Is this how my preceptor should be? Or is something wrong?

she's passing on to you little things like this that have proven to be time savers in the long run. not every person you work with is going to have the greatest personality to get along with what they are teaching to you. you're not seeing it now and she's probably not able to fully articulate the reasons why she does things this way, but i recognize what you are saying she is telling you to do as some things i do myself. her time management skills are probably why she was made a preceptor. you didn't mention that she was mean spirited so it sounds like you and her personalities just don't gel too well together. now, i, personally, probably wouldn't be that anal with you. i am articulate and might mention why i would tape an iv a certain way and why i would hang an iv bag here--once and maybe twice. after that, i'd let you sink or swim all on your own because i know that you will learn far more by having to spend the time cleaning up a big mess you made and figuring out how you could have avoided it. your preceptor is trying to save you some of that heartache because at one time she went through it herself and is trying to save you from having to experience it. however, she won't be your preceptor forever and soon you will be free to do things the way you want. i'm thinking that a few years from now you'll be taping and hanging ivs much the same as she is now telling you, much as you'll hate to admit it to yourself.

i just posted to a thread on iv starting on one of the student forums. i was an iv therapist and crni for many years. so many new nurses think that iv therapy is a skill that is as easily learned as any other and you are all wrong. it takes years and years to become proficient in the management and maintenance of ivs. it is such an important skill that there is a whole professional organization devoted to it. many of your hospital policies are based upon the standards written by this organization (the intravenous nurses society).

D2Nite,

I would like to read this thread of yours on IV's but cannot locate it. Can you please send the link?

Thanks!

I think this is the thread I was talking about. I made two posts to it:

• https://allnurses.com/forums/f50/iv-therapy-245146.html

i liked the articles as well as the links within the articles. fabulous array of info in there. but gawd the bickering about what gauges to use is giving me a ha and baffling me further. what's the bottom line there? if i do dare ask on another open forum?

oh, dare! makes life more fun!

there is always theory and logic behind the choice of the size and length of the iv device you use. the more assessment information you have about the patient, the more you know about the theory behind iv therapy, the better choice you are going to make. (there's that dog gone nursing process again!)

basically, you use the smallest gauge and shortest length of cannula that is going to give you the result you want. the reason for this is to

• minimize trauma to the vessel (a fat catheter that is bigger than the slim vein you shove it into = physical trauma)
  
• permit blood in the vessel to flow around the sides of the iv catheter, (see next line)
  
• which allows for hemodilution of the solution being infused into the vein (iv fluid mixes with blood) which decreases chemical irritation of the internal vein wall and minimizes development of phlebitis

here is what my resource book has to say about the sizes of iv needles to use (page 383, intravenous therapy: clinical principles and practice, by judy terry, leslie baranowski, rose anne lonsway and carolyn hedrick, published by the intravenous nurses society, 1995)

• 14 to 18 gauge (largest sizes) - use for trauma, surgery, blood transfusion
  
• 20 gauge - continuous or intermittent iv infusions, blood transfusion
  
• 22 gauge - continuous or intermittent iv infusions, children and elderly patients
  
• 24 gauge (smallest size) - fragile veins for intermittent or continuous infusions, (we used 24g in newborns)

nurses who work in the er and critical care areas will tell you, quite rightly, that you cannot rapidly bolus (push) life saving iv medications very effectively through small bore (gauge) needles, so they like to have at least a 20-gauge or larger catheter in their patients. emts and paramedics usually insert 14 or 16 gauge catheters in the field if they can. whole blood will literally pour into a vein through one of these 14g catheters. our anesthesiologists were always happiest if we put 18 or 16 gauge catheters in their or patients, but they do look like nails and can hurt when being inserted. however, for patients getting iv fluids with piggybacks of antibiotics a 22 gauge catheter will work just fine in most cases.

in general, i mostly see nurses taking a 22g or a 20g catheters into a patient to start an iv. a 22g is easier to manipulate because it is smaller (small needle + large vein = less margin for error and better success). one nurse on an iv team i worked on put 24g catheters in everyone, no matter what. then, we would need to go back and put an 18g or 20g in them if they needed to get a blood transfusion or go to surgery and she hadn't checked their labwork or admission diagnosis before inserting the iv. :smackingf i know she was thinking of the patient's comfort in inserting the smaller catheter, but how considerate was it to subject the patient to a second stick when a few minutes taken to check their chart could have avoided extra anxiety and trauma?