How long until you were pretty good at IV starts?

sandnnw, BSN, MSN, EMT-B, APRN · Apr 23, 2011

Took me about a year.

Start slow, use #22 and #20's on the larger veins. A lot of this is confidence and practice, but as mentioned previously, some folks are just difficult sticks!

I have found, #14 in the drunks gives you a large boost of confidence and that first liter of fluid in 10" helps sober them up rather nicely. Some may say, that's cruel, but considering I'm cannulated with TWO #14 when I donate at the Red Cross...nah. You must practice for those level I trauma patients who need #14-16s.

Best of luck, you'll get there!

bonestAx · Apr 23, 2011

Everyone here has given very good tips. Also, remember that the vein has muscle in it so when your patient has those big huge juicy vein's that you just can't wait to stick, they are also muscles that will clamp right down on your catheter and not let you advance it! I have noticed this many times, it feels like you hit a brick wall when you try to advance!

If this happens just hold your position and try to calm the patient and get them to relax their arm, open/ close their hand, or rotate their arm. All of these things seem to help. Also, look out for those valves they will mess you up too!

celticcare · Apr 23, 2011

I found I was good at them at first, then took an 8 month break from nursing for a while *needed to find if it was the career for me, thankfully it is :) * and then hard a real hard time cannulating. I have good days and bad days, I felt proud of getting an 18g in a trashing obese IVDU who was also drunk and yet missed another 18 in a perfectly veined youth. Its just practice and practice, I got a beautiful 20g in a bicep of a gentleman who needed bloods and meds and had no troubles compared to two sticks in his lower arms. Just keep focused, cuss in the staff area not at the bedside *easy to do I am guilty of it*.

keep the faith and the practice, and take any chance you can :)

Scotty

Delete_Me_Please · Apr 25, 2011

Once I shunned everything that my nursing instructors, preceptors, and well-wishers told me, it only took me a few weeks, and the QA report at my last annual review showed a 91% success rate with a few hundred pokes...

My suggestion for my students and trainees is to use your brain and your "mind's eye". FEEL for where the vein goes (don't trust your eyes), then get a mental picture of the path that it follows under the skin. Then just formulate a picture of where you want the cannula to go and then make it happen.

Personally, my biggest pet peeve, is hearing people blame everything but themselves for a miss. For as many times as I've heard a missed stick blamed on a valve, you would think that our entire vasculature is comprised of nothing but valves. Just own it... you missed. Chances are it wasn't the IV, the tubing, the valve, that they didn't pump their fist, that you didnt smack the skin, or whatever... just take the time reassess your performance and think critically about why you missed.

forwardd · Apr 25, 2011

First you need to find your comfort zone. Have all your equipment ready, bed at the right height, strips of tape ready, op-site ready, ect. then tell everyone to leave the room, take a deep breath, smile, and tell yourself you know what you are doing. Be confident with yourself, but never gloat. Remember everyone has a bad day even seasoned nurses.

mybrowneyedgirl, BSN, RN · Apr 26, 2011

Around 10 months. We have ed techs that do most of our ivs. I try to get there 1st so I have more practice.

kc87t, BSN, RN, EMT-P · Apr 27, 2011

You have to find what's comfortable for you. The hardest thing for me was to figure out where to hold the skin with my non-stick hand. My favorite place to stick is on the inside of the wrist. I've found that if I wrap my non-stick hand around their wrist and pull the skin taut with my thumb and middle finger it works great because the vein can't roll. Also, I think a lot of people are hesitant to hit deep veins because they don't pop with the tourniquet. But, I kind of like those because those are guaranteed not to roll. It's all personal technique really. I've got to the point where I stick so many pts in the ER that I'll go 99 out of 100 pts I'll get on the first try. You'll get there! Have you ever tried a 14G on an OD pt? Those are actually kind of tricky, it's like sticking with a railroad spike! :)

mcknis · Apr 29, 2011

I have been called mean a few times for dropping 16's on a few drunks or ODs, but I like knowing I have access if things go south quickly! Only been in the ER for a yr and a half, but relax, it will come! Just attempt at all the times you get. Don't beat yourself up if you are as good as the 5yr or 20 yr nurse who is hitting lots. It sounds like this may even be your first nursing job so just relax and chill. It will come in time. Good luck!

**canoehead, BSN, RN** · Apr 30, 2011

Pull up a chair when you're going for a tough one, and meditate over your veins. Check out every spot, palpate, rub, whatever, but take your time and tell your patient you like to look a lot. The hurry of nursing affects your performance, and you'll be surprised the difference a pause in the action makes.

herowneulogy, BSN, RN · May 11, 2011

Pull up a chair when you're going for a tough one, and meditate over your veins. Check out every spot, palpate, rub, whatever, but take your time and tell your patient you like to look a lot. The hurry of nursing affects your performance, and you'll be surprised the difference a pause in the action makes.

Best advice EVER.

I'm a new grad in the ER also, but my IV start/venipuncture competency test came early (about 3 weeks in, my orientation is 6 months). I would say that i'm okay with my "sticks". There are some days where i'll get everyone, and some days where I'll miss a 2-3 patients and have to call my preceptor in for help. I've learned to take my time, really feel for those nice veins, and sometimes, you have to guide your catheter in slowly (especially for the elderly and people with really bad veins). But it took practice. I'm at a Level 1, so we get Paramedics who need to do their own IV competency. I have to ask some of the nurses to save some sticks for me, or else all the paramedics will hop, skip and jump to any patient requiring an IV stick before I can get to them. I also had to tell myself to think clearly, breathe and be confident. Because, where I work, if the patient even suspects that you're new (and anxious), it will make them anxious and they will insist on having someone else do their IV before you've even touched them. I always take advice from the nurses, and it helps. Everyone has their own little tricks and mannerisms when it comes to starting an IV. The nurses laugh at me before I like to make mine pretty by creating a chevron with the tape.

One thing I have to work on is how to decrease the blood flow after I got a good stick, right before I either insert the vacutainer for labs or the saline lock. I was told to press down on the area above the cannulation puncture and to hold my catheter up a little. It seems a little tricky in the beginning because I'm left-handed.

Anyways....Good luck!

mcknis · May 11, 2011

edit from a posting earlier...defintiely take your time with getting IVs in. In my first post, I see I seemed a little overzealous, and mind you that was after 12 hours of traumas, codes, and the like, but some patients will only take a 24 and some will take 14s. It all just depends. Be patient, realize we all make mistakes, even on our bestest of days. My girlfriend sighs at me every time I start looking at her veins (which are pipes mind you), and she just says, "So this is what it is like being with a nurse, huh?" Yep :)

edmia, BSN, RN · May 12, 2011

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.

Or it starts to pulse and you've got a nice artery! Always fun :lol2: