IV Cannulation Start

[Zapi791, BSN, LVN, RN]

I have 25 experience as LVN, but only one year experience as BSN, RN.  I am horrible and very uncomfortable with starting IV's during my RN training/orientation rotation.  I bought a nice IV arm and a 'slab of meat' on amazon to practice with, and all my coworkers laughed at me.... LOL. I don't really need to start IV's to do my job because I can always call on specialized IV infusion nurses/PICC team for the very rare times my patients will need IV access in an outpatient clinic, but I just want to improve my skills for my own personal skill/knowledge and competence. 

Please post any reference of the best text, video, or courses that would be beneficial in improving IV start skills.  My goal is to become the best RN I can be for my patients. (No negative comments needed, I am only seeking professional correspondence.) Thank you.

[happyhippo]

I did my clinical in a surgery center and it was a great opportunity to learn IVs because everyone coming in needed an IV. When I started working as a nurse, I found time to do IVs and blood draws. If my patients need an IV or theirs expired, I would volunteer to do it. It only took me a few tries to master it. My tip is start with 22G first, find a really good vein, and start from there. When you feel like you get the hang of it, do it on a more difficult stick patient or go up the gauge. Trust me, the fake arm is nothing compared to real arms. Also practice finding veins on your family members or even yourself at home. You’ll be good at it in no time. 

[Flum Mox]

1. Jump on every opportunity to start an IV, even your colleagues patients.

2. Start with your body alignment. I hardly bend down or stoop to the patient. Instead, I raise the bed to my level.

3. Have the patient’s arm relaxed on the gurney or bed. But have the arm at angle or as far down gravity as possible. Gravity helps greatly.

4. Inquire with the patient where they last got poked. They may know their body better than you.

[eXistenZe]

Self-confidence during procedure is crucial. Observe as much as possible, train your fingers into feeling both arterial pulses and venous collapse on pressure, only then start making decisions.

Take your time. Keep the patients arm warm (yours too, icy fingers feel nothing) and if he has a history of fainting or any other procedure complication, start with him comfortably laid down.

Pick the location of the cannulation according to the what the patient will need. You will master them all in time. Antecubital is a good choice for blood samples and short term drugs such as adenosine, but nothing more. Start with the hand or forearm to promote comfort and upkeep on the long run. You don't want an easy access you have to replace the next day (unless it's an emergent procedure, obviously).

Always start the procedure with the arm lowered. It promotes arterial flow and make the venous return harder, dilating the veins.

Never use a curved back position for yourself and never hold your breath. Keep yourself straight and face forward. I am a tall nurse, and I place my knee on the floor from time to time so that my chin is not touching my chest when I place IVs. Raise the patient's bed or chair if possible (I work in ER so not quite easy).

Whatever the location, I always place the non dominant hand bellow the hand/arm and make sure the skin is not going to bend on the tip of the needle. Do not overstretch, but also keep the skin tight (use the main hand to feel the tension while cleansing, making sure the vein did not collapse).

For the procedure itself you need to train your fingers into actually doing what you want. I have colleges that place more than 1cm of needle almost horizontally inside the vein and only then remove it. I usually just insert the tip of the needle and then push the plastic tube with the index while the other fingers hold the needle. You need the find the technique that works best for you. No right or wrong here.

I work with adults, so I always place 20g or greater (in emergencies). There is no guarantee that a smaller tube will make the procedure successful. In fact, I find it way harder to place smaller tubes on adults. It's either a 20g or I call for help.

[HiddenAngels]

I also raise the bed or bend down on my knees if patient is in a chair.

Poke, lay, slide. Angle your needle and insert, once you see blood return, gently lay the needle closer to the skin and then advance the catheter in, and yes start off helping to do everyone's IVs and yes 22s are a great size to start and yes have fun doing it... Good luck

[Epidural, BSN, RN]

The best "You Tube" channel to watch for IV cannulation advice is: ABCs of Anaesthesia. The channel owner is an Australian anesthesiologist. He has about 20 different videos on how to start IVs; all of them are excellent. Follow his advice, practice, and you will soon become an expert at starting IVs.