i cant insert an iv catheter successfully :C help

turnforthenurse, MSN, NP · Feb 1, 2012

Practice makes perfect! This skill comes with time. Try using smaller catheters if possible - typically you should only put in the minimum gauge needed for whatever therapy the patient is to receive. Keep in mind that for blood administration, the patient needs at least a 20 gauge. A 22 or smaller will lyse the cells.

With some IV starts, you need to go at an even smaller angle, sometimes even 5-10 degrees in patients with very superficial veins (such as with the elderly). Make sure you have good lighting and sometimes placing a pillow above the elbow (but underneath the arm) and then placing the arm in a dependent position will help facilitate filling of the veins. Wrapping the extremity in a warm towel can also help.

Always wait until you see the flash before advancing the needle an additional mm and then advancing the catheter. I have a tendency to blow veins so the moment I see that flash, I will also take my other hand and immediately release the tourniquet.

Fiona59 · Feb 1, 2012

I suck at IV starts. I try once and ask someone to give it a try.

BUT I can insert a foley in most women first try, a skill that many of co-workers can't.

Guttercat, ASN, RN · Feb 1, 2012

Practice makes perfect! This skill comes with time. Try using smaller catheters if possible - typically you should only put in the minimum gauge needed for whatever therapy the patient is to receive. Keep in mind that for blood administration, the patient needs at least a 20 gauge. A 22 or smaller will lyse the cells.
With some IV starts, you need to go at an even smaller angle, sometimes even 5-10 degrees in patients with very superficial veins (such as with the elderly). Make sure you have good lighting and sometimes placing a pillow above the elbow (but underneath the arm) and then placing the arm in a dependent position will help facilitate filling of the veins. Wrapping the extremity in a warm towel can also help.
Always wait until you see the flash before advancing the needle an additional mm and then advancing the catheter. I have a tendency to blow veins so the moment I see that flash, I will also take my other hand and immediately release the tourniquet.

Great advice from start to finish! ^^^

justbecameRN, don't fret and don't be afraid!

Jump at any chance you have to start an IV. Ask other RN's if they will allow you to start their IV's.

So much of it is by "feel" that only comes with time, and learning what "doesn't work" first.

As mentioned in turnfor's post above, hanging the arm dependent is a great trick. I used it in ER all the time.

Just put the bedrail down and let the patient's arm hang. I bend down on one knee to make cannulating less awkward.

Also, apply downward traction on the pt's skin with a finger on your non-dominant hand, to help stabilize the vessel.

One thing you might do, is vow to only poke the patient twice, and then have someone else do it if you are unsuccessful. That way, it alleviates some the guilt and stress and allows you to relax and concentrate. You can also stand by and watch what they do differently.

Last suggestion. Before you poke the patient, ask them if they have had IV's in the past, and if there have been any problems people have encountered in placing them. A patient that knows they have rolling veins, or difficult veins in a certain area can save you a lot of trouble.

You'll get it! Really you will! So deep breath and onward go, brave newbie!

Guttercat, ASN, RN · Feb 1, 2012

Fiona59,

Speaking of Foley insertions...

We had to call an ER doc once to stick in a foley on a female patient after three of us tried (two young, newer RN's at the time, and one veteran).

He (the ER doc) hadn't stuck in a Foley in umpteen years and... ta-da! It was in lickety split.

Talk about embarrassing.

Turns out her urethral opening was buried up in the lady partsl wall. He knew exactly what the problem was before he started.

Sheesh.

MomRN0913 · Feb 1, 2012

I think your issue may be that you are technically analyzing your every move, to make sure it is textbook. Trust your instincts a little. With time, comes knowing the feeling when you got a good vein, when you are in, how much you need to advance the needle or the catheter, ho it feels on a larger person or a smaller person, tough skin, thin skin.....

All that comes in time.

An no, you are not harming any patients. Don't worry.

DixieRedHead, ASN, RN · Feb 1, 2012

Just look for a straight vein. The size is only relative to the gauge of the IV unless it's blood. Straight is way more important.

smiletoday · Feb 1, 2012

I just became a rn. we didnt have iv insertion class at school but i had successfully extracted blood under the supervision of my c.i before but that was it-- my only experience relevant to iv insertion. currently i am in the middle of my iv therapy training, ive passed the lecture with good marks and (quite surprisingly) passed my practicum, and i think that is just because there was an iv therapy expert assisting me with the procedure. my problem now is i STILL HAVE NOT inserted an iv catheter properly and im starting to feel really bad about the harm that i have brought to the patients with my inexperience and incapability in inserting ivs. i come prepared at the bedside and my hands dont even shake but after locating the vein, and inserting at a 20-30 degree angle (with i believe the right pressure, not too superficially) then laying the cath almost parallel to the skin, and pushing about 1 mm, i dont get blood visualization and in 2 of that 4 failed insertions, have produced infiltration. in all that 4 insertions, i had a supervising nurse at my side, and ive asked feedback from them ranging from wrong choice of vein (on 2 occasions) or too much pressure. i really am listening and opening my mind to their suggestions but i still cant do the insertions right. im currently looking at videos and rereading the procedure but i dont really know what to do anymore. i dont want another patient sporting a swollen hand. has anyone experienced this like i have? what did you do to improve?
although some of my patients were dehydrated, the supervising nurse was still able to immediately insert the ivs easily so it ist the question of the condition of the patients rather my skill. :C

It does take practice. Start with the smaller ones. The hands are the easist. Then move to the larger needles and other areas. The more you practice. The more IV's you will get in. It is a techniques that you feel. It will soon become second nature. When I first started. I could only get the 22's in. Then I graduated to the 20's in the forearm. Could not get an 18 in the AC no matter how hard I tried. Then one day, I got it into the AC. Now, I am pretty consisitent. But I still have times, the vein is waving at me and I can't get it no matter what.

MommaNurse26, LPN · Feb 2, 2012

For me the key was a deep relaxing breath... You will never find the vein if you are shaking in your boots sure you will miss it before you even place the tourniquet...

What I suggest is take a tourniquet to your own hand. Leave it for a moment dangling your hand at your side while sitting. Then close your eyes and gently start palpating your hand. What you want to imagine is a trampoline - a springing vein that when you press on it gently your finger bounces back up. (of coorifice u dont want to do this at work lol they may think you went bonkers)

Visualizing the vein sometimes means nothing if you cannot feel it. When you trust your sense of touch then you can add checking with your eyes. Combining both senses will increase your success rate and give you something to really focus on when you are feeling nervous.

I will not stick someone until I feel the spring and I learned what the spring was by testing out the bounciness of my own veins.

And as you get more experienced severely dehydrated patients or even babies will become very easy for you as you will learn to stick by touch and sight. Good luck! My IV instructor told us that feeling the vein versus just going for what you see - will reduce the infiltration. And I personally swear by. In fact, there are countless times where I either dont see the vein or can barely see it but I can strongly feel it.

Make sure the patient isnt cold when you stick...

If you dont see or feel a vein and have been looking for a minute its ok to tell the patient you are going to take the tournaqet off for a minute to let them relax again - while you clear you mind to go for another shot. Dont just stick blind bc u feel pressure from the patient or peers to get it done and over with.

CheesePotato, BSN, RN · Feb 2, 2012

IV starts have to be one of the most daunting skills for many new nurses to master--you know you don't get many tries, the patient is nervous (most of the time), 99% of the time the reason the patient needs an IV is because they are drier than the shoe leather skin on Joan River's upper lip thus making their veins flat and miserable, and if that isn't enough, you, the nurse, know that you are going to inflict pain on the patient. Ick.

That is one touchy situation.

So what can be done?

Well, first and foremost, remember to look for veins by feel not by sight. Why? Well, for two reasons:

-- Most decent veins tend to hide, the little jerks.

-- As I like to say, let your fingers do the walking. Feeling a vein can give you an idea as to depth beneath the surface of the skin, stability as some veins will actually roll or even wriggle away with nothing more than a gentle touch, and directional tracking--nothing is worse than trying to harpoon--I mean spear--I mean coerce a catheter into a vein which bends, twists and turns like a drunk man at a limbo contest.

This brings to me to my next point: be mindful of the size of glove you have on.

The days of barehanded IV starts are dead thanks to the wonderful world of blood born disease and the responding standard precautions. A glove that is too big will not allow you to feel the vein properly. Take whatever glove size you normally wear and go down a size. I, personally, make it a point to cram my Godzilla paws into a size small glove. Looks ridiculous, granted, but I can find what I need.

Remember to start an IV that is appropriate for the patient's condition and potential treatment. Example: Do not start a 22g on a patient with a hemoglobin of 7. You will only end up having to stick them again later for the 18g you need to have in order to properly give blood product. Stick once and be done. Your patients will thank you.

One last piece of advice:

Do not slap your patient's skin to "make the vessels rise". This is an absolute crock of horse spit. Some old battle ax somewhere got the harebrained idea to slap the bloody hell out of a patient's hand and some sweet young thing saw her do it and thought, "Hmmm, that seems to work."

Yeah.

Not so much.

Trauma to a vessel wall does not cause vasodilation. It causes vasoconstriction. The body tends to curl in on itself in order to protect itself.

I.E. Do not strike, slap, hit, tap, flail, beat, pummel, flick, etc etc etc your patient.

Dangle. Warm. Relax. Play some Marvin Gaye.

Like so many things in life, veins respond much better to sweet lovin'.

::hums "Let's get it on" and wanders off in search of buttered popcorn::

blondy2061h, MSN, RN · Feb 2, 2012

I'm really weird in my technique, but what I've found works for me is to connect a flush to the IV before I insert, then the second I get the flash of blood I pull the needle out, hold the skin taught, start flushing, and slowly advance the catheter alone as I flush. It's almost as if the flush guides the catheter through the vein. Works for me.

japae5 · Feb 2, 2012

If you ask you supervisor, she may be able to let you go to Day Surgery and get experience there. That is what my supervisor did. I spent ALL day just inserting I.V.'s under the supervision of a very experienced nurse....It really, really helped! Can't hurt to try and ask! Good luck!