How did you "get" the skill of starting IV's?

Nurses General Nursing

Published

I have a friend who is a new grad working on a med surg floor for about two months. She is really upset because she has missed her first ten IV starts. Although she hasn't gotten in trouble she wants to know what she can do to get this skill down better. I'm not sure what her error is although I think she may be going "through" both lumens of the vein. Any advice? Why don't hospitals have "skill labs" with state of the art simulators (or not so state of the art simulators) so that someone can practice these skills. If Peyton Manning has a bad game he can go down on the field and throw a few hundred passes to Marvin Harrison. Where does a nurse go when they have a "bad game"?

stidget99

342 Posts

I have a friend who is a new grad working on a med surg floor for about two months. She is really upset because she has missed her first ten IV starts. Although she hasn't gotten in trouble she wants to know what she can do to get this skill down better. I'm not sure what her error is although I think she may be going "through" both lumens of the vein. Any advice? Why don't hospitals have "skill labs" with state of the art simulators (or not so state of the art simulators) so that someone can practice these skills. If Peyton Manning has a bad game he can go down on the field and throw a few hundred passes to Marvin Harrison. Where does a nurse go when they have a "bad game"?

My advice to your friend is to practice practice practice! Try starting them on those w/ snake for veins and once she gets her confidence built up, then try the more challenging pts. When I was taught to start IV's my instructor said to keep advancing the needle until the catheter was all the way in. I advance the needle just far enough for the blood flashback then advance just the catheter. Works for me 99% of the time.

Jenny Renn

29 Posts

I have a friend who is a new grad working on a med surg floor for about two months. She is really upset because she has missed her first ten IV starts. Although she hasn't gotten in trouble she wants to know what she can do to get this skill down better. I'm not sure what her error is although I think she may be going "through" both lumens of the vein. Any advice? Why don't hospitals have "skill labs" with state of the art simulators (or not so state of the art simulators) so that someone can practice these skills. If Peyton Manning has a bad game he can go down on the field and throw a few hundred passes to Marvin Harrison. Where does a nurse go when they have a "bad game"?

A lot of useful information is available from Emergency Nursing World, to be found at: http://enw.org/IVStarts.htm

The thing is to believe in yourself and if you fall off the horse, just get back on and try again. Watch other people and your skill and confidence will improve until one day you'll be teaching other young nurses how to do this important skill. All the best and good luck. JR.

weetziebat

775 Posts

I've found that anesthesiologists are the best bet for learning tricks of the trade. If possible get one of them to let her watch. After that it is just a matter of practice, practice, practice. Naturally, after not getting ten veins she has very little confidence, but if she can talk the doc into it they might let her try with them watching. Hope she has good luck :)

Specializes in Behavioral Health.

I agree with everything stated above. It is a real blow to your confidence if you miss that many. She needs to seek out opportunities for those with really good veins. It sounds like she may need to adjust the angle she's entering the skin at. Also, she needs to "anchor" the vein well to prevent it from rolling on her.

It's definitely a skill that requires a lot of practice.

SmilingBluEyes

20,964 Posts

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

how?with years of practice. NO shortcuts exist to make you "good" at this skill.

payday

121 Posts

Maybe the hospital would let her spend a few hours in outpatient surgery starting IV's with a preceptor.

michw2

192 Posts

I am a nursing student in my 3rd semester. I have started alot of IV's. The first IV's I ever started was in out patient surgery. I started 5 on the first try. I now can do them where I work. I have missed a few at work. But I have learn that if you go in deep at first and then level out right away that sometimes helps. Is she getting a return at all or is she just missing the vein? I have learned another little trick. Is to use a blood pressure cup that will really help the veins pop up. I hope that helps.

AlixCoastRN

62 Posts

I like the 'go deep and level out approach' but I also hung out with a couple of phlebotomists who were very helpful.

SmilingBluEyes

20,964 Posts

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

yea if you ever want to get some "goods" get with lab techs. They RULE at finding those veins.

Speculating

343 Posts

I like to go deep myself and back out slowly. When I get my flash, I Stop and advance the catheter not the needle. At that point if I'm not getting anywhere I can generally float it in with some NS once the flash has been established. Anesthesiologists get good because of practice. And practicing is much easier when your pt is passed out unable to squirrel around in the bed and say ouch! It takes practice. It's an art not a skill. There are days I can't miss and others that I can't hit the broad side of a barn. You have to own up to the fact that you might have to miss ten a day for a while. Your friend really bits though. I don't think I could give a set up to an x-ray tech and they could miss ten straight ;-) Obviously their confidence is shot. You have to start with the water hoses first and work your way to the tough sticks. You don't get good over night you just find yourself there one day.

CseMgr1, ASN, RN

1,287 Posts

Specializes in Case Management, Home Health, UM.

I was fortunate enough during my years as an L.P.N. to have worked in a small community hospital where we not only did all the nursing care and passed meds, but we also functioned as the "IV Team". We did all the IV starts, hung all the IVF's, added Vitamins and mixed and hung all the piggybacks (except for blood and blood products). I received my training from an ex-army corps nurse (who was also an L.P.N.), and a nurse anesthesist. They were both excellent practictioners, and the best advice I can give you is to try and buddy up with nurses (like these), who will take the time to teach and train you. Good luck! :)

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