I am a new nurse having terrible problems starting IVs! Please don't just direct me to search this site for info, I have spent hours reading all the IV Tips & Tricks pages (all 15!) here on Allnurses, as well as following all the links posted in that thread and any other sites that I can find. I have a handle on the theory, it's just in practice, I can't seem to get it.
I started out my first experience on the floor (ER in a big busy hospital!) missing most of my IVs for several weeks...finally I started getting about 90% of them, (I still don't know what I did differently) then all of a sudden, I'm back to missing 90%!
So I have specific questions:
1. Often I'll go into the skin, and at some point (sometimes before I get flash, sometimes after) I'll end up seeing a nice big bleb of blood under the skin start to appear...have I gone THROUGH the vein? Or is that what it means when "the vein blows"?
2. What exactly DOES it mean to "blow a vein"? I see that phrase all the time, but don't know what it means!
3. OFTEN, most of the time, I'll get a flash, but the catheter won't advance. Yes, I KNOW, most people have told me to get flash, go in a little bit MORE, then advance the catheter. I TRY, I really do...but there are so many times when I just can't get that catheter to advance...so I'll go in a little more, try to advance, then more, etc etc...then I end up with that big bubble of subq blood appearing. I HAD FLASH, I KNOW I was in...why won't' it advance?
4. What if I can see or feel a small a portion of nice spongy, elastic vein...do I insert the needle at that point, and assume that the catheter, when it is threaded off, will just follow the vein wherever it happens to go...(even if it turns?) or do I insert well below that visible part, hoping to enter the vein at that point that I can actually see/feel the vein? Is that clear? I mean, is that visible part of the vein the place where I want the catheter to END, once it's fully advanced? Or is that the place to start?
5. And finally, could speed of advancing the catheter have anything to do with my problem of not getting it to advance? My preceptor goes SO FAST, he gets flash, and BOOM he advances very quickly and it's done. I am so nervous, I know I advance very slowly (praying all the while that it'll go in!)...if I really am in the vein, but maybe my angle is off so I'm not perfectly pointing in the direction that the vein is running, would it help the catheter to follow the vein by advancing quickly? Or is that just totally unrelated?
Thanks for any advice...please believe me, I have read for HOURS on this site and others, about finding veins, techniques for all of this...I can find them, but I just can't seem to get them in successfully!
VS