Good at placing IV's?

bosnanurse · Sep 28, 2006

HI!

I know somebody can say oh it will come ,it is not hard but you have to first go through your mind where this needle will finish and how you will pull it back. In beggining I was so BAD that I would always call girls form CCU to come and do it and then I started to observe how they are doing . Next time I looked veins, palpated( didn't find anything under the skin for a long time ) but I was looking for something and was exploring it >NOw I can find it in very "hard sticks" and I have my whole set up how I am doing it: Chair close to pt , legs spread , arm down , head of pt on other side, talk about weather, sing a song arange everything in same order (to calm down, to observe, to make pt confident and me of course!) and I am IN! Then I say, "OK , I am in so just do not move it is a few seconds to finish and you did wonderfull!" Again whole procedure to clean up and I am getting out from a room with a smile.

mamason · Sep 28, 2006

Yes, it takes practice. Plus, the pt's you are working with have probably been NPO for their procedure. Which could make finding a good vein hard. My preceptor usually picked out the pt's that had good veins and would encourage me to try with them first. The pt's that were a more difficult stick, I would stand back and observe how my preceptor inserted th IV. I would watch her and ask a lot of questions. Once I got used to the "easy" sticks,my preceptor encouraged me to try the more difficult ones. I eventually got it. Just takes practice and confidence in yourself. You'll get it.

RGN1 · Sep 28, 2006

Good advice here. Confidence & practice in virtually equal measure. Don't beat yourself over the head about it!!

Even a seasoned nurse like me can worry about it too. I used to do an average 5 IV sticks per shift now I only do about 1 per month, if that. I'm worried that I'll lose my ability so when I come over to the USA to nurse next year I'll be useless!! Also I'm much better when I'm not being watched & that might also play a part in your problems!

Keep your chin up & be positive, think about the theory of how you insert the needle & the anatomy involved. I'm sure you'll soon find it 2nd nature!!

Good luck xx

P_RN, ADN, RN · Sep 28, 2006

I found that once we went to the protect-iv sets I suddenly got good at it. I think it's that little extra bit of plastic to hold onto. Another trick is to look and then feel your own veins. They have a certain "feel" and you need to be able to identify the feeling. If your husband, fiance, roommate is agreeable ask them to let you palpate their veins. Soon you will find yourself looking at people on the elevator and evaluating their veins. I even notice athletes on tv. Believe it or not those big ropey veins may not be all that easy to stick. Remember on older folks you might not even need a tourniquet. YOu can use a BP cuff inflated to above the systolic and then deflated and closed just above the diastolic. It feels better to the patient also.

Good luck. You'll be an IV wizard in no time.

mamason · Sep 28, 2006

I found that once we went to the protect-iv sets I suddenly got good at it. I think it's that little extra bit of plastic to hold onto. Another trick is to look and then feel your own veins. They have a certain "feel" and you need to be able to identify the feeling. If your husband, fiance, roommate is agreeable ask them to let you palpate their veins. Soon you will find yourself looking at people on the elevator and evaluating their veins. I even notice athletes on tv. Believe it or not those big ropey veins may not be all that easy to stick. Remember on older folks you might not even need a tourniquet. YOu can use a BP cuff inflated to above the systolic and then deflated and closed just above the diastolic. It feels better to the patient also.
Good luck. You'll be an IV wizard in no time.

Yes...I did that too. Drove my husband nuts! And the big ropey veins tend to move a lot.

suzy253, RN · Sep 28, 2006

I'm getting better and better and will always seek out IV starts where I'm working. Getting more confidence is a big thing too. At my hospital, there is a very large elderly population so their veins are not the best to say the least. I've heard nurses say that if you can start IV's where I work, you'll be able to start them anywhere. I limit myself to two sticks...then I'm out and will seek out someone else to try. Often they can't get them going either.

OBSFlightRN · Sep 28, 2006

I agree with the others that it has a lot to do with confidence. Even now that I'm experienced, I'll occassionally get on a "bad run" where I miss a bunch. The more you miss, the more your confidence drops and you start to missbecause you think you will. It's important to relax, take your time, and pick a vein that you're sure you are happy with before you stick anything. I most often use the cephalic vein. It's the one that goes up the inside of the wrist and up the inside of the forearm. In most people it's big, straight, and easy to palpate.

Good luck. Relax, keep practicing and one of these days it will just kind of click for you.

AB_NormalRN · Sep 28, 2006

What they said. With 5 years as a Medic I could hit an A/C with my eyes closed. But AC is not the best of places in a lot of cases. LOL! So I ended up going back to the drawing board. And yes! I suck royally at times. But after watching people, looking at vascular anatomy charts, closing my eyes and palpating for veins...I've somewhat mastered hand and wrist veins.

And you know what I've been told? There are things you will be good at in nursing others will not be so good and they will be good at things you aren't so good at. I know that at times I believe in the ideal world vice real world...but I still believe in teamwork and positive thinking! And when I started IV's? I was about your initial ratio as well and never thought I would get better. But you will. And when you're a seasoned nurse and that new nurse comes on the floor and gets frustrated because she has a hard time 'sticking' the side of a hay barn? You will take your time, show her, give her positive thoughts, praise, and tell her the same thing. We've all been there.

anne74 · Sep 28, 2006

Thanks so much for your words of confidence guys!

Do any of you guys use "blebs"? We first adminster a solution of saline and alcohol intradermally to numb the site. A wheal is created, much like TB shots. Then we're supposed to aim in the middle of the wheal - but is further masks the vein, and I'm having trouble sensing the depth I need to go in, since the wheal is essentially a bump in the skin - right over the vein I'm going for.

I guess this bleb thing is evidenced-based, and the patients seem to really like it. It's less painful and probably has an even bigger psychological/placebo effect. But I don't know how good it is when I can't get it in and have to try again. (Or someone else tries - I only try once.) I guess I'll get used to it?

JMBM · Sep 28, 2006

Confidence, confidence, confidence.....easy to say, hard to do. First, why is confidence good? I'm sure there are lots of psychological reasons, but one big reason is that the nurse's confidence is felt by the patient. A nervous patient tenses up and vasocontricts. That big vein you thought you felt suddenly dissappears. So, how do you get confidence? One way that really helped me was routine. An Army nurse taught me. Always, always, always find a stool to sit comfortably low. Get a mayo stand or something to put stuff on. IV kit just so, guaze pads lined up here, tape cut and hung right there......the same way every time. The routine makes me comfortable and the patient sees that. I always ask if the patient has had an IV before. If so, I ask if there's a particular spot that worked for them. Often the patient will show you a great vein. More importantly, they become part of the process. If the patient hasn't had an IV, I explain why they are getting one and that the needle goes in for just a few seconds and then comes out. Some patient's have no clue why they need an IV, which makes them scared. For some nervous patients, I even take a catheter (ditch the needle first) and show them the "soft tube" that will be left in. Alot of patients think the needle stays in. Finally, if the patient is a woman, I explain (truthfully) that many women handle IVs alot better than men. That almost always gets a chuckle and relaxes the patient alittle...... As for the stick itself? Look back as to why you are missing. If you aren't getting a flash at all, you either aren't finding a good vein or the vein is rolling. So, you need to get your preceptor to help you either find good veins or be super diligent about anchoring. Get out the anatomy text and memorize the general areas you are looking for. If the veins are blowing, you are probably going in at too high an angle and are going through the vein. Pick a spot about 1/4" distal to that good vein and slide into it at a real shallow angle. Missed? Don't get flustered. Explain that occasionally happens when a vein rolls away or deflates when the catheter touches it. Show confidence, even if you don't feel it. Mostly, I'm sorry to say that it comes down to practice. When do you get good at IV's? Never. Years and thousands of sticks down the line and you'll still be learning every time. Best of luck.

nursejohio, ASN, RN · Sep 28, 2006

I second what everyone else has said about practice and confidence. Fake it if you have to, but if the pt sees you're relaxed, they'll relax a lil bit too. You can search the threads here for some more "technical" advice, there have been several discussions about IVs in the past. Also, try to find a willing co-worker or 2 for a bit of practice. There seems to be less pressure with a non-pt and they may be able to coach you while you're doing it. I worked on ICU/stepdown before I moved to L&D and only had about 20% failure rate with the old sick people. Give me a young, healthy pregnant woman? Sheesh... I didn't get a good start for a month! My preceptor let me stick her once to get over the mentality that I couldn't do it anymore and I've only had a few that I couldn't get in since. Just returned the favor to a new hire on week 7 (of an 8 week orientation) that has only managed to get 1 IV started. Needles don't bother me, and if I can be a slump-buster, that's building good karma :rolleyes: