Could I get some quick tips on IV starts?

Personally, I prefer veins I can feel to the ones that I can see.

Me too, but I think that has come with a lot of experience. It's been my experience that newer nurses/nurses who are uncomfortable with IV starts look for veins that are visible, and nurses who are skilled at IV starts look for veins that are palpable.

When I do an IV start, I start at a more acute angle, and then as soon as I get into the vein, I become much more shallow as I advance it a little bit more/obtain flash. Once I've had flash, I advance the catheter, and only after the catheter advances do I retract the needle.

Glad to see this b/c as a new nurse I am not great at IV starts. I have the hardest time getting the catheter advanced and the needle pulled out at the same time. I also seem to have a hard time guaging how deep to go. Great tips btw. I work L&D and usually they have nice juicy veins, but not always and of course due to my inexperience i can't always get them, but hoping with practice!

Another tip - after you've advanced the catheter but before you pull out the needle, take a finger or thumb and press on the vein above where the catheter tip would be, THEN remove the needle. This helps prevent a big bloody mess (but not always, so I NEVER start an IV before putting down a chux first.

But really, the best thing you can do to get better is just practice practice practice. In L&D there are lots of opportunities - offer to start other RNs' IVs for them.

I think the type of device used is also important - in the hospital I work in we use Braun Introcan's - the needle doesn't retract, you have to physically pull it out of the catheter - I've lost several good starts that way because the catheter comes with it (due to inexperience)...

If it's not contraindicated a little heat will cause 'hidden' veins to distend and rise and bounce upward. I usually place a hot pack on the area where I'd like to insert the peripheral IV and let it sit there for five minutes.[/quote']

Thanks! In what situations might a hot pack be contraindicated?

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I always use a manual BP cuff, inflated to about 90mmHg (less for tiny thin skinned folks) instead of a tourniquet. I can use a tourniquet if need be, but I find the BP cuff gentler on veins (they blow less often) and patients tell me it doesn't pinch as much.

My biggest tip though is to ask one of the IV gurus where you work to show you their tricks.

When people say rub with alcohol, they mean RUB, not just wipe. Put a little elbow grease in to it (within reason of course )

Also on the heat/warmth thing. I often just wrap the arm (or arms if I'm unsure which I'll use) in a heated blanket for 5-10 min before starting.

On elderly patients I pull down below where I'm starting the IV and also hold slightly above where I'm starting, it sometimes helps those veins from rolling on you at the top and blowing the vein.

I've been lucky that the floors I've been on in school have allowed a lot of IV starting practice and awesome patients that allow a student to start them. Practice is the best way to get good at it.