I cant start IV's!

[Creamsoda]

Ok, so ive been a RN for almost 4 years. Mostly in ICU. We dont start IV's often. So therefore, I am awfull at them. I mean horrible. Ive probably tried maybe 15 times in the past 3 months and have gotten 2. Thats pretty routine for me. The problem is I am starting a new Job in a large trauma emerg and I am worried that ill never get good. Im worried about having to start IV's quickly when I cant start them at the best of times. Im thinking im going to ask to shadow the IV team or something in the hospital because I cant work emerg and not start a stupid IV. did anyone else have this problem and get any better?

[iamablonde, BSN, RN]

Well, Maybe at this point, you have said you "CAN'T" so much that you have psyched yourself out! Once you get more practice you will probably be AWESOME at it!!!!

[tanthalas]

My first IV starts were bad. I was like, maybe 15/70. One day it just all sorta clicked and I've only missed 2 in around 50 attempts or so. It just takes practice :)

[Satori77, ADN]

I love placing IV catheters! It is very gratifying when you get it. I purposely try the difficult ones, that is the way to get better. Of course, I work with animals, so I really don't know how different it is in humans (I was fascinated in watching my husband get one placed before his surgery, thinking "I want to try that!" LOL). I do wonder if it will be harder, or scare me to place an IV in a person when I am done with school. But I can't wait to try. Like with anything else, you just need to practice. Isn't there IV classes people can take as well??

[Azzurri]

I hate when pts say "I'm a hard stick, and you can only use butterflys or a baby IV or a 22G or 24G IV or my veins roll, etc". I'd say that 98% of the pts that say that aren't really hard sticks, they just had unexperienced nurses stick them before. There are ways to get veins that seem small pop up better that I've learned. For example, putting 2 tournequets on or putting a tournequet up near the bicep and then one above where you're sticking.

I'm a very confident person when it comes to starting IV's for my own pts or even others. I would even venture to say that on occasion, I am almost cocky about it. Like when another nurse asks me to get a tough stick and I go in there and get an 18G like it was nothing or when my pts say they're a tough stick I'll do the same. Those instances will make you cocky about IV starts. The funny thing is I'm not an overly confident person either, except when I'm at work.

I find that if a pt asks me if I'm good and I say yes I sometimes jinx myself and miss. So usually unless I'm asked by a pt multiple times, I just keep telling myself I'm gonna get it.

Every nurse has their bad days. Some shifts I'll miss every single IV or every vein I blow. It sucks and puts me in a bad mood but it happens.

Like I said before, just practice alot and you'll get your skills.

[FireStarterRN, BSN, RN]

I just want to mention to people, it's really not necessary to use tourniquets if you can see the vein. You will blow veins with tourniquets. You can always use one temporarily, in order to mark two points on the skin as targets, but really, you have more luck on these old folks without a tourniquet.

Tourniquets help lab people, of course, because they create more pressure, causing the blood to flow for the lab draw. But they will definately contribute to blown veins in the elderly.

[neko11111]

Practice, Practice, Practice..... that's the only way you get better! Another thing is - even though it's a trauma center - they're not going to throw you to the wolves on the first day, they'll probably start you out with the less severe cases...don't fret. You'll get it, and no matter how good we all say we are - everyone hits a 'funk' every once in a while. Sometimes you can't even hit a garden hose sized vein. Just keep at it You'll learn to pick good spots away from valves, tricks on how to advance past valves, etc... Just take your time, and the major trick is to make sure that you anchor it down good! Good Luck!

[Azzurri]

I just want to mention to people, it's really not necessary to use tourniquets if you can see the vein. You will blow veins with tourniquets. You can always use one temporarily, in order to mark two points on the skin as targets, but really, you have more luck on these old folks without a tourniquet.

Tourniquets help lab people, of course, because they create more pressure, causing the blood to flow for the lab draw. But they will definately contribute to blown veins in the elderly.

Well where I work we use tournequets because we get labs from the IV when we place it. I've done IV's without the tournequet before but veins that are very small and hardly palpatable they work better for. I'm not gonna put an IV in and then stick them a 2nd time to get bloods via a butterfly unless I can't anything from an IV. I would also like to say we don't take blood off IV's after for repeat labs or new labs that we didn't get the first time, those instances we'll use a butterfly. Even in trauma's, we keep the tournequets on to get trauma labs, but if its a serious trauma and we need immediate access, we'll get bloods later on.

I agree that a tournequet can lead to blown veins in the elderly but I don't think that's neccessarily true for all ages.

[SecondGenRN]

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.

Hi there!

I'm a new grad who just started in the ED last week. I have to go with the confidence idea. As funny as it sounds, the best advice I got was to quit being so worried about whether or not I will be successful and "just put it in" lol Obvioulsy more to it than that, but I found when I relaxed, it led to better outcomes. On my 3 shifts last week I attempted over 30 iv`s and was successful on all but 4. Also I have a friend who just started in ICU and they had her come down to the ED for a few hours and do nothing but start IV`s. I wonder if they would allow you to do something like that?

[53Kalypso]

I'm a first year student, and today was my first time doing clinicals in the ED (LOVED it!), but I was so nervous about starting my first ever IV. The nurse I was paired up with was fabulous... He spent about 10 minutes of his time talking me through everything step-by-step at the nurse's station before we went into the patient's room. His advice was also to just fake the confidence (seems to be a re-occuring theme). Well it worked, I got it on my first try! I've been all smiles the whole day!!

[MassED, BSN, RN]

once you move to the ER, you'll become excellent at them. You'll never be alone in the ER and if you have difficulty, you can ask another nurse, all the while gaining experience. You'll get better and be able to start one in even the most difficult patient (COPD on steroids, dialysis patient, etc.) It takes time, don't worry.

[deelyn4]

Last week was my first week in the ER, after working 2 years in med/surg night shift. I maybe had to start 3 IV's on med/surg. I am still really nervous about starting them. But I know that I will get lots of experience where I am now.

I work with some pretty great nurses, from what I have experienced. I know I will learn alot from them!

In the 3 days I worked last week, I failed alot on my first try but often got it on my second. I had alot of blown veins. The tourniquet idea may have contributed, but we collect labs on the iv start.

I have to say that I love the ER! Why didn't I just start out there?!

[twinmommy+2, ADN, BSN, MSN]

What works for me is getting it in to the flash point, then just a little further, then advancing the catheter without the needle so I don't blow the vein. That works pretty well in most cases.