I Stink at IV's.

[Mrs.S]

Hi!

I am an RN 2 years out of school but new to L&D, and I just recently found this site. Yay! What a wonderful resource!

I am currently experiencing a very long, bad run on IV starts. I used to think I was fairly talented at them; used to do Mom/Baby and Peds at my old job and seldom had a problem, even on the kids. But since starting a new job in May I don't think I've gotten one on the first try yet! Not only do I feel bad for my poor patients who have to endure all my poking, but it makes me feel so incompetent having to always be asking other nurses for help!

I'm wondering if it's due to the size of the angio's we're using? At the old hospital we were pretty lax about that and mainly used 20's on adults. At the new place (as well as at most other normal hospitals I suspect), 18's are the hard-and-fast rule. I don't know really how much difference that makes, but it's the only thing I can think of that's changed!

I've talked to some of my new co-workers about it, and they each seem to have their own special trick, none of which has worked very consistently for me. (even had one very experienced nurse simply say "no xxx-footing around.") I have no problem getting into the vessel and getting that return, but then I either can't thread the catheter, or it immediately swells up like a little purple balloon, or just won't flush for heaven knows what reason.

Anybody have any suggestions I maybe haven't tried yet? My confidence is really shaken!

[SmilingBluEyes]

Sometimes starting IVs can be the most frustrating procedure you do--take this from someone who has been starting them for over 45 years in anesthesia. But, there are a few tricks.

1. 18 gauge are important in OB cases for the rare emergency that you need for fast infusion. They are no harder than 20 gauge, if you select a large enough vein. Veins are usually distended in pregnant patients and should usually accommodate an 18 gauge.

2. Make sure the tourniquet is tight and fairly close to the vein you are going to use.

3. Keep the arm below the level of the heart prior to tightening the tourniquet.

4. Find the strightest vein you can. It is hard to advance a straight catheter in a crooked vein.

5. Veins on the dorsum of the hand are usually superficial--don't go too deep.

6. Advance the needle about 1 cm into the vein before advancing the catheter, keep tourniquet on until catheter is advanced.

7. In anesthesia, I almost always use a skin wheal of local anesthesia with a 30 ga needle prior to insertion of the angiocath. You can argue about this, but a 30 gauge needle hurts less than an 18. But I am an anesthetist and hate pain and my patients love me for it. In California, the BON has ruled it acceptable for RNs to do this without an order.

8. If you miss after two times, get someone else to try. You will have good and bad days with IVs and that's that.

yoga crna

excellent and helpful post.

WELCOME To ALLNURSES!

[lisamc1RN, LPN]

As a student who has now had 3 unsuccessful IV sticks, I share your frustration! I just have to believe that some day I'm going to get it! :) Glad to read that you got it, and in a skinny vein, too! Yippee!