I just started my first nursing position at a ED of a hospital and things are great but I am having the hardest time inserting IVs in patients. I have been reading so many forums about the subject on this board but I never learned how to put in an IV in nursing school, the hospital taught me how to do it last week, and this week, I only had two successful IVs out of eight.
My coworkers say it just takes practice but my question to you is
How long did it take you to become an IV master?
and How fast can you put in an IV in an emergency situation?
And any personal tips would be greatly appreciated
Go by feel, not by what you see. It does take time. I was somewhat of an ok IV starter but I worked on the floor so I didn't have much of an opportunity to try. Once I came to the ER I was starting them all of the time so now I have gotten proficient at it but there are still times when I have to call in for back-up. And there are times when I get a patient on the first stick and they tell me that usually they have to get stuck multiple times. So really, practice makes perfect.
And as others have mentioned, there will be times when you'll get them all and then you'll have "bad" IV" days...so it just depends.
Oh heavens....this is a skill and it takes time.....the first hundred or so. I'll bet you are trying to float it too soon. advance just a hair further with the needle....then float. Hold the skin beneath the puncture site taut to stabilize the skin and vein.
It's not 4 out of 13....it's..... YOU STARTED 4 IV's!!!!!!!! CONGRATS!!!!!
The first year is the hardest.....((HUGS))
Ok, now I'm at 5 IVs started! OMG, i feel like i should be at 6....
Question: which site do you normally start it? I'm thinking AC might be the most practical because if they come in with abd pain or something that needs a CAT scan, then access is already available. Does that rational make sense?
Or maybe, I'm just not comfortable going to the hand and forearm.....
Hand veins hurt a little more, but the technique is not really any different than the AC. It's been probably 10 years since I've started a line (inactive Paramedic) but I still remember how. Just put the tourniquet on, palpate for that spongy vein, swab the area, pull the skin tight and puncture the skin on the opposite side from where you're pulling tension on the skin. Once through the skin, lower the angle of the needle. Imagine your eye is at the bevel and you just want to thread through the vein wall right into the lumen... and go where you "see" you need to. Once you're in, advance just a little more, then advance the catheter, occlude the tip briefly to control blood loss and connect your prepared IV line. Flush. You've just successfully started the line!
There are some small details I've probably forgotten to list, but it's really just a skill. Like any skill, it just takes practice. Just make sure your practice is as perfect as possible. Soon you'll be getting sticks that you though were impossible. The first couple hundred can be a bit intimidating, but as you get better, you'll feel better. And yes there will be days you can't seem to be able to stick a garden hose, and there will be days you could thread a needle blindfolded.
You can do this!
As for me? It's been so long that I expect to have some difficulty getting back into the groove of it.
Ok now I'm at 5 IVs started! OMG, i feel like i should be at 6.... Question: which site do you normally start it? I'm thinking AC might be the most practical because if they come in with abd pain or something that needs a CAT scan, then access is already available. Does that rational make sense? Or maybe, I'm just not comfortable going to the hand and forearm.....[/quote']
I really try to go somewhere other than the AC if I think it's likely they'll be admitted. Otherwise, unless the pt keeps their arm straight the beeping from the pump saying it's occluded can drive the pt and nurse crazy once they're up on the floor. That being said, if they need one in the AC or if that's all they have then that's where it goes, regardless.
When I first started the AC was easiest for me. Then I started moving down to the forearm area. Now I've gotten where I can do the hands. Those are tough because they a re so superficial. I would blow them at first because I would go in too deep. Now I've gotten where I can get creative when I can't find any others. I stuck one in the "dummy vein" the other day! Felt very accomplished! It takes lots and lots of sticks but each shift you'll do better!
I still haven't mastered it, and I've been an ED nurse for a few years. I'm not terrible at IVs, I'm actually pretty good, but anybody can have a bad day. As others have said, you just have to practice. There are times, though, when I know I can poke someone six times and I'm not going to get anything, so I just find the most experienced nurse around and ask for their help. It's not an ego thing as much as it is for the benefit of the patient.
Ok, so I had to laugh, 5 for 13, I don't know about anyone else but I needed a whole lot more attempts than 13 to feel mildly proficient at starting IVs. NG tubes, foleys, yea proficient in a handful of attempts, IV starts, nope, nada, no way. So, OP, don't feel bad about 5 for 13, that's a dang good ratio.
I only know of a couple of people who I would say "mastered" starting IVs, most of my ER crew are very good at it, but mastered. That's another story, and most who have start dozens a day, or did at some point in their career.
As for location, I first got the hang of starting them in the wrist, I know, funky place, but for some reason I find that vein on the distal edge of the radius never seems to roll and if you can see or feel it I can hit it. About the time I got that one down, the folks in radiology got a new CT machine and they claimed that I had to have an 18g in the AC for certain IV contrast studies. sigh. Well, I felt really bad about having to start a second IV just because they didn't like the location of mine. And, since I was a new RN, I didn't really have a full grasp of which pt's might need their IV in the AC and which did not. So, I switched and got proficient in starting them in the AC. Again, veins there are big, plump, and really give you a fair amount of leeway while your learning. I haven't had too many issues with the pt not keeping their arm staight and it occluding the vein. On several occasions I might start the IV in the upper part of the AC joint so as to not have an issue with a bent arm causing a problem if that's where I choose to go.
For some reason, I avoided the hand veins when I was starting, they looked small sometimes, I don't know. Anyway, after I got reasonably proficient at starting them in the AC, I found that AC is not the best place to try in dehydrated, obese, junkies, or some other patients. A mentor of mine suggested hand veins to me, and I would try those veins in situations where it was hard to find a good AC or wrist vein. Yes, hand veins are more painful to some, although I think there are many pts who say they don't feel them at all. But the hand veins are often the easiest to hit, and if you miss, the next guy can still try just a bit above your try, can't try just below it though!
After I got ok at all of those, then I started finding veins on the forearm that I could hit, but I would say these take more skill than the above locations do.
I guess the moral of the story (if their is one) is don't get down on yourself, try to take your time and make sure you learn with each attempt and give yourself time to get good at it. Stargazer makes an excellent point, I've looked up and down someone's arms, and just not had the feeling I was gonna get it, off that day, terrible stick, nothing showing, whatever, if that's the case, spare the pt, just go get someone who is one of those rare expert IV starters, and let 'em take a shot at it. It's not about ego, it's about the pt.
Oh man, this question hits so close to home right now. I have a year of experience in the ED, and I still dread having to drop a line in someone. Don't get me wrong -- I will never refuse to TRY, but more times than I'm happy about I try to sticks and get nada. Luckily for me I have my fellow nurses and the paramedics to call on to help me out. And let's be honest -- when THEY also struggle to get a line I feel somewhat vindicated.
And then there have been times where I have stuck someone "impossible" and nailed it. The stealth 20ga in the forearm, the miracle 24ga in the hand, sometimes you just see/feel it and go for it and it's there. Other times you can be confronted with PIPES and blow every chance you get.
I'm getting better, no doubt. But I'm still frustrated every day when I miss something I feel like I should be able to get.
As much as I HATE the answer, I feel that the most accurate response is still, "It just takes time and practice." Even when you blow it. Even when you can't even FIND it. Ask the experienced nurses and medics to let you watch/palpate when they go to stick. Ask them for tips and tricks (use a BP cuff on the elderly to prevent blowouts, or try going in bevel up). People will be more sympathetic when you show a desire to better yourself.
IV starts (IME) SUCK, but never turn away an opportunity to try/learn something.
I actually do feel like I'm improving. My first two IV starts of the day were successful. For one patient it was in the AC and the other was in the hand. For one of these two, I did have trouble inserting the saline-lock so I made a small blood pool on myself and the patient. The second was cleaner and more successful.
I had two later that day but that was less successful
I wore blood on my scrubs for weeks. Well, I should say, had lots of blood on my scrubs that I had to change. That comes with practice too.
It's a lot of hand eye practice. I would get the lines and then accidentally pull them out grabbing for stuff.
My work would really get behind trying for iv's, now I'm getting pretty good.
I promise, it will come and we can all relate. As you notice, noone's wrote in here how they were great off the go, never missed, never hit an artery, never wore blood ect lol.
But in traumas/codes, it's great!
turnforthenurse, MSN, NP
3,364 Posts
Go by feel, not by what you see. It does take time. I was somewhat of an ok IV starter but I worked on the floor so I didn't have much of an opportunity to try. Once I came to the ER I was starting them all of the time so now I have gotten proficient at it but there are still times when I have to call in for back-up. And there are times when I get a patient on the first stick and they tell me that usually they have to get stuck multiple times. So really, practice makes perfect.
And as others have mentioned, there will be times when you'll get them all and then you'll have "bad" IV" days...so it just depends.