during each stage, and why.

Learn to feel veins, and landmark anyway you can -- freckles, corner of an alcohol wipe.

Around here, they teach students to start at a 45 degree angle to the vein and then drop it down when they get into the vein. Don't do this. Start shallow.

Ask to watch the IV gurus on your unit and take tips from them. I love teaching people to do IVs! Chances are someone like me exists where you work, too. Everyone loves to hear "you're so good at these! Can you give me some tips?"

green34 · Jun 13, 2013

Also, some IVs you should start without a tourinquet. If they keep on blowing, consider trying it this way.

nrsang97, BSN, RN · Jun 13, 2013

I agree with finding someone on your unit who is a go to person for IV starts and have them go with you a few times. Just keep trying. The more you try the better you will be. Volunteer to do any IV if you can.

Emma_H · Jun 13, 2013

Thanks everyone :) Great tips.

Emma_H · Jun 13, 2013

I am having trouble threading for sure... seems like there are always new IV's coming out!! Thank-you.

stoberto · Jun 13, 2013

Many times if you can't thread your cath isn't actually in the vein yet. When your needle tip goes in you get flash, but you have to advance a little further before you can start threading. Some old school nurses where I work actually insert the entire needle if the vein is straight before they retract...it's crazy to me but they have done it for years.