I suck at IV starts

Published

Anyone have tips on how to get good at placing IVs? My previous job did not require it, and now I am suddenly expected to be able to do this with no experience or instruction or anything! I know the most likely answer to my question is, "practice", but I HATE doing that to patients. I have missed the last SEVERAL I have attempted on people and it's breaking my spirit. I feel like it makes patients mistrust me and think I am incompetent right off the bat.

Up Vote Up Vote ×
Specializes in Surgical/ Trauma critical care.

Practice is the best thing you can do but make sure you go in to the pts room with someone who is good at it he/she might be able to point out things you're doing wrong.

Up Vote Up Vote ×
Specializes in ED.

I'm just a nursing student but I didn't really successfully start an IV until last semester. I had a seasoned nurse tell me to quick looking at the best vein and to feel for the best one. She showed me to start at the AC and work my way down to find the right one but in an emergent situation just hit that AC and go.

Feeling for the vein helped me SO much more than trying to see one. Once I felt for that vein-y toughness under the skin, I can poke then kind of dig for the vein itself and I feel that *pop* and I know I'm in.

I'm far from being a pro but i am at least more confident in finding a good vein.

Good luck!!

meredith

Up Vote Up Vote ×
Specializes in Critical Care.

Does your facility have a vascular access department that does any IV inserts? Do you have an area you could ask for time, like a pre-op area to get more sticks? For specific tips/techniques, I'd contact the intravenous nurses society..they used to have great references available.

Without further information about your technique and the fact that this is an online forum, it's hard to pinpoint why you might be having problems. Some things off the top of my head: are you using the right size cannula for the vein you are selecting? Are you applying counter traction when going to insert? Are you remembering to insert the cannula in the right direction (not trying to be insulting, I did this when I was a new nurse..went to stick a pt on the underside of the arm, blew the vein and my preceptor then reminded me of which way blood flows...boy was my face red. Don't think I've shared that with ANYONE over my career). It may help to get a diagram of veins in the arm, become more familiar with landmarks to looke for when palpating veins, helped me when I first started out. Also, are you trying to insert too close to a valve? That can cause a vein to blow? Do you know the difference in the feel of a vein vs. a valve? Just things to keep in mind.

And remember an important point: some days, you're gonna hit everyone. Other days, you're not gonna be able to hit the side of a barn....you'll see a vein big enough you could put a 12 guage in blindfolded and still blow the vein. It happens, don't beat yourself up.

Up Vote Up Vote ×
Specializes in onc, M/S, hospice, nursing informatics.

Don't feel bad. I suck sometimes, too. And I've been at this a while. But when I don't get a lot of practice, I get sucky again. I don't start them often on night shift, especially when I work in rehab (patients don't usually have IVs there) or NICU (I only float there occasionally, so haven't been checked off on babies). Hang in there. Some of us are better at other skills than others. I can put a foley in a 400 lb. woman no problem. I'll bet you have some skills your co-workers can't boast of, too!

Up Vote Up Vote ×
Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

http://www.saddleback.edu/alfa/vid_index.aspx

Saddleback College in California has this wonderful instructional page. Check it out

Up Vote Up Vote ×

I'm a pre-op nurse who is often shadowed by nurses wanting more IV experience. I often start up to 30 IV's a day. Some of the tips I can offer may go against what you've heard but they work for me. I must be doing something right because when there is a patient who is a hard stick anywhere in the hospital, I am one of the 2 people they call.

1.Nothing is more important than being organized and having everything you need. I have my tape torn, etc.---everything is laid out with extra in the tote I use. Don't laugh, one of the nurses I was precepting got as far as being ready to hook up the IV to the tubing before she realized there was no LR hanging.

2. Contrary to what I was taught in school, for IV's in the hand, place your tourniquet on the wrist. Further up and it just doesn't work as well.

3. A warm patient is much easier to find a vein on than a cold one. Take the time to wrap them and their hands in warm blankets if necessary.

4. A common mistake I see and one I was once guilty of is getting in a hurry. Slow down, take a deep breath......sometimes with some very dehydrated patients you'll get very slow flashback. Before you try to back out to change your angle, thinking you didn't hit anything, give it a second or 3.

5. Patients that are elderly and/or have very fragile veins with transparent skin many times need no tourniquet at all.

Everyone has offered great advice but as already mentioned, without seeing your technique, it's impossible to know specifically what kind of advice you need. I would also encourage you to have an experienced nurse observe you so you can get immediate feedback. You didn't mention the type of patients you typically are starting IV's on. If they're going to have surgery, usually nothing less than a 20 or 18ga will do and preferable not in the A/C. I try to avoid the A/C unless absolutely necessary because it's uncomfortable to the patient and if the IV is on a pump, it's alarm will be going off constantly.

I also have days I can hit anything and others where seems like I'm missing even the "easy" ones. I've been doing this for over 20 years and that has never changed. Hope I've offered something here that helps.

Up Vote Up Vote ×
Specializes in Vascular Access.
http://www.saddleback.edu/alfa/vid_index.aspx

Saddleback College in California has this wonderful instructional page. Check it out

Second post I've seen regarding this website.. Which will not open for me, anyway.

Up Vote Up Vote ×
Specializes in Vascular Access.
I'm just a nursing student but I didn't really successfully start an IV until last semester. I had a seasoned nurse tell me to quick looking at the best vein and to feel for the best one. She showed me to start at the AC and work my way down to find the right one but in an emergent situation just hit that AC and go.

Feeling for the vein helped me SO much more than trying to see one. Once I felt for that vein-y toughness under the skin, I can poke then kind of dig for the vein itself and I feel that *pop* and I know I'm in.

I'm far from being a pro but i am at least more confident in finding a good vein.

Good luck!!

meredith

As a nursing student you will hopefully learn that it is NOT "okay" to "kind of dig" to find the vessel... There are major nerves near blood vessels and you could cause your patient great pain, not to mention the possibility of permanent damage and functional limitations. Also, if you are feeling a "pop" it usually means that you are using an IV catheter that is not sharp enough. An appropriate catheter should smoothly slice through all three layers of the blood vessel.

Up Vote Up Vote ×
Specializes in Oncology/Palliative Care.

Loved the website. I've been in practice almost 18 months and it is so good to be able to review some of these skills again. Thanks!

Up Vote Up Vote ×

Hope this helps you, great page with great tips!

http://www.enw.org/IVStarts.htm

And for videos:

http://sfghed.ucsf.edu/Education/Viper/VIPER_StartMenu.html

Up Vote Up Vote ×

Sheesh Kris, that first one made me jump ...didn't expect Obi-Wan (had my volume up too high).:lol2:

Up Vote Up Vote ×
+ Join the Discussion