HOW TO PUT IN A IV: ANY TIPS

Betsy Dunn · Oct 19, 2000

[Hi, I have just entered this forum for the first time. I have been starting IV's for 17 yrs. As all our peers have indicted, warming the extremity helps and dropping it below heart level. The type of cath makes a difference,as not all the bevels are the same. Remember that once you get a flash you have not really gotten into the vein all the way. Advance the needle a little way and you will generally find you have been sucessful. Really look for the best site and not the most convient one. ( its nice but not the best). Keep trying.

Best to you

betsy

sonnie · Oct 19, 2000

Originally posted by egmillard:
I have just started my orientation on a telemetry unit, and have just been taught to put in IV's, sometimes I get it and sometimes I dont. How long does it take to be successful. I know that we all have times when we can't do it, but I want to be 80% successul. Any tips and ideas about the best way to do it would be most welcome, thanks Emma...........

Emma,

After teaching IV skills for 12 years all I can say is PRACTICE, PRACTICE, PRACTICE!!!!!!!!!! this is a skill that just takes time for most folks. Yes there are those wiz kids out there that can put a 20 g jelco in a prune blindfolded, but I promise with practice you can start just about anyone you try on the first poke. A big thing to remember is to explain as best you can what you are doing to/for the patient, this will help with cooperation alot in most cases. I learned to start IV's on small animals first when I worked as a vet tech., then really honed those skills when I worked on our local ambulance. Also be careful of the site you pick. Don't always go for the biggest vein if it is in a bad place, BE PICKY!!! Choose the size of cannula that is appropiate to the job and the vein. Many older people cannot tolerate an 16-18 g jelco and do much better with a 20-22. But as I said before PRACTICE, PRACTICE, PRACTICE!!!!!!!

Now onto the NG thing....

try wrapping the tip of the NG tube around your hand and letting it soften and warm some, usually 2-5 minutes is long enough. This also helps to form a curl that matches the nasal oral passageway and makes NG's slide right down slicker than you know what!!!!!

hollykate · Oct 19, 2000

Thanks Sonnie,

Glad to know the NG tips, because if one more patient dutifully swallows, and then opens their mouth with this big plastic snake popping out, I am just going to cry...

DO you all still use jelco's? We are not allowed, got the fancy safety ones which are actually (IMHO) a little more difficult to thread. I also must agree, put in the right size catheter for the job- ie if the pt is just going to get a small amount of fluids say 30 cc an hour a 20 ga or even a 22 depending will do, but if you are doing a big dilantin loading dose- please do us a favor and put in the biggest IV in hte bestest sopt you can find (oh, my pet peve, seeing 1400 mg dilantin in 100cc of saline, running into the teeny 22 ga iv in the hand...)

Can't wait to get to work, and find someone who needs and NG! Thanks, especially for not laughing at my lack of skill in that area.

sonnie · Oct 19, 2000

Originally posted by hollykate:
Thanks Sonnie,
Glad to know the NG tips, because if one more patient dutifully swallows, and then opens their mouth with this big plastic snake popping out, I am just going to cry...
DO you all still use jelco's? We are not allowed, got the fancy safety ones which are actually (IMHO) a little more difficult to thread. I also must agree, put in the right size catheter for the job- ie if the pt is just going to get a small amount of fluids say 30 cc an hour a 20 ga or even a 22 depending will do, but if you are doing a big dilantin loading dose- please do us a favor and put in the biggest IV in hte bestest sopt you can find (oh, my pet peve, seeing 1400 mg dilantin in 100cc of saline, running into the teeny 22 ga iv in the hand...)
Can't wait to get to work, and find someone who needs and NG! Thanks, especially for not laughing at my lack of skill in that area.

hollykate:

Yes we can still use jelcos because our DON and I both absolutely HATE the retracting sheath cannulas and since we have had no problems with needle sticks from the jelcos our insurance carrier hasn't made a fuss about them. Don't cry over NG tubes they also take practice!!!!

tmblweed · Oct 20, 2000

Hi, I find if I anchor the vein between my thumb and index finger of my left hand and start the IV with my right hand, that helps to stabilize the vein. Warm soaks help the veins to pop up and sometimes if you use a larger size jelco it's easier to get through the skin, esp. on young people. Also stay away from valves and bifurcations. Good luck!

Trauma Columnist · Oct 23, 2000

I'm an ED nurse and practice is about the best advice. However, you can also try a double tourniquet technique. That is if you have a hard stick, you place two tourniquets about 3-4 inches apart above where you plan to stick.

On babies, I prefere to cut the tourniquet in half lengthwise, so that it is more effective.

I truly love the Introcan brand of retractible IV caths. They are extremely sharp, easy to use and very safe. We trialed them this past summer and the concensus was that they are wonderful. Best of luck!

bluesgirl · Oct 25, 2000

Kinda embarassed to be answering this post--good tips, I hope to use--I Love central lines myself--he-he.

Got a few tips though--bifurcations--start 1/2 to a 1/4 in. below and in the middle, aim for the middle--works well on the hand!

Hold skin and arm on forearm tight from underneath, go above wrist, or P.T. will get a little perturbed, can't excercise the wrist, limits patients mobility, too.

On Dobhof's and NG"S--We all hate NG's--

I do a little better.--My humble suggestions,--sit that pt up straight and sweet talk them, Don't look at their nose while inserting, look at the throat, tell them to swallow, no matter what they feel, three times in a row and say swallow, swallow, swallow, and watch their throat--they almost always take a breath, hesitate, then swallow, so don't poke them while they're taking that breath or hesitating,-use the ice chips too--they are so thirsty, and I have to admit to giving one or two a tic tac to "tuck it in your cheek--makes them salivate to swallow--Also tell them to tuck your chin---I have good luck with that--I'm good at this, make me look good sweetie---they like to participate--loosen them up a little, a cause I pity the poor nurse coming at me with an ng tube---Don't you!!!

Thanks for all YOUR tips.

Blues

egmillard · Oct 26, 2000

WHY ARE YOU EMBARRASSED TO BE ANSWERING THIS POST?

Originally posted by bluesgirl
Kinda embarassed to be answering this post--good tips, I hope to use--I Love central lines myself--he-he.
Got a few tips though--bifurcations--start 1/2 to a 1/4 in. below and in the middle, aim for the middle--works well on the hand!
Hold skin and arm on forearm tight from underneath, go above wrist, or P.T. will get a little perturbed, can't excercise the wrist, limits patients mobility, too.
On Dobhof's and NG"S--We all hate NG's--
I do a little better.--My humble suggestions,--sit that pt up straight and sweet talk them, Don't look at their nose while inserting, look at the throat, tell them to swallow, no matter what they feel, three times in a row and say swallow, swallow, swallow, and watch their throat--they almost always take a breath, hesitate, then swallow, so don't poke them while they're taking that breath or hesitating,-use the ice chips too--they are so thirsty, and I have to admit to giving one or two a tic tac to "tuck it in your cheek--makes them salivate to swallow--Also tell them to tuck your chin---I have good luck with that--I'm good at this, make me look good sweetie---they like to participate--loosen them up a little, a cause I pity the poor nurse coming at me with an ng tube---Don't you!!!
Thanks for all YOUR tips.
Blues

bluesgirl · Oct 26, 2000

Originally posted by egmillard:
WHY ARE YOU EMBARRASSED TO BE ANSWERING THIS POST?

Because I'm pretty lousy at putting in IV's myself--better at ng's

sanshin99 · Nov 2, 2000

Lots of great tips!!!! I have always been hot or cold.I think Bettsy's tip about advancing after the flash is the best. I had a IV nurse give the same advice and it has made the difference. Once again I can only repeat what others have said. Take your time and look at both arms before sticking your patient. Also do not be afraid to get a more experianced person if necessary. I absolutely hate it when a nurse trys four or five times before grabbing me. Never let your ego get the best of you. Even the hottest iv person misses once in a while.

Jay-Jay, RN · Nov 7, 2000

When it comes to IV's I have my good days and my bad. My hardest challenge was an elderly, frail terminal CA patient who was dehydrated...got her on the second poke.

A tip I learned in school which not many people know is once you get flashback, shove the cannula forward about 1/8 in. so it's covering the needle, THEN advance into the vein. This will prevent the needle from going through the vein wall as you advance.

egmillard · Nov 13, 2000

Thanks for all your advice. I have been trying to put in IV's, however I always appear to get the most difficult of patients, frail, dehydrated and elderly. I know it will take time, but I am the sort of person that wants to be good at things straight away, but we will see. Thanks to everyone, that gave me advice. Emma