HI! I am a new nurse, only 5 months old now, actually only been off orientation for a month. I am having trouble with IV's. I have no problem getting a flashback at all, but I DO have a problem getting the cathalon to thread in! I even have tried to advance the needle in some more once I get a flash, and it just seems like its stuck, and it won't go in! I work on a med surg/telemetry floor, with almost ALL elderly people. The easy sticks I have no problem with, but the hard sticks, which are MOST of my patients, I just cant get it! Its so embarassing and I feel so incompetent! I am a darn good nurse, I just need to figure out what I am doing wrong! I love my patients' and I WANT to be able to do this for them. I have tried watching other nurses but it just doesnt seem to be helping. ANY suggestions??
A little trick I learned that really helped me out a lot...
When you first get flashback, drop the IV almost flat with the skin and lift up before you advance- this keeps the bevel running against the vein wall instead of the tip of the needle, lessening your chances of blowing the vein
To go along with MissBrahmsRN, after you release the tourniquet, wait a little bit, because if you've hit a valve, it might relax, and then you can get through.
As for 18s in everybody, I think that is crazy. I work onan iv team, and I was taught smallest gage to get the job done.
Stuck on minutiae here... Isn't 9 days against CDC guidelines?
We also keep IVs in as long as we can. (Peds.) It's silly to introduce another stick and another site of possible infection if the current site is asymptomatic and working just fine.
When I did grown people, we'd always leave the line in while we tried for another site to rotate to when the deadline came. But I'm not going to stick someone over and over again if they don't have good veins just so I can say we rotated. If the IV is still good and asymptomatic, I'm not taking it out until I have another good one in.
I have no problems telling a physician their patient will NOT have IV access unless they order a central line or PICC. If you want to extend those 72-96 hrs for "a few" until you can get another site, ok... but I have issue with bending rules indefinitely when my patient's safety is in question.
Those guidelines aren't in place to make our lives more difficult. How do we expect nursing to be elevated as a profession if we don't follow IBPG?
So it's "safer" to not have IV access than to leave an IV in for an extra day?
"Sorry, don't want you to get an infection. So I'm pulling out this IV and you won't get antibiotics for a few days. You may go septic, but at least you won't get an infection."
What about the risks of a central line or PICC? Compared to the risk of an extra day or two of leaving an IV in?
How do we expect to be elevated as a profession if we blindly follow rules instead of using our critical thinking skills to know if the rule truly applies in each individual case?
To go along with MissBrahmsRN, after you release the tourniquet, wait a little bit, because if you've hit a valve, it might relax, and then you can get through.
As for 18s in everybody, I think that is crazy. I work onan iv team, and I was taught smallest gage to get the job done.
So it's "safer" to not have IV access than to leave an IV in for an extra day?
"Sorry, don't want you to get an infection. So I'm pulling out this IV and you won't get antibiotics for a few days. You may go septic, but at least you won't get an infection."
What about the risks of a central line or PICC? Compared to the risk of an extra day or two of leaving an IV in?
How do we expect to be elevated as a profession if we blindly follow rules instead of using our critical thinking skills to know if the rule truly applies in each individual case?
IBPG = International Best Practice Guidelines. Following those isn't considered "blind" -- at least in most circles, these days.
Also, I wasn't advocating that you simply d/c the line and do nothing for an indefinite period of time, until you can get another one. Reread my post.
And stop taking this as a personal attack. That wasn't my initial intent.
thanks so much for everyone's help! I work again in just about an hour and half so I am going to try some of these tips! As for the length of time the IV stays in...well we rotate every 72 hours, BUT if they are a super hard stick, we always just watch the site, as long as its flushing well and shows no signs of infection, it STAYS. Being on telemetry we may need it at any time!
Thanks for clarifying that you agree that those are "guidelines" we're talking about.
Following those isn't considered "blind" -- at least in most circles, these days.
If it was all about "guidelines" and rules (no matter how good those rules are), we could all stay home and just let the webmd symptom checker take care of everyone.
People are there because:
just because it looks like a duck and quacks like a duck, sometimes it's not a duck. When it's a duck, guidelines work great. When it's not a duck, sometimes we have to actually use our brains.
I sometimes have trouble threading when I start too high in the vein instead of just below.
Agree.
When I start my puncture into the vein, if I don't push the vein out of my way and actually get it in the vein, I always have trouble threading it. Always works better to start just below the vein. If you can start just below a fork, even better.
Another way to think about the angle needed to thread the cath is, you wouldn't have a very steep angle on the needle if you were to attempt to enter the vein from the side instead of the top, would you? Use the "steep" angle for penetrating the skin, a "medium" one for penetrating the vein wall, and a shallow one after that to get the cath into the lumen and off the needle. Done smoothly, your fingers will almost trace the letter "J" with it lying along the skin...
MissBrahmsRN
170 Posts
wow that's a good idea i will try that!