How long until you were pretty good at IV starts?

himilayaneyes · Apr 22, 2011

Practice makes perfect. I don't really have too many problems with IV starts after 3 years. However, I still have on and off days. You'll get there eventually.

battymom · Apr 22, 2011

I am in my second semester so we are just now able to start IV's. I have only been able to start 2 & it went so much smoother than I thought it would. I hope it continues to go smoothly, cause now I see veins every where that I could start an IV on! Good luck to you!

FancypantsRN · Apr 22, 2011

Just take your time when picking your vein (for now) - sometimes the big ones are deceptive, depending on hydration level.... and be patient with yourself! As the pp said, practice is the key. I am in the ER as well and usually go for the AC, especially if they probably won't get admitted or if you think they will need a CT with contrast.

Btw, I have been at it for 4 years and am still in the practice stage bc on the floor we did not have to start many.

firewalkr333 · Apr 22, 2011

I would ask a couple of things first. Are u making sure to anchor the vein with the nomdominate hand? Are u cupping ur hand and tapping the site to engorge the vein? Are u milking the vein with ur skin prep? I know for me that's what has worked

floatRN · Apr 22, 2011

It took a full year before I started to feel comfortable with it. Now after 3 years, I am just starting to get the more difficult ones.

Isabelle49 · Apr 22, 2011

Most important think is to take your time. Nail that vein down with the fingers/hand you aren't sticking with. Sometimes the easiest looking vein is a real booger. I was pretty good at IV starts out of school, but I also worked for 2 years as a phlebotomist.

Very important. Don't get down on your self if you miss veins. I have always told new nurses, including my daughter that its 5% skill and 95% luck!

Bumashes, MSN, APRN, NP · Apr 22, 2011

I started off on the floor in medsurg, and now I'm in the ER. It took about a year for me to be comfortable. Starting in the ER will give you lots more opportunities for IV tries than the floor. I'd say for every one IV that I started on the floor, I start about 5-10 IVs in the ER. I was always in a rush to find a vein b/c I felt the pt must think I was stupid if I took too long. I know better now. I just explain to them before I get started that I will be looking for the best possible spot with a nice, straight, bouncy one.

Just an example of why looking for all possible locations is a good idea: I work with a new grad in my ER right now. He went in to start an IV, and when I came in later to give meds to the pt, I saw the odd spot he had chosen. He had placed it in the AC, but in such a way that the plastic hub was perpendicular to the crease of the arm. So it was smack dab across the crease. So the pt could not do anything but keep the arm perfectly straight! There were ample other veins I could see, so I decided to ask him why he chose that spot later. We had a good laugh about it when I brought it up. I always try to be friendly about my constructive critism. He admitted that he was just so happy to be able to find a vein so quickly, that he just forgot to think about the location it was in.

Also, take a turniquet home with you and just feel your own veins or those of your family. They don't always feel bouncy or obvious. Sometimes you can only feel a "depression" in the skin, so instead of a bump you feel a dip. Or they might be hard like wires. A good tip for figuring out if what you're feeling is really vein or not is to keep feeling on it while you release the turniquet. If the suspected vein "disappears" all the way (or almost all the way) after the release, then it's a vein. If not, then it's probably a tendon or a particular weirdness of the skin the pt has.

Good luck!

Chin up · Apr 22, 2011

I have never been good, have been shown a thousand times and tried 1001 times. I am in the office now, but for 20 years, I had the worst time with them. I think I psyched myself out and made sure, I would never prevail. But you, keep trying. Practice does make perfect for most. Peace!

**canoehead, BSN, RN** · Apr 22, 2011

Five years to be really good, two years to be average.

DogWmn · Apr 23, 2011

I worked in a clinic and did TONS of phlebotomy and that helped me big time because when LPN's got to start IV's and I took a class it was welllll a no brainer...LOL. When you are looking for a vein 30-40 times a day, you learn the good bad and really ugly PDQ.

WonderRN · Apr 23, 2011

I've been a nurse for 1 1/2 years. I have worked in the ED the entire time. I think I was decent after 6 mos, and after a year, colleagues would ask for help on hard sticks. I would get the hard sticks, say 75% of the time, within 2 sticks. But everyone has off days. I just switched facilities and this new place has totally different J loops and securing supplies, I was having a hard time my first two weeks.

I also had been drawing blood for a while as a tech before i became a nurse.

Tricks I have learned: Two tourniquets on really hard sticks, have them hang their arm down off the stretcher for a minute, wrap the arm in a warm blanket. Feel for the springy-ness. I sometimes have to close my eyes, it helps me feel it better for some reason (haha, sometimes patients think I am cuckoo :)

My last 2 spots I look are on the back of the forearm (esp on the dominant hand for IV drug users, they often can't get to that one) and the bicep, just above the AC.

Don't be afraid to look in the shoulder region (as your facility allows), you can often see them there on fair skinned folks and hit them with a 22g.

If you are getting in the vein and having trouble cannulating, I often pull back slightly and try to advance the catheter again. It sometimes works.

When I was on orientation as a new grad, I had a HORRIBLE time at first. When I was finally on my own, my preceptor told me, "you are getting pretty good, I was worried about you at first." (she was serious). Haha.

Confidence is key. REALLY.