IV insertion problems

[nursing_problem]

hi guys. just want to ask how do you deal with relatives who demands nurses to make sure they can insert or start iv just once esp. in pediatric patients. we all know that we dont like failing an iv to any ptient but their are times that we have bad luck on starting one. The relatives kept on telling me that i dont know how or im not good at inserting an iv for failing once.i tried again and i succeeded.

It bothered me how they yelled at me infront of other and told that i dont know how to insert an iv.

[psu_213, BSN, RN]

Patients tell me all the time "you only get one chance" or a family member chides me for missing on a 95 year old patient. In our PG reports there are always a few patient comments along the lines of "that nurse is SO unprofessional...she had to stick me 4 times and got nothing. I am so easy to get and now I have a black and blue mark!!!!!" Ugh.

I have missed what appears to be the "easiest" veins. I have see staff members who are the best sticks miss some that are not too difficult. Misses happen, even on the easy sticks. I will never promise a patient that I will get them, and I will never blame them if I do miss. If they are going to be mad about a miss, so be it. Move on, and that's that.

[Altra, BSN, RN]

When I get that vibe from patients/families I take a timeout. I actually sit down, if possible, to have a conversation. I review with them what we're doing and why. I calmly and matter of factly state that no clinician in the history of the world has gotten every patient, every time, in one stick. That one stick is absolutely my goal. That if I truly do not feel/see anything I am confident of I will call another clinician. That these are the things I'm doing to maximize our chances of success (making sure the arm is warm, letting gravity assist us, using ultrasound when needed and available, etc.). That if they would be more comfortable stepping out for a few minutes while we do this, I absolutely support them in that. Do they have any other questions or concerns about what we're doing or why? And if they insist that only one stick will be allowed, what is their plan for the patient if one stick is unsuccessful?

One of three things happen:

1. About 1/2 or 2/3 of the way through this spiel they get bored and say "just do it". (seeking additional information or even emotional support really wasn't the goal of these folks)

2. We proceed, with or without family present, and access is obtained. About half will be genuinely grateful, and about half are disgruntled that that potential source of complaint has been removed.

3. The patient/family asks for a different provider. Most IV team nurses at my hospital tell ED patients up front, "I'm happy to take a look, but if the ED staff was unsuccessful that will probably be the case with me as well."

Be confident in your skills. Take your time with someone who appears as though s/he will be a hard stick. And let comments roll off you -- trust me, the comments are not about you. They're about someone else acting out.

Good luck to you. :)

[psu_213, BSN, RN]

and about half are disgruntled that that potential source of complaint has been removed.

This is right up there with when patients are upset the we didn't find something more serious on their x-ray, CT, MRI, etc.

[nursing_problem]

actually i brought the kid in our nursery to Ask for assistance. However, they went outrageous when they learned that the kid will be the only one to go inside and.without them. So i brought the kid back to er and inserted it myself. I actually believe tht sometimes having relatives who have attitude like that brings negative vibes. It may cause stress and pressure making you fail.more

[RN&mom]

I had to go to the ER for a migraine recently and it happened to be after work on my 12th day in a row (I had volunteered to pick up the time)... Anyway, it was really hot & humid that day and I was extremely busy and didn't drink enough water so I really didn't want to go because I knew I'd be there a while :/ It was a nurse that didn't know me (surprising because I live in a small town & unfortunately have been to the ER a few times for my migraines), so this woman didn't know I was a nurse which was nice. It took her 4 times to get my IV in and she felt so bad, I could tell she knew what she was doing but I was dehydrated, it wasn't her fault! I'm usually a very easy stick so I had to explain to my husband (once the nurse left the room) why it took so long to get an IV in but then he understood as well. We are humans, it's amazing to me that we are held to a higher standard and never allowed to be imperfect?? Why is that? There are some mistakes that are unacceptable but we can't always be perfect and I don't know why the public has that perception?

[nursing_problem]

I agree with you mam. If only they know how much we do our best not to commit any mistake to our patients.

[Chesam7]

I just let them know I am going to do my best. I had a woman yell at me telling me that she was stuck 15 times and nobody could get anything so I better know what I'm doing. I told her that I was going to take a look first and I would only try twice. She agreed and I got one on the 2nd try. Don't let people be pushy and stand firm but also reassuring. Be confident!

[iluvivt, BSN, RN]

Do not let patients and family rattle you with that line. They often do not think much beyond that demand. Sometimes I want to say "OK then I guess you will not be getting the antibiotics and IV fluids that will save your life". I never would of course say it that way but I have many times had to remind patients that if they want the treatment then it must be done.

I do not spend too much time trying to convince them or talk them into anything and I do understand this in part comes from a sense of loss of control. What I do say" OK..I will take my time (if not emergent) and look very carefully and make this as easy as possible for you and I am kind. Once they see I am confident and caring and I am doing my best even if I do miss they let me try again. I also gently remind them we will getting whatever it is they need as soon as we can (pain meds, IV abx,antiemetics). This approach works wonders.

Once in a blue moon you will get a nut job that enjoys being a challenge for you and when you get it on the first attempt they say something stupid such as "You just got lucky". I usually do not add any fuel to that one but want I want to say is, "yeah right! my 32 years of nursing and 26 years as an IV nurse means nothing". There will always be ungrateful demanding patients and you have to let those types not bother you.

[Mandychelle79, ASN, RN]

From the other side... I know I am a hard stick. I never tell someone they have only one shot. For my surgery they started one IV and then put me under and started the other one. I had major bruises. When I had my daughter, the vein they were able to access made it impossible for me to move my arm, every time I did it would occlude. I was in labor for 3 days, by the end of my labor, my hand looked the hamburger helper icon. So fast forward almost 3 years and I am in having my son, when they went to start my IV I asked the nurse just to call the IV team. It was explained to me that they were required to try. I said thats fine, please use this vein ( surface vein my forearm), they calmly explained the reasons they did not like to use that vein. Warm towels, slap therapy, 2 nurses, 4 missed sticks and 2 blown veins later, they called the IV team. 20 mins later I had the IV exactly where I asked it to be placed.

[Poochiewoochie]

Every time they try to start an IV on top of my hand they hit a valve. The last surgery I had the nurse tried 3 times before she managed to get it in. I think she was more flustered than I was and she told me to make sure I tell anyone else the next time I need an IV. But I already knew it because it happened before but won't tell the nurses because they don't believe me.

I'm having surgery a week from Tuesday and look forward to another session where they can't start an IV and I have bruises on my hand for several days after.

[Judy Mae]

I was admitted directly to the hospital from the doctors office. I was very sick, they tried putting an iv in me. However i was dehydrated, and a hard stick that day.The nursing staff stuck me 26 times and could not do it. The head nurse on that floor called the emergency room and two nurses came. These nurses stuck me twice each they could not get my iv in. I did not tell them that i am a nurse. I know these nurses only wanted to help me. Then four years later, i was at the doctors office and very sick again. When my doctor said he wanted to hospitalize me, i refused to go to the hospital that stuck me so many times. I was sent to the new hospital. I told them "I am a hard stick when i am dehydrated" and two different nurses could stick me two times each. And that was it. Both nurses stuck me. IV was not inserted. I had to drink plenty of water and take oral antibiotics. Even if you are in the nursing field some things leave a lasting impression.