I cant start IV's!

j450n, BSN, MSN, RN · Feb 10, 2009

I did an ABG once when the lab tech couldn't. It wasn't really that difficult, just aim for the pulse. It's not like you have to advance a catheter. The artery has so much pressure, the syringe fills itself.

Good to know. :up: I think starting IVs is probably my worst fear when I become a nurse, especially since I don't have steady hands.

firstyearstudent · Feb 10, 2009

Ugh. I have been a nurse for two years now on a hematology unit and my IV skills are worse now than when I was a student. Ninety-nine percent of our patients have central lines and the ones that don't have terrible veins. I've tried to stick three in the two years I've been employed and had zero success.

FireStarterRN, BSN, RN · Feb 10, 2009

My nursing school didn't stress IV skills. They told us that was the least of our worries. It's merely a technical skill, even EMTs start IVs. They wanted us to understand things, the mechanical skills come later.

Azzurri · Feb 10, 2009

I work in one of the largest/busiest ED Trauma centers on the East Coast and I honestly feel that IV's are one of the easiest parts of my job. We never use the IV team unless we have multiple unsuccessful attempts by a couple nurses only because its hospital policy to call them. We do as many IV starts if not more than IV nurses and I believe we're better at it.

There really isn't a shift that I don't do atleast 5 IV's and I've done in the upwards of 20+ IV starts in some shifts where I'm extremely busy. I get more annoyed having to do my own EKG's than IV's.

Most ED's don't hire you with a contigency you know how to start an IV. Alot of people in my orientation group had never done an IV before and are good now. I can't speak for all ED's but the one I work at, I'm not always in the assignment with the trauma's. We have 2 designated trauma bays and 3 critical care rooms next to they bays and that whole assignment has 3 RN's working it per shift, one of them being a trauma clinical leader. So what I'm saying is I can go a couple of weeks and not be assigned to the trauma assignment because we have almost 200 nurses in our ED alone. Of course I've gotten trauma's in less acute area's when we're full but most of the time it doesn't work that way.

If you need practice, start off with 20G IV's..they're not so big where its hard to advance but they're still stiff enough where they're not going to bend too much. I hate 22G for that reason, they're too damn flimsy. And I've never even used a 24G, not even for a newborn.

I'd say that probably 95% of my IV starts are 18G. Some people think 18G should only be used for trauma's or critical situations but in critical situations, I'm using a 16G or 14G. And you never know how serious a pts situation is. There are people that you think just have a cold or indigestion and they end up coding. I've seen it multiple times, so I rather have atleast 18G for those circumstances. I will say that I've been putting in a few 16G IV's per week and alot of nurses look to me when they can't get large bore IV access. Just this past weekend I put in 3 16G and a 14G on top of numerous 18G.

Don't worry, you just need to practice. During our orientation they made us practice on each other. One piece of advice I'll give you is, in the beginning during you first few weeks, don't tell pts you're new to starting IV's. It makes the pts nervous and less likely to let you stick them and in turn makes you nervous and anxious starting IV's.

Azzurri · Feb 10, 2009

"My nursing school didn't stress IV skills. They told us that was the least of our worries. It's merely a technical skill, even EMTs start IVs. They wanted us to understand things, the mechanical skills come later."

Actually EMT's don't start IV's, paramedics do. EMT's work for the fire company and all they basically do is transport pts. Medics are the one's that can start IV's, give meds, and even intubate.

FireStarterRN, BSN, RN · Feb 10, 2009

EMTs here can get IV certified, I know a woman who is.

I_LOVE_TRAUMA, RN · Feb 10, 2009

I think spending a few hours with the IV therapy team would be a great idea, but really you just need practice, practice, practice. They get to be like second nature. At my place the floor nurses call the flight nurses when they can't get a stick (or if ER, ICU, OR, NICU, can't do it) and if it is a down time for them they will come start it, so I have sent new grads/inexperienced stickers with them for a while before. Also our ER, ICU, advanced care nurses do all of their own ABGs, a lot of the floor nurses con the RTT into doing theirs, but still do quite a few. These are sooo much easier than piv starts. Its a blind stick, about a 45 degree angle, and you just find the pulse and "dig around" until your syringe start to fill on its own. Don't fret, everyone has to start somewhere, in no time at all you will be so good that you will get tired of having to start IVs for everyone else.

Reno1978, BSN, RN · Feb 10, 2009

BTW: I find it ironic that you work in the ICU. At my hospital, if the IV team can't stick someone, they call the ICU to send up an experienced nurse to do the lab draw or IV start.

LOL - it's the same way in the ICU that I used to work at...charge nurse would send someone who wanted to practice their IV starts because we really don't do too many IV starts in the ICU. In the past year in the ICU I've started 5 IVs successfully and have had a few failed attempts. Usually ICU patients have some type of central venous access for medications and blood draws. I always thought it was weird that they called us and we always joked that they're calling upon the unit in the hospital that is probably least competent with IV starts....

Nonetheless, you'll get plenty of opportunity to start IVs in a ED setting. The idea to go to ambulatory surgery/same say surgery would be a great place to build your skill level...or if your hospital has any type of outpatient infusion center, that'd work too. Ask about it! Even if it's just for 4 hours a week in addition to your regular shifts so you don't get OT and can still complete your regular shifts....

RochesterRN-BSN, BSN, RN · Feb 10, 2009

Well if it makes you feel better my first job was in Labor and Delivery and I gotta say I was aweful with the IV's!! I remember calling my long time friend who had been an RN in the PICU for years and telling her I was never gonna be any good at that skill --she tried to give me pointers and told me to just keep at it........well once I got to a med/respiratory floor after trying out med ED for 3 months and hating the staff there--(I tranferred) so the nurses on the floor would say to me---oh you came to us from the ER so you must be good at IVs and would ask me to do their tough sticks-- I jumped on all that extra experience and ended up calling my friend to say --guess what? The nurse that couldn't get in an IV for anything.....now awesome at it and now staff nicknamed me "the IV Queen" for the floor---Me! I never thought I would ever get better and I never gave up and look what happened. I at one point actually applied for an IV nurse job! LOL I am in psych ER now though and never get the chance to do them and I miss it............though I still help the techs out with tough blood draws. Moral of the story don't give up and don't let hearing a patient is a tough stick discourage you. If I got awesome at it anyone can --really!!! (My first preceptor form L&D would laugh at me and ALL my misses! LOL)

pererau · Feb 10, 2009

One thing that I have found is important in starting IVs is confidence. It is kind of a vicious circle, because when you miss, your confidence goes down, and when your confidence goes down, you are more likely to miss. You have to trick yourself into thinking you are going to get it, because I've found that when I go in with no confidence, I create a self-fulfilling prophecy.

GooeyRN, ADN, BSN, CNA, LPN, RN · Feb 10, 2009

I sucked at starting IV's and I knew it. I started asking all of the nurses on my shift to find me if one of their patients needed an IV, I wanted more experience. :mad: They were all fine with that. They stayed near by for if I didn't get it on the second try. I got better really fast doing that. I would not consider myself great at IV's now, I am not the "go to" person, but I would say I get 75% now on the first stick.

RochesterRN-BSN, BSN, RN · Feb 10, 2009

One thing that I have found is important in starting IVs is confidence. It is kind of a vicious circle, because when you miss, your confidence goes down, and when your confidence goes down, you are more likely to miss. You have to trick yourself into thinking you are going to get it, because I've found that when I go in with no confidence, I create a self-fulfilling prophecy.

Absolutley!!! confidence is KEY!!! Go in telling yourself you will get it. It's funny that you say that cause I always go in with with just what I need, set up and start looking for a vein. When I would go to do one for a nurse who would tell me she needed me to get a tough stick......I would ask if the stuff was in the room, assuming she tried at least once. She would say oh no, you'll need to get it. I just know I can't get him cause he's really heavy......or she's really frail and has tiny spider veins.....or the patient says they are a hard stick.....she wouldnever have even LOOKED at the patients veins and told herself she couldn't do it!!! LOL Then when asked how I got so good I would tell these nurses ....well I never asume I can't get an IV cause of weight, skin color (yeah...I've heard that one too!!! LOL) age, whatever......I go in with my stuff and know I will get it.---that is what I am telling myself and 99% of the time I did. So YES, YES YES Confidence is KEY.....and this goes for blood draws too.....I have told the same thing to techs who have a hard time and ask how I got goo. PRACTICE, CONFIDENCE and PRACTICE!!!!!!