I'm a terrible sticker. It doesn't matter if I'm using a butterfly to draw blood, or putting in an IV.
Also, exactly when do I release the tourniquet?
Which size catheter? Best place to go?
How deep to stick? What angle?
I heard that using a blood pressure cuff is better on old and fragile veins. Any truth to that?
If you can help me I will kiss you! :kiss Nurscee
Sep 27, '05
I had no IV skills when I started out. My first employer asked me how good my skills were and I said "don't know, haven't tried".
I did all the sticks on my 40 bed unit for 4 months straight. No matter how difficult, nobody was allowed to try until I had tried twice or it was an emergency.
I missed 40 times straight at one point.
But now I'm a good stick, A resource starter for my hospital.
Practice, Practice, Practice. Don't pass up opportunities. Don't go get help until you've tried twice. No matter how difficult. Don't cringe at the opportunities. How else are you going to get good at it?
Learn to start both by feel and sight. I find the vein by feel BEFORE I put on gloves. If you can only start by sight, you are at a huge disadvantage.
Unless it's a child, avoid a 22g like the plague. It is simply not an adult catheter. They don't last as long, they aren't stable enough to site properly on an adult, and they are useless in an emergency. Using a 22g in an adult is cheating. (I know some will disagree with me on this, but I stand by it. You can't give blood through a 22g, and you can't give bolus fluids, if needed - they aren't large enough. And they don't last - they blow veins because the smaller the lumen, the more pressure you are using to flow fluids into the vein at that site.)
Because I was banned from using 22g in adults when I was learning the skill, I find it much easier to place a 20g than a 22g, no matter how small the vein. 20g and 18g are more stable. If you only practice on 22g, you will never learn how to start 'real' IVs.
Learn to use 18g PIVs. If it's a big vein, try an 18g first. It is my experience that 16g for OR/Trauma/Need to give fluids very fast, 18g are the preferred size, and 20g are for difficult veins. 22g are for children only.
Last edit by ZASHAGALKA on Sep 27, '05
Oct 6, '05
All of the above poster have given some really good tips. I work in a surgical prep area and put in about 4 to 5 IV's an hour.
Another thing I like to do if I have someone that seems to be a difficult stick, is sit them up in the bed and hang both of their arms straight down (let them dangle). I let them do this while I arrange my supplies. Make sure you have good lighting and are comfortable (pull up a chair). Once I sit down and I am ready to go, I tie the tourniquet a couple of inches above their wrist. I like to have the patient place their thumb on the inside of their hand, it helps stabilize the vein. Have the patient tilt their wrist however you need to straighten the vein for you. I've never learned to enter the vein from the side, I have always went bevel up through the top. My angle depends on how deep the vein feels. Once I get my flash I straighten out my angio, advance slightly, then slide the angio off the needle. Then I release my tourniquet.
As the other poster said, the size of the needle and the location of the site will all depend on the reason for the IV.
Keep working at it and you will develop your own style that works for you.
Last edit by Darlene K. on Dec 25, '05