Bad IV Day

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UPDATE: Changes: New Log In Requirement

Does anyone have a guess as to why some days you miss even good veins when  doing IV's? I can't figure out why it happens, but so frustrating!

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Specializes in Psych, Addictions, SOL (Student of Life).

What age group are you working with?

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60's and up usually. 

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In my experience, rolling veins are more common in geriatric patients due to decreased skin elasticity and tissue, which can contribute to unsuccessful IV sticks

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It's because you're still learning. When you become a complete expert at putting in IV's  you don't have 'bad IV' days. You just have really hard IV's.

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Specializes in Infusion Nursing, Home Health Infusion.

I'm a a long  time IV specialist . The reason you have off days is because there are so many variables that effect whether you. easily succeed at gaining IV access. When I was still learning a few decades ago every single time I failed I evaluated why I failed . Did I not look enough? Was I rushed ? Did I select a cannula that was too large ? Did I not use the proper skin traction ? Was the vein too sclerotic? After I determined what if was it added to my skill level and I just got better and better. Several main reasons for failure are improper angle of entry causing a through and through puncture or just nicking the vein and it's blown ,failure to drop your angle after achieving a flashback or other confirmation that you have entered the vein then advancing a few more mms before pulling your needle back and threading the remainder of the cannula , failure to stabilize the vein by appropriate upward or downward traction or both and not taking the time to look for a good vein with the appropriate characteristics that will lead to success. I actually use Transpore tape to stabilize and straighten out the selected vein . I usually just use it for upward traction because I can easily hold downward traction . This one little trick I created a long time ago as increased my success rate and honestly I rarely use US unless I'm placing a PICC or Midline. I got good because I had to do so and didn't have all the tools we have now. I hope I was of some help. 

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Thank you for all your helpful tips! I do try to review what I might have done wrong. I realize sometimes I just "do it" without really thinking and might miss a step I shouldn't have. I learn so much from other nurses! I appreciate your advice!

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When I used to train new nurses in the ER, I'd get a short piece of IV tubing to let them practice on.  We'd do this after they'd already stuck several IV's and had missed a few.  I typically knew what they were doing wrong (too deep an angle, not getting the entire bevel in before trying to thread, etc).  However, showing them on a clear "vein" helped them actually see it and was the lightbulb moment for most.  Once they realized which mistake they were prone to, they could practice figuring out how to compensate.  You can also mimic various patient conditions.  For example, to mimic veins you can see but not feel, put a pillowcase over it.  To mimic obese patients (especially those with big AC veins in a deep crevice!), roll up two paper towels then try to stick between them.  Give this a try, and if you need help assessing your mistakes, ask an experienced nurse to help you troubleshoot.  Hope this helps!  

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You have been given some excellent advice. As a nurse of 30yrs and ER experience, I want to go back to basics: Make sure you're comfortable. Sit down, if possible, allow gravity to help you and allow the extremity to hang downward. This will cause some veinous pooling. Keep the ski taught. Start the IV low and slow in a steady forward motion. and most importantly, trust yourself! Don't automatically assume you missed...back the needle up just slightly and reangle slightly upward / downward or more toward the direction the vein is going then advance again. I do a lot of teaching, and these are game changers. NO BODY KNOWS YOUR SKILL SET. Breath and be confident. We all miss some days.  YOU GOT THIS.

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Thank you so much! 

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Oh the Pipes.  I love those 💖

Most of the time I find you can't use a tourniquet or if you do use one, tie it loosely because those suckers blow just as fast..

And all of the above comments as well (luck)

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