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
Specializes in Emergency/Trauma/Critical Care Nursing.
i hate to say it but you tube has some pretty decent "how to" videos for IV insertion. Of course you have to weed out the ridiculous ones, but I just found a pretty helpful one for difficult neonate iv insertions that I like!
I am a recent grad (Dec '11) and have been working as an ER Tech over the last 6 months. One of my primary responsibilities is starting IV lines in the ER setting. We tend to drop an 18 in the AC as our primary option, and go down in size and/or further down the arm if necessary. My IV insertion skills have improved by leaps and bounds over that 6 months of experience, let me tell you! (so practice, practice, practice is certainly the best advice).
What has worked for me is to talk with my patient (if responsive, and if not in an urgent/emergent situation, and if able to understand what's going on) about their IV experiences and after making sure there isn't a reason to avoid a particular arm (mastectomies, dialysis grafts, etc..) I always suggest that I put a tourniquet on each arm in turn and "just see what veins they brought to the party" before I even reach for my IV cart. I make sure not to be rushed as I examine their arms/hands in turn looking and feeling to see what our options are before I even select a needle gauge.
After I know what veins they have, I can select the best (biggest available, best flowing - for the ER setting) IV catheter for the job. I don't always use the biggest vein. Instead it may be the one in the best location or with the least obvious valves, or the one that actually runs straight instead of twisting turning and diving up and down. Don't feel married to the AC, the Forearm and the back of the hand. Take the time to look and feel - all over the arms
The actual insertion technique is well described here already, and there are some great You Tube videos out (and some really bad ones!) I spent several hours watching videos after my first night of work 6 months ago. They helped me more than my preceptors did when it came to IV insertion! I do tend to do a little tunneling through the skin/fat before I attempt to pierce the vein. That allows me to flatten my approach angle to match a little easier. If I'm using a 1-1/4 inch long catheter I probably have a quarter to half an inch of catheter tunnneled into the skin/fat before I even enter the vein itself.
My proudest IV moment so far has been starting a 22 in a patient's middle finger - because that's the only vein they had and we needed access before they could leave the ER and go up to the floor.
I've noticed that some nurses go for the same veins on patients, and are usually successful, even if the veins are not visible, but palpable.
I used to be really bad at IV sticks, but my hit rate of late has been 100%. I'm so proud. I usually go for the radial branch of the cephalic vein (had to google that to get the correct anatomical name), about 2 inches proximal of the wrist. I don't know why, but it has become my go-to vein. Much of the time, that vein is palpable after tourniquet application when nothing else is.
Anybody else want to share their go-to veins and why? I need to expand my horizons...
Golden_Dawn
22 Posts
Great suggestions from everybody, thanks so much, you helped me too!