HOW TO PUT IN A IV: ANY TIPS - page 3
I have just started my orientation on a telemetry unit, and have just been taught to put in IV's, sometimes I get it and sometimes I dont. How long does it take to be successful. I know that we all... Read More
Nov 20, '00Occupation: RN Joined: Apr '00; Posts: 107; Likes: 8I have a word of advice on the retractable IV's. We use Insytes at our hospital (We all hated them at first) One thing I suggest before starting any IV is to test it before trying to insert it. More specifically, push the plastic cannula over the metal needle and give it a 360 twist to make sure it will slide freely when you finally do get in. (Obviously you will put it back in its place after you do this) Nothing is more frustrating to try and advance a dinky plastic cannula into a 93 y/o with dehydration and pneumonia.
Nov 23, '00Occupation: RN Joined: Jul '00; Posts: 7Look at the other arm first! You know...the one that's on the other side of the stretcher near the wall. With IV drug abusers use their dominant arm. That's the one that they use to hold their syringe not the one they usually stick. Look for where a vein bifurcates ("Y" shaped), where 2 veins go into 1 and go right in-between it. Also try a larger cath not a smaller one. Believe it or not it's easier to hit a target with a large object (18g) than a smaller one (22g). Finally, expect hot and cold streaks...it's inevitable.
Nov 24, '00Occupation: R.N. Joined: Jul '00; Posts: 32; Likes: 9Originally posted by hollykate:
Just want to say THANKS for the advice for putting in NG tubes. I finally had an opportunity to try it out, the warming of the tube really made it slip in easier. No problem to pop a few IV;s in the pt, but the NG, I was quaking. Thank you so much for your advice!!!!
Nov 26, '00Occupation: Registered Nurse Joined: Nov '00; Posts: 5HI, Good luck with you orientation. Some suggestios. Make sure you are in a comfortable position. I always bring the bed up so I am not bending over. Have all your equipment ready. Make sure you have good lighting. I hold the vein real taught so if it is a wiggly vein it will stay put. Just keep practicing. You will get it. It will take time. Have confidence when you are going to do an IV. Don't get discouraged. There is going to be times when you can't get an IV in. Good Luck.Originally posted by egmillard:
I have just started my orientation on a telemetry unit, and have just been taught to put in IV's, sometimes I get it and sometimes I dont. How long does it take to be successful. I know that we all have times when we can't do it, but I want to be 80% successul. Any tips and ideas about the best way to do it would be most welcome, thanks Emma...........
Nov 26, '00Occupation: RN Joined: Aug '00; Posts: 2#1 - Spend more time looking and less time sticking. It's important to find a vein that feels soft, like a deflated balloon. Those thick, hard, "ropey" ones have a very small center (lumen) but thick walls. They're very hard to get into the center of them. And try to find one that is straight for a little ways. Try finding a vein that's easy to find but in a bad place (ex. anticube) and then follow that vein along to a better area. #2 - If you get a flash but then it stops ... pull back alittle and feel around. Sometimes you feel a little "click" that tells you that you're back in the center again. #3 - Try to release the tourniquet ASAP. You'll "blow" less veins by decreasing the pressure.
Nov 27, '00Joined: Sep '00; Posts: 24Kudos to you all and practice does not make perfect--I have good days and bad days
but all of you advices have been helpful,
worked vents for a long time---they all have central lines and was nervous about inserting piv's
I've gotten more experiences in the last mo.
WITH your help!! If I didn't get it at first, I had another "helpful hint " in the back of my mind--got one yesterday without the tourniquet---worked better that way--some advice please about--spasms-------I think I saw it today---his veins "blew up"---2-3 inches above the site---major pain at sitew--never saw before but was this vasospasm???excs, sp?----Rt. arm paralyzed--had seizures, tremors, two minutes, multifocal --drop-(asleep) for 60 seco.. with pain or excitement---tremors with severe pain in paralytic rt arm---anybody know what this is???
Nov 29, '00Joined: Sep '00; Posts: 24First of all i'd like to say we are all good at what we do the most.
the thing i like about top ten nurses is that you all share with me---you are a resource, not a potential write up, ie incident report---sometimes if feel funny about a patient---got the heeby jeebies, ya know
I wrote about it a few days ago and I got the experience of a nurse-----I'd already said somethings wrong--listen to me doc--(ha ha)something ain't right---i wrote a few words and miss Hollykate--knew---experience--I just wanted to say thanks holly kate---It is so hard to be new at this--I've been a nurse for six years and consider myself to be new===and I always look up what I'm giving to a patient, unfortunately we get busy and we try to keep up with the old timers and somebody had already given that drug as ordered by the doc===ha ha===look it up any way==that's what I learned from Holly-
also always listen to the patient, if it hurts, it's wrong===
I've been much braver with IV's and more successful since reading all your tips. thanks for starting this''''''''''''
Nov 30, '00Occupation: rn Joined: Oct '00; Posts: 524; Likes: 48Lots of good tips here. I like to use a BP cuff instead of a tourniquet. Pump up to just above the patients systolic BP, palpate for the radial pulse, release the pressure, when you feel a radial pulse, tighten the valve screw thingy (whatever that's called). The most difficult part is releasing the cuff once you have a flash. I also use lidocaine, 10 minutes with a hot pack, take the time to pick the site, and focus, focus, focus. My most difficult sticks are in obese patients or ones with tough skin. I have always have better luck with no smaller than a 20. With NGs, I also always use an anesthetic, preferably viscous xylocaine, explain, encourage, pray.
Dec 1, '00Occupation: PACU RN Joined: Nov '00; Posts: 12Hi all
I was looking for my trick and no one has mentioned it yet. For those little itty-bitty rollers I use a syringe on the cath to pull the vein onto the needle. I pin the vein with my thumb and index finger. Insert the stick, pull back on the plunger with my ring and pinky finger of my right then push in the stick more. I rarely miss. I also believe in the 3 strikes you're out policy.
Also I ask the patient where do you usually get a good stick. They always know. And I also look away while I FEEL the vein...Can I hit it blindfolded?
Eat, Sleep, Save Lives
Sep 4, '01Occupation: RN Joined: Jan '99; Posts: 3These are all great tips. I can only add my 2-cents worth here. I work on the adult medical floor. Old alcoholics'veins just don't allow for a tourniquet. The veings just seem to blow once you get in the vein if there is too much back pressure. Best here is to apply some pressure with your non-dominant hand couple inches above where you are going to stick. You can let go once you are in the vein.
This trick I learned from a ped nurse. Use a manual BP cuff. Deflate the cuff slowly and stop it just a few beats below their systolic pressure. It is more comfortable to the patient and does a better job holding back the blood flow.
Yes practice is important.For me, I started with the garden hoses as veins until I got comfortable with my technique. Then I started for the smaller and harder-to-hit ones. Now I can get in on those you can only feel.
Sep 4, '01Occupation: RN (ER) Joined: Jan '01; Posts: 53; Likes: 1BP cuffs are a great tip, esp with the older pts.
They never told us this in school, but if you get a good flashback, but can't advance the catheter, try floating it in with your saline. Sometimes the catheter will get stuck up against a valve, and the flush will push it out of your way.
And if your pt tells you they're a hard stick, that nurses can never find their veins, ask them where they are usually able to get the IV. I've been surprised at the number of times a pt can say, "oh they usually go right here or have better luck in this arm, etc." And they're right.
Practice, practice, practice!
Sep 5, '01Occupation: RN-i (RETIRED) Specialty: ORTHOPAEDICS-CERTIFIED SINCE 89 ; From: US ; Joined: May '00; Posts: 14,479; Likes: 2,298I see this topic is fairly old, but it's a goodie. First advice..just do it....2nd advice Always use a #20.
I haven't seen it mentioned, but I'd bet most if not all of us here notice other folks "great veins" while standing in lines, riding the elevator or going out to supper. I know my husband HATES when I casually palpate his hand....subconsciously even now.
While you ar watchingtv notice your own veins and how they feel.
Next time you have your blood drawn watch and see if you can pick out when the needle hits home.
And NEVER use a tourniquet on those old ladies with the tissuepaper skin. You can usually get them using the finger stop method mentioned earlier.
I'm a pretty good sticker, only because I never let a stick go undone. It takes awhile but once you figure our how it's supposed to feel....you have got it!!
PS as a dear head nurse told me....."I'm never be too proud to get down on your knees and ask for help from above. Oh and always use a 20"
Sep 5, '01Occupation: RN Joined: Mar '00; Posts: 77; Likes: 1Yeah, I look at peoples veins all the time, funny how we do that.............