I cant start IV's!

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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?

Specializes in OR, ER, TRAVEL, SURGICARE, WOMENS HOSP.

I have a trick. If you first get a flash and your angiocath will not advance then, take the needle out leaving the plastic sheath in and slowly pull out until blood drops out of the end, then slowly try to push the sheath in. Works everytime. Use a 22 or larger because they are longer. Can't do it with a 24. Also always start at the AC for it is the largest vein you can palpate. Practice, Practice, Practice... do follow the IV team around the hospital for that would give you practice the differance is... they only have to stick a vein and not thread an agiocath. Do follow IV team and not lab. Let me know how it works out and if this helped. ambulance.png

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i went through nursing school without ever starting an iv.

except on the kind emt/ fellow nursing assistant who let me try one on him.

of course he had excellent veins.

:)

i would suggest something involving a paramedic or emt. they are most excellent at iv starts

i also look at my own hands, and then the hands/ arms of the person im trying to stick and try to visualize about where the vein is on them, especially if i cant really see their vein or they have a lot of edema or tiny old people veins.

it helps for the most part.

i agree with practice helping. get as much experience as you can.

most patients will let you try at least once.

where i work, the nurses are supposed to get any labs from the patients (we are not allowed to draw labs from ints) so that has been good practice also.

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Specializes in Emergency.

I really think the best thing is to find super easy sticks and do a ton of them. You won't be able to get a difficult line without knowing how to do an easy one, what it's supposed to feel and look like. Find a bunch of dumb teenage males with pipes who won't care if you stick them over and over and then the harder ones start to make sense.

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Specializes in Psych, ER, Resp/Med, LTC, Education.

One thing I found, especially in the older folks with more fragile veins--If the patients blood pressure is really high and they have fragile viens they seem to blow one after the next no matter what I do, even using the largest cath....and I never blow veins any more.....theis has happened to me a few times. I taked to the doc and got some meds in for the BP--either a one time dose of something or a med early--and once the pressure came down it went in like a charm --no blown vein....and yes for the elderly no tourniquet or even not so tight helps!

The other thing is ....I am in NY state and here students in all the schools I know of are not allowed to do IVs--that is a skill you have to be taught and learn---as far as on real people-- once you get a job. I can't say for certain but I think it's against the law in NYS for a student to put in an IV.

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Practice, practice, practice!

I have gotta pretty good at starting IVs now but am working on the not making a bloody mess. chucks underneath is a must!

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Specializes in CEN.

Your own thought of trailing the IV team is an excellent idea. A lot of hospitals no longer have IV teams, so try to take advantage of the opportunity.

I agree with numerous others that state most ICU nurses deal with central lines, so don't necessarily have peripheral IV skills. In our hospital, it's the ED nurses who get called for in-house pts needing a new line.

I'd also think if you're starting a new position, you'll have an orientation, and hopefully, an opportunity to develop some skill before you're in a crisis situation.

Good luck!:)

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Specializes in ED.

Maybe if the floors (ICU excluded) were not so pushy and demanding about the patient having an IV before coming to the floor then they would get more practice. We don't have an IV team, but if did, then we would be the IV team. I've been an ED nurse for 3 years and probably placed about 5000 IV lines.

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Specializes in LTC,ICU,ANESTHESIA.

I was an ICU nurse for a long time and lost all IV skills while I was there, my wife, who is also a CRNA , would be on call in the hospital and I would page her to come start my IVs when I could not.

" Honey, if you loved me you would come start this IV for me" .

IV skills are a matter of practice, practice, practice and more practice.. and nothing more.

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Specializes in Spinal Cord injuries, Emergency+EMS.

practice , practice and more practice ...

a lot of good advice has been given ... release tourniquets sooner rather than later , shallow approach etc ...

but nothing beats practice - I don't claim to be able to get a line in any one but i'll at least have a look and if someone is really bad to get access on they may end up with a line in an unconventional place ... i've ended up on the ulnar aspect of arms and on bicpes in people who have become human pin cushions pin cushions through repeated attempts of having to have lotsorf peripheral lines due to prolonged IV therapy anda reluctance to get them a central line /PICC

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Specializes in Emergency.
Practice, practice, practice!

I have gotta pretty good at starting IVs now but am working on the not making a bloody mess. chucks underneath is a must!

Yeah, nothing beats practice. And sometime, you're just simply in IV hell.

If I can feel but not see the vein, I mark it above & below with my pen so I have a target in the middle. I'm a big fan of the cephalic, try to save the AC if possible.

Do you occlude the vein just above the end of the catheter after removing the sharp and/or blood draw attachment thingy (nice medical term, huh?)? I use my ring finger and that pretty much prevents the blood from pouring out & making a mess.

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Specializes in Women's health & post-partum.
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.

I discovered when I was first learning to start IVs that if I reviewed mentally the whole procedure, step by step before I went to the patient's room, I was usually successful. If I hurried, I missed more often than not.

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Our hospital frequently sends people to our ER when they want practice starting IV's. They just wander around and when we have a patient that needs an IV we let them try to start it. Don't worry someone told me that until you've started at least 100 IV's you don't really feel comfortable doing them, and even after 100 you're no where near an expert, so don't feel bad about not being able to start them. I feel pretty comfortable now and I've only been doing them for about 3 months now. Just remember to use a shallow angle, I blew a few IV's before I figured that out :) Just practice! You'll get it soon.

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