I suck at IV starts

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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.

If you have an IV therapy team, or have an area that starts IV frequently (like a previous poster's pre-op area), see if you can shadow an RN in that area for a shift. Start all the IVs for that shift, with the IV therapist (or whomever) looking over your shoulder, giving you real-time tips, suggestions and encouragement.

You *must* practice on patients. You just must. You can't let it intimidate you. You also can't let a failed IV attempt ruin your confidence. I'm the go-to nurse on my shift for IVs, and I only hit about 80% of my first attempts. There are nights where I *cannot* hit a rope on a young, hydrated patient, and there are nights where I can throw the cannula from across the room and get a hit it on a first attempt on an old, dehydrated, chemo patient. Some nights it takes a couple of times before I can hit it. Sometimes I can't no matter what.

If you miss, don't apologize as if it's your inexperience. Simply say "I'm sorry; I didn't get it...it didn't thread/the vein blew/whatever." Try twice. If you don't get it the second time, get someone else. I always tell patients I won't stick more than twice. Either I'm on or I'm not. I'm not going to torture a patient on a day I'm off. I'll request assistance from the ED or ICU instead.

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I agree with Blessed RN. Great tips. I, too am a preop nurse and my hospital has a program that allows all new grads to shadow in the preop area for 1 or 2 days to get IV experience. At my hospital, we use lidocaine on all patients unless contraindicated. It is usually not used in nursing school, but can make it less painful for the patient if you don't hit the vein immediately upon entry. Some patients would prefer only one stick as opposed to the lidocaine stick as well, but if you've ever seen a nurse "digging" for that vein, you'll understand. It takes practice and gaining more confidence. Good luck!

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Specializes in behavioral health.

I have never inserted an IV; however, I can empathize with the patient who endured torture of a nurse digging in the vein. I will ask them to re-stick instead of moving the needle around, as it is painful. Once, I had a nurse give it four tries, then I insisted that she no longer try. I told her that I wanted an IV specialist or someone who can hit hard veins. I would have had more respect for her, if she had given up after the second stick. It wasn't just the stick, its that she moved the needle around so much. I learned to tell the nurse to please not move the needle around, if they miss. I prefer to be stuck agian, then them digging for gold. It is not the stick, but the digging that really hurts me. I do not have good veins, so there is no shame in missing me. I don't tell them that prior to the first stick, as I don't want to make them nervous.

I am afraid that I would suck at IV starts as well. I know that I am not too swift at phlebotomy. I am afraid of hurting the patient. I have no problem with giving injections, but IV makes me nervous. I am certain it is because I know the pain that I have felt. My daughter has great phlebotomy skills. And, she can get the tiniest veins. I wish that I had IV skills.

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Thank you so much, everyone, for the advice! Today I had 5 attempts and got...... ONE! Terrible. I know I just need to keep trying, and I need someone good to tell me what I am doing wrong. In general, I have no trouble hitting a vein (get immediate flashback), but I CANNOT thread the catheter. Often I blow the vein (get a big ol' bubble), but many other times I just can't tell why it won't thread. I have been through other periods of time where I seemed to get most of mine in, but lately I just can't do it. I know there has to be some consistent, tactical error I am committing!

Anyway, thanks again.

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Specializes in ER, ARNP, MSN, FNP-BC.

see if you can't go down to the ER and work along with a paramedic. call the er manager, or talk to your house supervisor one day. we get lots of good "practice patients" down there :)

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Specializes in ER, ARNP, MSN, FNP-BC.

by the way, everyone goes through this at first. There have been veins I could have crawled into and set up a tent in that I have missed LOL. The more anxiety you have the more difficult the task will be. Relax and learn to laugh at yourself too :)

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Specializes in Women's Health/Pediatrics.
Thank you so much, everyone, for the advice! Today I had 5 attempts and got...... ONE! Terrible. I know I just need to keep trying, and I need someone good to tell me what I am doing wrong. In general, I have no trouble hitting a vein (get immediate flashback), but I CANNOT thread the catheter. Often I blow the vein (get a big ol' bubble), but many other times I just can't tell why it won't thread. I have been through other periods of time where I seemed to get most of mine in, but lately I just can't do it. I know there has to be some consistent, tactical error I am committing!

Anyway, thanks again.

I had the same problem for a while. Then I read on a website that often this happens d/t not getting into the vein fully. Since you insert the needle in bevel up and the tip of the needle is slightly longer than the catheter, it is possible to get a flashback while only the tip of the needle is actually in the vein--not the catheter.This makes it nearly impossible to advance the catheter into the vein without blowing it.

A couple tricks I learned:

1. Next time you get a flashback, watch the flash chamber and wait to see if it continues to fill before you attempt to thread.

2. I've also heard that after getting the flashback, its better to decrease the angle of your needle so that the angiocatheter almost lays parallel to the arm, and then advance the needle a tiny bit more into the vein BEFORE you try threading. This ensures the catheter is fully in the vein.

3. For a stubborn vein, you can also try hooking the heplock up to the hub and attempt to "float" it in with a saline flush. This opens valves and carries the catheter through forks. NEVER force it in, and stop immediately if it begins to swell around the site.

Unfortunately, after I discovered these tricks, I stopped having to insert my own IVs (our techs mainly do it at the hospital that I work at.)

Good luck to you!

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Specializes in Spinal Cord injuries, Emergency+EMS.

there are 3 things which affect your ability to cannulate

1. practice - it gets better with time and practice ...

2. have all your stuff together and ready, go into it calm with all your stuff together and in order

3. don't be afraid to take your time to find a good vein,

--know and understand the anatomy - but also realise that there is a big range of 'normal' for the locations of veins

- the dorsum of the hand sucks unless you've got a patient with big hands as does the ACF unless you want a big line in a crisis

( save the ACF for that and for venepuncture )

- avoid joints - then the line will need to be pulled because it;s time expired not becasue it fell out ...

- be prepared to be creative if the patient has a lot recent sticks ... there are some great veins on the ulnar aspect of the arm or even over the Bicep

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