Humiliating IV questions

[elizabells]

Hey, y'all.

I have an embarassing confession to make. I've been in the NICU, student and RN, since March of 06. In that time, I have successfully started ONE IV. One. Now, I'm really good at venipuncture. Good enough that I help out other nurses when they can't get their labs. But I have some kind of psychomotor disconnect when it comes to advancing the catheter and flushing. It's truly pathetic. I know that it's hard to say what I'm doing wrong when you haven't seen me do it, but does anyone have tips? I just can't advance that d(&* catheter properly! It bends, it kinks, and if by some miracle I get it in all the way, it's gone straight through the vein and it blows, or it just won't flush.

thanks

[prmenrs, RN]

I use the old Jelcos ONLY! Can't get the hang of the safety caths. I really hate the ones w/the clip on the end--got one in a 500 gram kid, went to pull the stylet out, the whole thing came out! :angryfire:angryfire:crying2:

Lately, I've had a hard time hitting anything, my hands shake a bit too much. But, here are my tips: Go in slowly, when you get a flash, push the catheter forward a little (maybe 1-2 mm), then pull the stylet back slowly as you advance the catheter. Don't pull the stylet all the way out till you have more of the catheter in--there's not enough strength in the catheter, it'll kink, and then it's pretty much over. If you miss, pull back slowly, if you see blood, pull the stylet out, and try and "float" it in w/your flush--someone else gently flushes while you try to advance. Works once in a while.

If you have a big NB fighting you, have someone start feeding him/her/it, or use Sweetease. Swaddle (tightly!) all but the desired extremity. Use a rubber band for a tourniquet (or non latex type rubber band).

Need I mention appropriate prayers to the holy person of your choice never hurt!!

[nursecave]

We don't have any choice in what angiocath we use. They don't stock anything else. We did have the BBraun's with the clip on the end, and it only took about 2 months and the whole corporation quit using them because they were so hard to deal with. It wasn't a neonatal only problem, nurses couldn't get IV's in adults with those things! I like the ones we use now better,the BD's, they are what we used prior to the BBrauns. Sometimes the old way IS the better way!

[prmenrs, RN]

Of the ones I have tried, the "ProtectIV" catheters is better than the clippie one. Problems are that it's hard to get catheter off the stylet, and there is so much weight @ the back end of the device, it pulls its own self out by itself.

What a pain.

[preemieRNkate, RN]

I miss the "unsafe" angios! We've been using Jelco ACUVANCE catheters for awhile now though, and I like them (once I got the hang of them!) much better than the BD push-button ones. Sometimes the Jelco ADVANTIV catheters will show up on the unit (I guess if whoever does ordering isn't paying close enough attention) and they are terrible! They're the ones that you almost have to screw off, and I can never do it without at least 2 other people helping! The problem is, they look very, very similar in packaging.

[prmenrs, RN]

I liked those--not so much weight on the back end.

[edmia, BSN, RN]

I take out the stylet as soon as I get a flash of blood, flush the catheter, then advance.

It's interesting to hear you describe this procedure. I'd read that you could "float" the catheter in as you flush, but can't seem to do it properly.

I'm a tactile learner and also seem to have some kind of spatial disability going on with the catheter. Give me a butterfly and I can get as many tubes as you like, but ask me to leave a line in and I start sweating.

This past week, I decided to pretend I'm just getting blood, and it's helped in terms of confidence, but I've had a couple of those where you can hit the vein, get your tubes filled just fine, but then when you try to flush - NO thank you.

We use the angiocath to go in, attach a 12mL syringe to it when you get your flashback, fill it for the tubes, remove it (getting blood all over the place unless you can maneuver your finger to clamp off the catheter just right), attach the saline lock thingy, flush and you're done.

What gets me as well is advancing. Many times, I've been left with a catheter that will flush only if it's pulled out about 1/2 inch, which of course is a no go, so I have to stick the pt. again... No fun.

I keep thinking it's a matter of practice, but I find myself scoping out pt.'s arms as soon as I see them. Never thought I'd like bulging veins as much as I do now. I find myself staring at people's arms everywhere and thinking "Oh, you'd be an easy stick" or "Oh my G-d, I hope you never need an IV!".

Thanks for the advise everyone.

[SteveNNP, MSN, NP]

Ha! I remember being horrified at the amount of blood I was drawing when I'd work the ED or have a teenager in PICU. Seriously though, 12 mls is like 50% of some babies total blood volume.

[RonbabyRN]

I once had a mom ask me recently how much training I have had on getting IV's on Neonates. I replyed to her "15 years of training, I'm always learning." She seemed very impressed with that answer.

[Jokerhill]

It takes time to get good at them and to develop tricks that work for you. I have tough a lot of nurses but never on line so I will just list a few things to try on difficult starts. Some times I will use a tourniquet some times I will not, If the vein blows when I first puncture the vein with it on my next try I will not use it. I always use a 1ml syringe to guide the cath in if it will not easily advance, I have even had success spinning it around like a corkscrew as I advance to get passed a valve or bifurcation. I will also us the trans illuminator if I cant find a vein in the first place. Try to get to all the new admits you can before all the veins are blown to gt practice and build up your confidence. I hope I helped, Joker.

[Sweeper933]

While new admits are usually wonderful to practice getting IVs on - they can be the hardest as well. But when they're volume depleted (especially sick term kids) getting an IV is usually horrible. You'll get great flashbacks, but then won't be able to advance / flush the IV for the life of you. So frustrating!

[santababy52]

We use those in our NICU and I have found that lately we have had a bad batch where they are so flimsy they kink really bad, and to make matters worse, the hub is very difficult to dislodge. The catheters with wings makes it a little easier. When you are having the luck (or skill) to get your IV in and it is in good shape, wrestling with the hub makes me want to swear! Once the catheters came with the needle protection devices they became much harder to insert. For some of us older nurses it was a difficult adjustment to make. I know it is better for us but it sure is harder.

[Pedi-Gree, BSN, RN]

elizabells, I have the same issues you have. I've been working at my job for many years and can always get the labs, but threading in the catheter totally eludes me most of the time. Funny though that the ones I DO get are the ones where three other people have already tried, the kid is screaming and cartwheeling across the bed and OMG there it is - in! I'm going to take the tips I've just read here and put them into practice the next time I try one. Then I'll report back.