Iv help pleeeeeasssssee!!!!

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I am a new graduate and I am having MAJOR trouble starting IV's. Im working in the ER and allll of my work is taking forever because I cant really complete any of the orders until the IV is in....it's just to the point of ridiculous. Can anyone tell me anything that I can do to get any better at starting IV's...any outside help, class, certification...whatever it takes! Thanks in advance for any help/advice that you are willing to provide me with!

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Specializes in Emergency Medicine.

You're talking about simple venipuncture. Whether you are drawing blood or cannulating a vein the mechanics are the same. I would suggest hanging out in the lab and just draw blood for a day or two. You just have to practice at it.

Assess your site. Determine the size of the vein before choosing the size of the catheter. Don't try an 18g cath in a 22g vein. Make sure the vein is long enough to accept the IV. Don't rush it.

Just my 0.02

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Specializes in ER.

Honestly, it is just doing them over, and over, and over......and over. Its kind of like learning to drive car...hard to give someone specific instructions on how to get better at it, you just get good with practice.

I remember that being the worst part when I started ER out of school...I was always behind because it took so long to start my freakin' IV's, then after 30 minutes of trying and you can't get it you have to find someone else, wait for them to get it for you, etc. I feel you pain and can assure you that even though it can feel hopeless, you will eventually get better/quicker at it.

If your workplace has IV therapy, you could request to spend a day with them doing all the IV starts, just to give yourself extra practice.

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Specializes in Med/Surg, Tele, Critical Care.

I feel you... I suck at it too! I work on the floor and I don't come across it as much as you, but I still have a lot of people who have had their IV for a couple days and it just stops working, and then I can't get anything done either. My co-workers are often getting me every time they have a start so I can practice. I get it like 50% of the time. They tell me that eventually you can just "feel it" and it's like a lightbulb turning on. I can't wait until that happens!

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I would suggest warming up the arm first with warm wet towels for a few minutes so the veins will pop up better, then put on the tourniquet before you take off the warm packs (keeps the veins up) find your vein. Watch your angle on how you stick (about 30 degrees) New nurses want to stick at a 90 degree angle almost.Tape. Be sure to take off tourniquet before you remove the needle part and it won't bleed so much. Good luck!! It just comes with practice.

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Specializes in Hospice, corrections, psychiatry, rehab, LTC.

I didn't get a lot of practice on IVs in nursing school, and I went straight to a hospital mental health unit upon graduation (probably half a dozen starts in four years, not all of them successful). Then I went to work for a rehab hospital where we had a lot of recent post-ops and a lot of IV starts. I was determined that I wasn't going to ask coworkers to do all of my IV starts and I just stuck with it. I got considerably better at starting IVs just through repetition. One thing that held me back was apprehension from a lack of experience. My confidence grew with each successful start, and it got to the point that there were very few I could not get.

Several people have given you excellent advice about the mechanics of it all and some ways to get more practice. Just stick with it and your skills will improve. People actually come to me now for help with difficult starts - something that was unthinkable ten years ago.

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Specializes in ICU.

if your in an ER.... I'd ask one of the medics after they've dropped off a patient for some tips. (I assume you have already asked your preceptor, or unit educator for help) Medics start IV's in all sorts of crazy places with very sick people.... in the dark... bumping down the road.... in a ditch... in the rain.... :) It's a good time.... if you ask a good medic, or one interested in training, they may invite you down to the station after your shift to practice, or know of an EMT class that's practicing...

It's hard to describe what to do to improve your technique without first seeing what you are doing. Usually if the problem is the IV 'goes away' after you've got the flash, you have prematurely released traction / stabilization and the tip of the needle has slipped out of the vein. remember to pick your site, clean the site, apply gentle distal traction (enough to stabilize the vein, not enough to collapse it completely), insert the needle bevel up at anywhere from almost flat to 45 degrees off the skin (depending on location and depth of vein) get a flash, advance the bevel length, drop the catheter down to about half the angle, advance about an 1/8th of an inch (this initial advance of the bevel length assures the needle stays IN the vein, the advance after you've flattened out a bit, assures your needle is in and a bit up the vein if that makes sense). then begin to advance the catheter off the needle. remember you haven't yet let go of traction!!!! advance the catheter to the hub ( or as far as it will go without forcing it), release traction, pop the tourniquet, compress the vein at the proximal tip of the catheter so you don't have a blood letting, (really helps to make sure you feel the tip of the catheter and press hard depending on where the vein is and your patient) disconnect the needle, (if you have the button pushing type, remove the needle, THEN press the button) secure your sharps, connect the tubing, release compression, flush, tape.....

hope that made sense... if you were in Boise I'd say come by... :) Good luck, seriously practice and confidence like the other posters have said.

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sometimes having the pt "hang" there arm over the side of the bed helps. We had a nurse anesthetist who NEVER started an v without warm soaks,,,

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Specializes in ICU, nutrition.

Relax and practice. And try for the "easy" spot, AC space. Even though it's not the ideal spot, if you're in ER the IV may not be in for that long anyway (IVF and then send them home, etc). That's how I built my confidence. Also, if you let your co-workers know you need some IV starts, maybe they can get you some easy ones (young guys and pregnant women usually have great veins). Heck, if I knew you, I'd let you hit my AC space or wrist a few times, I've got awesome veins! Build up some confidence on some easy starts and you'll relax and you'll be more likely to hit them most all the time.

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Specializes in ICU, Research, Corrections.

Excellent advice from Charmander.

The only thing I can add is slow down your initial search and look and feel well for a good site before you stick. Finding a good site depends on feeling for veins, rather than visually seeing them.

I usually inspect both arms from the AC down, with the tourniquet on. If you can only feel the best vein, I clean the site with an alcohol pad and leave the pad on the arm with a corner of it pointing right above where I want to stick. That gives me a visual landmark.

If you see no good sites, make sure you look at the back of the arms too. You can also use shoulders - or I have even seen IV's in the breast. (No comment on where to put the tourniquet for that, LOL.) I have never used the breast site, just have seen them there!

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I'm in my practicum and was having a difficult time starting IVs until a nurse gave me this trick: look for a vein that forms a Y then put your needle right where the two veins come together (right at the vertex of the v part of the Y) then the tail of the Y holds the cannula (so make sure it is straight before you pick that spot).

Her rational is that the vein is more anchored and will not roll as much. Ever since she told me that trick, I haven't missed an IV (yet, as I'm sure it will eventually happen in the future!). However, this approach has upped my success rate greatly even on my more plump and frail patients!

Hope this helps :D

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Specializes in Infusion Nursing, Home Health Infusion.

Do you have an IV team there? I woud ask to go with them for a day or two....I have instructed hundreds of nurses over my long career and many have told me how much easier it got after they were shown the proper steps and allowed to practive with an expert helping them. You can also see if there is an LVN class or RN class to go to. Often the LVN classes are really quite good with a lot of technical help... i have done the practicum for many of them and thought that many RNs I know need this class

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