I REALLY suck at starting IV's

Do you guys find that it's easier to lower the pt's arm, and then stick them while going upward? I can't seem to hit when their arm is lying flat on the bed.

Also, after you get blood return - do you at that point release the tourniquet, or advance the catheter? I thought you advance the cathether, and then relese the tourniquet after the needle is out...but I've seen people release the tourn and THEN advance the catheter. Hmmmmm.

Any other tips you want to share? Sometimes I think I'm going in too deep. A friend of mine said to go in a tad deeper than what you would if you were giving someone a TB shot.

[TCASII, ADN]

Do you guys find that it's easier to lower the pt's arm, and then stick them while going upward? I can't seem to hit when their arm is lying flat on the bed.

Also, after you get blood return - do you at that point release the tourniquet, or advance the catheter? I thought you advance the cathether, and then relese the tourniquet after the needle is out...but I've seen people release the tourn and THEN advance the catheter. Hmmmmm.

Any other tips you want to share? Sometimes I think I'm going in too deep. A friend of mine said to go in a tad deeper than what you would if you were giving someone a TB shot.

Relase the tourniquet after advancing the cath and removing the needle. It just takes practice, and some are always better than others at doing it. Also, after the flash, insert the needle and cath a few more millimeters to be sure it's in place. To minimize blood loss, you can also place your thumb proximal to the site over the vein after you've removed the tourniquet and needle.

Keys points: Never withdraw the catheter back over the needle, this can cut a plastic part of the cath off and cause an embolus.

For difficult or deep veins, a 3 or 5 mL syringe can be attached to the catheter and used to check for proper placement using aspiration.

Whaid's maneuver: Take about a minute or two milking blood with both hands towards the forearm. Then place a tourniquet above the elbow. Then milk blood from hand/fingers toward the forearm for 3 to 5 minutes. Then tourniquet around the wrist. A vein should be more prominent for you to stick. Just make sure you don't leave the tourniquets, especially the wrist, on for very long (

[rehab nurse]

the nurse that inserted mine today, (after the 7th poke!), did so on the anterior of the wrist as i laid my hand straight above my head. it was at an odd angle, and it was difficult for her to get it in with my arm pulled in front of me. btw, i was very very dehydrated today. i have never been poked more than once, that i remember. oh, the joys of the stomach virus....

i tend to have an easier time inserting iv's when the pt's arm is left to dangle about four inches down off the mattress. it seems to make them stick out just far enough for me. but there are always people i can't stick, and i don't more than twice. i go get someone who is better than me! and believe me, there are many! lol...

good luck, it takes lots of practice!

[Paleobug]

I was taught that as soon as you see the blood pool, you should immediately release the torniquet.

[klone, MSN, RN]

Tourniquet should be removed as soon as you get flash. That's how we were taught.

[enfermeraSG]

Raindrop,

I don't think you can specify how deep to go in, because it is going to vary a bit with different arms, etc. Also, unless someone has spectacular veins I always milk down the forearm towards wrist and tie the tourniquet on above elbow to "have a look". It plumps up the veins better. If you have a chance to go around and start a bunch of IV's - do it. You will get better with practice. Spend a day in a busy ER if you can, or hang out with a resource nurse, or IV team. That's what I did years ago and it helped a ton. Everyone has their own tricks and technique. BTW, what is the reason behind removing tourniquet before advancing catheter? I've never seen that before in 13yrs, just curious. It is one smooth move for me, I advance the catheter, stabilize it and reach up for tourniquet. SG

[jasonglh]

If your hospital has an IV team go hang out with them for a bit. At mine they do the really hard sticks and restarts when the RN's are busy.

As far as popping the TQ I pop it right before I withdraw the needle and then put my thumb over the catheter to minimize the mess. Its just going to take you some practice and learning whats most comfortable for you. A great piece of advice I had was to not run away from the hard ones because you wont learn anything sticking the easy ones all day.

SameDay surgery is a good spot to start IV's all day as well.

[mariedoreen]

Do you guys find that it's easier to lower the pt's arm, and then stick them while going upward? I can't seem to hit when their arm is lying flat on the bed.

Gravity is your friend :)

[sgent]

If your hospital has an IV team go hang out with them for a bit. At mine they do the really hard sticks and restarts when the RN's are busy.

.

Amen, we have a FP that start's them better than anyone other than the Anesthesologists. Someone asked her where she learned -- she followed the IV team around for two days while in med school.

[enfermeraSG]

If your hospital has an IV team go hang out with them for a bit. At mine they do the really hard sticks and restarts when the RN's are busy.

As far as popping the TQ I pop it right before I withdraw the needle and then put my thumb over the catheter to minimize the mess. Its just going to take you some practice and learning whats most comfortable for you. A great piece of advice I had was to not run away from the hard ones because you wont learn anything sticking the easy ones all day.

SameDay surgery is a good spot to start IV's all day as well.

Great advice Jason, same day surgery is a wonderful place to line up the IV's. Also, a walk-in clinic/ urgent care clinic. I floated there as a tech for a few shifts and that's all I did was go from room to room sticking patients. (My idea of a good time! ) And definately try those sticks that you think are too difficult, you will learn and you might surprise yourself too! SG

[suzanne4, RN]

I also recommend Same-Day surgery, the patient is usually in reasonable health and not dehydrated, etc. It just takes practice, the more that you can do the better.