Any advice on IV insertion skills?

R!XTER · Jun 13, 2013

One major factor I find is making sure the patient holds still. If they move or tense up their muscles you can miss or blow even a really prominent vein. I'll often tell the patient something like " OK sir, your one and only job is to hold perfectly still so I only have to poke you once" that usually works because the don't want to be poked twice!!

That Guy, BSN, RN, EMT-B · Jun 13, 2013

Practice on each other. Have the people who are good tell you what you are doing wrong. We have the nexiva too and I hated them compared to the Insyte. There is definitely a different technique between the 2. Just practice practice practice.

NicuGal, MSN, RN · Jun 14, 2013

No way would I let anyone stick me lol

bratmobile · Jun 14, 2013

Funny I was just about check you tube for video demos on Iv insertion lol.. I'm having a dry spell ..was getting pretty good but now I've failed at my last 3 .. I hate the feeling that I can't do what I'm supposed to be able to do : (

bratmobile · Jun 14, 2013

Ps there are some good demos on you tube ..just looked at a few..

musicnursing · Jun 14, 2013

When I was new to my current hospital setting, my director had me on orientation 2 days back in our ambulatory surgery area (I normally work Med-Surg) and start IVs all day for 2 days, they always have an IV nurse back there that is all he/she does all day is go from bed to bed starting IVs. After about 50 IV starts a day x2 days, I was feeling a whole lot more comfortable. Also, back in ambulatory, they start all the colonscopy pt's so they are usually pretty dry after thier prep and its work to get into thier veins, it was excellent practice.

Bezoars · Jun 15, 2013

I usually have to see a vein or I can't get it. That being said... I have stuck veins all over before, if there's a good one. I will do upper arm, arm to shoulder area, foot (with an order if they aren't running continuous fluids.... I have even stuck the top of a large woman's breast before b/c she had veins popping out everywhere there. Sometimes, you just need something... even if it's not the greatest spot or you can only get a 24g in.

bigsick_littlesick · Jun 17, 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?"

LOVE those Nexiva catheters! I did my preceptorship in an ER and they stocked those. I never missed a vein! Found it very easy to thread using finger flick method. Poke, flash, drop angle, advance slightly, then thread, DON'T move the needle. You have good tips above. After doing so many in the ER, it got pretty easy. I think I still need practice searching for a vein, however, like when I can't see it but I'm supposedly supposed to be feeling the "bounciness" of it and I don't :/

jadelpn, LPN, EMT-B · Jun 17, 2013

It is all in the feeling for the vein that should feel like a rubber band. Hold the skin taut if you need to to prevent rolling. Agitate the skin well with the wipe. I have had patients hold their arms straight down. AC's are not my preference, however, the elbow needs to be really straight for you not to blow the vein. And if you feel like you did not get in right away don't just pull the needle back out. Reposition without coming all the way out. Feel your path. Hand veins are tricky, as they tend to have a lot a valves. So if you can go to day surgery one day and just keep sticking, you will find your flow.

Don't hesitate to really feel for the vein. Sometimes you have to depress the skin well to feel it. Not all veins are surface veins. They need you to go into the skin past the very surface--but not at some crazy angle. And check multiple sites. Sometimes one side is better than the other. Sometimes a patient knows where they "get" them for IV's. So take your time and really feel.

Also be 100% sure you are fully set up. Sometimes just reaching around for stuff (tape, op-site, tubes if you needs labs) is enough to dislodge the catheter.

Now if this is an emergency insertion, go right for the AC--right down the middle. Take the elbow, straighten it out, agitate, FEEL for it, and go. Keep that elbow straight.

You will get this!!

lilaclover6984 · Jun 17, 2013

Some great advice on here so far!! I also realllyyyy suck at IV's and I don't know what my problem is. I often can get flashback but then when I go to attach it and flush I loose it. Any ideas what I may be doing wrong ?