I am a moron--I need I.V. help

TiffyRN, BSN, PhD · Dec 29, 2003

I really struggled with IV sticks when I started and went with everyone to watch and started them in the presence of experts asking for advice. . . The whole she-bang. I've heard it said earlier on this thread and I will re-iterate. Try and try again. Experience will teach you. I knew an experienced charge nurse that had great skills except when it came to starting people with dark skin, missed every time. She had been a nurse over 5 years and charge over a year before she finally started getting them

Real ego-buster is going from being the "go-to" nurse on the floor for IV's then change to Neonatal where I think I've gotten

veetach · Dec 29, 2003

First, what kind of jelco's are you using??? I dont know if anyone uses the old Jelco brand anymore but they used to pop when you entered the vein.

We use a "needleless" setup where you push a white button and the needle sucks back into the base of the jelco. I cant for the life of me remember the brand name but you have to loosen the plastic base of the cannula before you stick the vein.

Our hospital prefers that we use #22 jelco unless the pt is having a special test or is a trauma pt because they are easier on the veins and there are less cases of thrombophlebitis.

also if you enter the vein from the top instead of from the side, you wont have the potential of nicking the vein from the side and causing it to blow.

good luck!

Shellsie · Dec 29, 2003

i think we all have those "barn door days" as i like to call them...you know the days you cant hit a barn door...let alone a vein on a 90 yr old dehydrated little old lady.

hehe

hang in there and you will find your "nitch"

Rena RN 2003, RN · Dec 29, 2003

INT = intermittent needle therapy at our facility. sounds korny as hell to me but i don't get to make the rules. :chuckle

Deaconess · Jan 6, 2004

What I have found helpful in improving my IV skills is watching others. When I have "struck out" on a difficult stick, I hope that one of the one or two nurses that can get anyone is on. I watch them and get tips. We only call IV therapy as a last resort to document the need for a PICC.

Another helpful thing to remember is that if you are getting flustered, its probably time to get a fresh set of eyes to look at those veins.

For patients that you just can't see or feel anything on (renal patients, especially), warm packs work nicely.

Anyone have tips for babies and tots?

teeituptom, BSN, RN · Feb 20, 2004

Just keep sticking untill you get it right

just stick to it

a stick in time saves nine

sticktoitness is a good habit

thanatos · Feb 20, 2004

Lidicaine is helpful to us on our end, but speaking from the end of the receiver, Lido is painful!! The one time someone (an anesthesiologist) started an IV on me using Lido it stung like a son-of-a-gun, hurt much worse than the IV stick. The MD told me he gave it to "numb up the area" where he was starting the IV!
Good try! Of course he had no idea I was an ER nurse!

Try buffering the Lidocaine w/ Bicarb (we call it BiLi), it works great! It numbs the areas immidiately around the site w/out the burning sensation. Lido is packaged in an acidic solution in order to provide stability, and that causes the burning sensation. The bicarb raises the pH and thus decreases the pain. I became a believer after the day surgery nurse used it on me...I barely felt the IV (an 18g). I use it w/ good success in the ER on school age children (and certain adults). Ask your pharmacy about it; it's easy to make and stable for about 1 week.

thanatos · Feb 20, 2004

Here's a trick to practice the one finger advance. Take some IV tubing, wrap it around a table top, and then tie the ends in a knot. That is now your practice vein. Stabilize the tubing "vein" w/ your nondominant hand above & below the venipuncture site. Now cannulate the "vein" @ 10-15 degrees. As soon as the needle enters the lumen (in a real vein this would be designated by a 'flash'), lower your angle to nearly flush to the skin, and advance the needle another ~ 1/8 in. Now, while mainting traction w/ nondominant hand, slip your dominant index finger off the needle and onto the hub of the catheter...then gently advance the catheter by pushing off w/ your index finger. After some practice, it becomes second nature. Good luck. Remember: practice, practice, practice.

thanatos · Feb 20, 2004

Some tricks when starting IVs on infants:

1) Place Emla or Elamax on target veins (I always place it 2 different sites).

2) Flush the angiocath w/ N.S. and the leave the back cap off. This allows for quicker visualization of blood flash, esp. in dehydrated kids.

3) Try using a transillimunator if available.

4) On the dorsum of the hand, there is almost always a vein above the 4th metacarpal.

5) The saphenous vein, located just anterior to the medial malleolus, is a great site on infants.

6) Don't forget the scalp veins.

Good luck

veetach · Feb 20, 2004

who has EMLA or a transilluminator available in their ED? not us...

lynn27 · Feb 20, 2004

Those big ropy veins can be so misleading...I had a patient that had those big ole ropes (pt was in her late 30's) and I could not believe it when I missed her vein--so I called another nurse who attempted x2 sticks without success. Finally, the doc (who was quite annoyed with us since we were obviously so inept) states, "Well, I guess I WILL HAVE TO DO IT". And then he misses it, x2. Was funny--even the pt who had endured so many attempts laughed at him. Finally our salvation was an ER nurse who made us all look so bad...she did it in one stick and wasn't in the room 1 minute!! Thank you to all of you ER nurses out there--have helped me more times than I can count!

thanatos · Feb 20, 2004

who has EMLA or a transilluminator available in their ED? not us...

We have both Emla & Elamax in our ER pyxis. As soon as child appears to be candidate for an IV (non-emergent, of course), we try to put some on.

We don't have a transilluminator in the ER, but we can borrow the Nursery's. You can actually use a strong penlight or otoscope with the same effect.