IV Insertion Difficulty

Steve_e · Dec 5, 2015

My advice before you give up would be to not give up. Some people just aren't good at them and that is ok. But You will learn that you will have good runs and bad runs. Maybe you'll sink 2 or 3 in a row, and then miss 2 or 3. It's just how it goes, sometimes. My advice. Warm packs, if the patient is mobile enough, have them hang the arm off the edge of the bed, low, for a few minutes, this allows blood to pool to the extremity thus "puffing" up the veins. Tourniquette a couple fist squeezes, if they can. Look and feel, don't feel with a glove because you wont feel anything. A big one, I tell all my students, don't stick them if you don't feel or see anything, that would just be silly. Constantly mess with your own hands and arms, not actually sticking, but feel where your veins are, see what makes them puff out and what makes them hide, chances are your patients will be similar if not the same. Also, chances are where you have a big vein, your patient will have one in that GENERAL area too. Lastly, if you don't see or feel anything, there is no shame in calling the vascular access specialists, if you have them, and having them use the ultrasound machine to find a nice deep big vein.

As far as the poke, find your spot, try not to go anywhere it is bifurcating or if you are so blessed to be able to feel valves, obviously avoid those. Stabilize the vein, hold a finger or a mental spot of exactly where that sucker is if it isn't visible. Another good trick keep the corner of your skin cleansing pad right at the point you want to insert, this way you won't lose your spot. Have everything prepared, stabilize the site with one hand, and insert the needle at a moderate angle, the angle depends on how superficial the vein is, and this I can't really describe in words, you kind of just get a feel for it. If there is no flash back right away feel free to maybe advance a very little bit, or pull back a very little bit and slightly reposition and re-advance, be patient, do this until you get blood. Don't give up after the first 30 seconds. Sometimes it takes some finesse and a whole lot of praying . Don't give up, keep practicing. The only way to get good at them is to do them, and try.

RescueNinjaKy · Dec 5, 2015

See if you have a vein finder in your unit. Go with it for a little bit so you know where you're looking for the vein. Then as you get more comfortable do without it. Also definitely use a warm pack, have them pump their arms a bit and Gravity is your friend.

Before a patient gets send to the floor, insert a peripheral on them so that the floor doesn't. The central will be taken out on the floor so they will need an iv access anyways.

Therhapsody89 · Dec 5, 2015

I so feel you with this one. I can never get my own iv's but can FAITHFULLY get everybody else's difficult sticks. Maybe it's mind over matter and we're really just psyching ourselves out!

I have noticed though that within moments of sticking a patient, I know whether or not it's going to work. I've found that digging rarely helps.

Remember to stick to the 2 stick rule: Try to get the IV in 2 attempts, then go find somebody else. That way you are still getting your experience in and not putting the patient through misery.

Good luck!

jadelpn, LPN, EMT-B · Dec 5, 2015

It is not what you can see, it is what you can feel. And getting to know by feel the veins. And that the arm in positioned in such a way that it offers max placement.

Agitate, feel, agitate, feel. The deeper you press, the deeper the vein. Hands are vaulvie...otherwise, you are going in on a bony area....meaning that the elbow needs to be almost hyperextended. The wrist needs to be straight.

Non dominant hand to hold the joint in place. You can use your thumb to hold down (SLIGHTLY) loose skin.

If it is a non-emergency, I sit, extend arm, almost dangling off of the bed. I have held the arm in place with my knees before. Whatever works for access, and to be able to feel your way.

You gotta use a bit of an angle. AND don't just pull the catheter out sometimes it takes some play before you get into the vein.

AND use your phlebotomist as an educational person--they are the vein whisperers!! Watch how they find them.

You will get this! And once you do it is a small addiction--you will be offering to do all of them....the more difficult stick the better. Mark my words!!

Best wishes!

martymoose, BSN, RN · Dec 5, 2015

Dont feel bad. I suck at them too- and its true when you have a long streak of fails that you dont want to even try anymore.And Im not a new grad.

Hopefully the others here give you some good pointers.

nutella, MSN, RN · Dec 5, 2015

Starting IV and phlebotomy is not me forte either - never has been and I have been a nurse for 20 years.

I also worked the first 9 something years in critical care where literally everybody was lined up coming out of the OR or a line in place from coming through the ED and we hardly ever had to get in a peripheral IV. Not to mention draw blood. Arterial lines and CV access were the norm.

So I thought I just did not get exposed to that skill enough but it turned out that it is just not one of my skills. When I went to home care I even went to a blood draw center for 6 hours to get better skills but it just is not really for me. I gained more confidence though and can draw blood if the vein is good - if somebody is a difficult stick I pass.

I know nurses who can basically draw anybody and everybody and I admire them! I can access ports, I can access dialysis fistulas, I get almost any central line to work unless clogged but drawing blood and PIV is not for me.

If you work in a hospital you can ask your manager if it is possible to go with an IV nurse or phlebotomist for a day.

LadyFree28, BSN, LPN, RN · Dec 5, 2015

See if you can shadow in the ED and get some practice; if not, try a peripheral IV course to see if you can get comfortable starting IVs.

Best wishes.

CrunchRN, ADN, RN · Dec 5, 2015

Go slower and not so deep. It is the polar opposite of injections. I can get 30 blood draws in a row and then miss a couple and those 2 drive me bonkers for weeks. Still working on it lol.

chivon101 · Dec 6, 2015

I am extremely good at PIV and I do ultrasound guided PIVs as well. I got really good at PIVs because I always wanted the hard sticks. Like the other post, go for what you can feel not for what you can see. When I'm training, the first thing I do is teach them how to feel for vein, learn to feel for the rebound and learn the difference between a vein and a tendon. Some vein are deep and some are not. Holding the skin taunt helps also, especially with elderly. If you could follow an ED nurse or even a paramedic tech in the ED that would definitely help you. Learn to feel for the spongy rebound.

mago8388 · Dec 6, 2015

Watch this vid. I like his technique.

Biosphere · Dec 6, 2015

Takes much practice and 8 months isn't nearly enough. You just have to keep doing them even if you miss. It's just that simple. Regardless, you CAN stick by sight, I've been doing them since 1998 all in the ED. You have to use all your tools to be top notch. Using feel or sight , anatomy , ultrasound , old people big people little people . Nothing is going to subuitute practice. All you have to do is work in the ED and you will be a pro in two years. Even the ultrasound isn't going to substitute practice. Develop your own technique after much practice. It's that simple ..