How to start an IV

[LisaRN1105]

I am a new nurse and am horrible with IVs and blood draws, I almost always miss and I see the vein. Every experienced nurse is telling me they were all like that and it just takes practice. Anyone willing to share some tips/tricks/advice on starting IVs?

Thanks!!

[delphine22]

also its easier if you lower the arm off the side of the bed (gravity helps fill the veins), and if the patient is on propofol.

*snort* Thanks for my laugh of the evening!

[BSNbeauty, BSN, RN]

Thank you for this post. It is very helpful, as starting IVs is my weakness. Not good, being a new ED nurse.

first, find a good site. then assamble everything you will need, flush your tubing or pig-tail/heploc/extension. cut your tape. now....

apply a tournaquet a few inches above your site. tie or secure the tournaquet in such a way that it can easily be removed after the catheter is inserted.

wipe the site with the alcohol pad. this is a good time to make sure the vein is relatively straight, doesn't split off into two or more veins where you want to insert the cathetor (bifurcate), or has large valves that may impede catheter movement.

choose a catheter size. in the case of the elderly or very young, a smaller catheter (indicated by a larger number) may be the better choice. in the case of emergency fluid replacement, choose a larger catheter (indicated by a smaller number).

remove the cap from the catheter. pulling the skin on the iv site taut with one hand, insert the needle catheter at the site you've chosen. keep the catheter as closely parallel to the skin as possible. imagine an airplane landing on a runway; that's the angle you are looking for.

you will know you have "hit" the vein if you see blood in the catheter's plastic applicator. once you see this "flash" of blood, began advancing the catheter.

while advancing the catheter, keep skin pulled taut, remove the needle in whatever way is indicated by the brand you are using. once the needle is removed, secure it so that no one can be poked or injured by it.

remove the tournaquet. don't forget this step, as you can cause tissue death, discomfort and blown iv's by leaving the tournaquet on.

remove the plastic applicator from the catheter. prevent back-bleeding by either applying finger pressure (firmly)on the vein above the catheter, or by applying a 4x4 under the catheter to catch any escaping blood.

attach the iv tubing/pig-tail/heploc/extension tubing to the catheter. apply tape or a commercial securing product to the catheter to keep it from moving.

open up the iv line. if you were successful, you will see fluid dripping in the drip-chamber of the tubing, as well as no swelling or leaking at the iv site. if the iv site swells, or there is no fluid dripping in the drip-chamber, you were unsuccessful.

use tape or commercial securing products to further secure the iv line to the patient's arm or hand. adjust the drip rate to whatever is appropriate for your patient. turn the drip rate down to just a few drops a minute to keep the line "tko" or "kvo" ("to keep open" or "keep vein open").

http://youtu.be/2-jdbffjx1e

i hope this helped......but in this case it's true. practice makes perfect.:heartbeat

[klone, MSN, RN]

Play with the IV get comfortable with it. Make sure you know how it works as far advancing the cath, and removing the needle.

Absolutely. And, if you have someone who is skilled at starting IVs, have them work with you on technique, angle, etc, as you practice on a piece of soft-skinned fruit.

[klone, MSN, RN]

Remember that starting IV's is 95% luck and 5% skill!

Rubbish. It's mostly skill, but it's a learned skill. Nobody's great at it at first. It takes lots and lots of practice to become skilled at phlebotomy and IV starts.

[itsnowornever, BSN, RN]

I always give myself a pep talk before hand so I don't spazz out! LMAO

I also find that if you raise the bed, lower the rail and arm and can sit down its easier, or squat if you're steady. Doing it while hobeing or standing over a vein I find my angle gets too deep.

Posting from my phone, ease forgive my fat thumbs! :)

[sandyfeet]

I always turn the lights up all the way in the room. Normally I wear a size medium glove but I use a small for IV starts because I can palpate easier. Then I place a folded sheet under the patient's arm or elbow, depending on where I'm going. Often times I need a quick AC so a sheet propped under the elbow helps push veins to the surface. The sheet can also catch if you don't occlude the vein well and spill some blood.

Other tips:

-Use gravity to your advantage. Arm hanging off the bed.

-Raise the bed to save your back.

-A glove filled with warm water and knotted off can help bring veins up.

-Loosen the cap on the T-connector beforehand so you can easily twist it off while occluding the vein.

[Floridayz, ASN, RN]

I am a new nurse too, and didn't feel confident with them either. My preceptor said pull up a chair, get comfortable, calm down and take your time. I haven't missed since! I think there was some mental block that it was an unattainable skill...