I am a moron--I need I.V. help - page 3

Hi everybody. I was hoping someone can help me. I am in an awful slump. It seems I can't start an IV to save MY *******' life. I had an old lady with nice old ropey veins you could see clear as... Read More

  1. by   Shellsie
    i think we all have those "barn door days" as i like to call them...you know the days you cant hit a barn door...let alone a vein on a 90 yr old dehydrated little old lady.

    hang in there and you will find your "nitch"
  2. by   Rena RN 2003
    INT = intermittent needle therapy at our facility. sounds korny as hell to me but i don't get to make the rules. :chuckle
  3. by   Deaconess
    What I have found helpful in improving my IV skills is watching others. When I have "struck out" on a difficult stick, I hope that one of the one or two nurses that can get anyone is on. I watch them and get tips. We only call IV therapy as a last resort to document the need for a PICC.
    Another helpful thing to remember is that if you are getting flustered, its probably time to get a fresh set of eyes to look at those veins.
    For patients that you just can't see or feel anything on (renal patients, especially), warm packs work nicely.

    Anyone have tips for babies and tots?
  4. by   teeituptom
    Just keep sticking untill you get it right
    just stick to it
    a stick in time saves nine
    sticktoitness is a good habit
  5. by   thanatos
    Quote from Scis
    Lidicaine is helpful to us on our end, but speaking from the end of the receiver, Lido is painful!! The one time someone (an anesthesiologist) started an IV on me using Lido it stung like a son-of-a-gun, hurt much worse than the IV stick. The MD told me he gave it to "numb up the area" where he was starting the IV!
    Good try! Of course he had no idea I was an ER nurse!
    Try buffering the Lidocaine w/ Bicarb (we call it BiLi), it works great! It numbs the areas immidiately around the site w/out the burning sensation. Lido is packaged in an acidic solution in order to provide stability, and that causes the burning sensation. The bicarb raises the pH and thus decreases the pain. I became a believer after the day surgery nurse used it on me...I barely felt the IV (an 18g). I use it w/ good success in the ER on school age children (and certain adults). Ask your pharmacy about it; it's easy to make and stable for about 1 week.
  6. by   thanatos
    Here's a trick to practice the one finger advance. Take some IV tubing, wrap it around a table top, and then tie the ends in a knot. That is now your practice vein. Stabilize the tubing "vein" w/ your nondominant hand above & below the venipuncture site. Now cannulate the "vein" @ 10-15 degrees. As soon as the needle enters the lumen (in a real vein this would be designated by a 'flash'), lower your angle to nearly flush to the skin, and advance the needle another ~ 1/8 in. Now, while mainting traction w/ nondominant hand, slip your dominant index finger off the needle and onto the hub of the catheter...then gently advance the catheter by pushing off w/ your index finger. After some practice, it becomes second nature. Good luck. Remember: practice, practice, practice.
  7. by   thanatos
    Some tricks when starting IVs on infants:
    1) Place Emla or Elamax on target veins (I always place it 2 different sites).
    2) Flush the angiocath w/ N.S. and the leave the back cap off. This allows for quicker visualization of blood flash, esp. in dehydrated kids.
    3) Try using a transillimunator if available.
    4) On the dorsum of the hand, there is almost always a vein above the 4th metacarpal.
    5) The saphenous vein, located just anterior to the medial malleolus, is a great site on infants.
    6) Don't forget the scalp veins.
    Good luck
  8. by   veetach
    who has EMLA or a transilluminator available in their ED? not us...
  9. by   lynn27
    Those big ropy veins can be so misleading...I had a patient that had those big ole ropes (pt was in her late 30's) and I could not believe it when I missed her vein--so I called another nurse who attempted x2 sticks without success. Finally, the doc (who was quite annoyed with us since we were obviously so inept) states, "Well, I guess I WILL HAVE TO DO IT". And then he misses it, x2. Was funny--even the pt who had endured so many attempts laughed at him. Finally our salvation was an ER nurse who made us all look so bad...she did it in one stick and wasn't in the room 1 minute!! Thank you to all of you ER nurses out there--have helped me more times than I can count!
  10. by   thanatos
    Quote from veetach
    who has EMLA or a transilluminator available in their ED? not us...
    We have both Emla & Elamax in our ER pyxis. As soon as child appears to be candidate for an IV (non-emergent, of course), we try to put some on.
    We don't have a transilluminator in the ER, but we can borrow the Nursery's. You can actually use a strong penlight or otoscope with the same effect.
  11. by   BadBird
    Some things that I find helpful are to make sure all my supplies are ready, tape, etc.. when you find a nice bouncy vein, anchor well, hold it down so it doesn't roll, make sure the angiocath is bevel up when you enter the vein. Once you get blood return release the tourniquet and advance the catheter. Have the extension tubing with the flush hooked up and ready, always check for a good blood return and flush.

    Never stick a ecchymotic area, or below one, try not to stick the anticubital area because we will bend our arms and occlude the iv.

    The more you try the better you become. Sometimes those big ropey veins are so occluded that you never get blood from them. Once you learn to stick what you FEEL instead of what you SEE and gain some confidence you will do well. Remember to try to feel that bounce. If the vein is small use a #22gauge, I never put in anything smaller than a #22 because many of the meds we give are viscous and will blow anyway, also you can't or shouldn't give blood in anything smaller than a #20 gauge, 18 is preferred.
  12. by   kcrnsue
    sweety,(I hope you don't object to me saying that). You just reminded me of the very first I.V. start I did as a student. This LOL had hoses for veins. With my instructor watching over my shoulder, I stuck her, and very slowly tried to advance the catheter. No flash. Palpated. My instructor palpated. There was no way I missed. My instructor fished, I fished. Then, my instructor and this extremely sweet and patient lol, started trading jokes. This lol laughed at whatever it was my instructor had told her, and halleluia, I got a flash! It was the funniest thing ever, but my instructor just chalked it up to a spasm, that resolved after the patient relaxed! Sometimes, things are beyond your control. You will get it!
  13. by   sharann
    Don't feel bad. I miss as often as I try, but I always try to avoid the AC site, and maybe it's my fault then! We had a post-op in PACU 2 days ago. I tried the hand which had a lovely vein, blew it. Another nurse tried..blew it. THEN 2 different Anesthesiologists tried..guess what? Then the 3rd Anesthesiologist got it(On his 1st try the bum). So anyhow, there is some great advice above, which I will follow as well!