IV Insertion Difficulty

[chanjyj]

I'm a new grad (Nov 2014), having a mid career change from business to nursing. I feel pretty competent in all aspects of my ICU nursing path so far except one - a horrific failure rate for IV starts.

At best, I probably get an IV in 10% of the time the past 8 months. I'm traumatized to the point where I avoid starting IVs like the plague, and get the phlebotomist to take blood. This is further compounded by the fact the most ICU patients have a central line of some sort and the opportunities to insert peripheral IVs are low. The facility in which I work in does not have senior nurses who are willing to watch you put in an IV - and I can't gain any feedback this way. Sadly, their mentality is to call a physician if you can't put one in; rather than try improve on your skills.

I've read multiple articles and "tips/tricks" on this topic. None seem like to have helped me.

I don't get a flashback most of the time and cannot figure out what I'm doing wrong. Been following textbook instructions to the letter. Any advice before I give up?

[momathoner09, BSN, MSN, APRN]

We can use lidocaine or a Pain Ease spray. I've seen it used in our area & outpatient surgery. I personally prefer the spray & rarely use the lidocaine. But some people swear by it. I have had a problem with people literally pushing me out by jumping out of the beds practically after I stick.

[akulahawkRN, ADN, RN, EMT-P]

I had a patient in a recent shift that wasn't happy at all with getting an IV line. This patient had already been stuck twice without much luck and had been stuck a few times a few days before. I stepped in and found a very nice vein in a less comfortable place ("Intern's" vein) in the wrist that I had to finesse just a little to get into. Here's the secret... if you're not finding good veins right away, stop. Do all the typical things to make those veins stand up and become plump. Look other places beside the AC. Trust your fingers to tell you not only where that vein is, but also where it goes. Then, with some confidence, insert the needle, aiming for a place that's right in the middle of the lumen of that vein. If you're not sure just how deep, even if it's there, puncture the skin, pause briefly to palpate the location of the tip and direction of the needle and the vein's location and track. Often you just need a little adjustment in your aim and go for it. Often it's just less than .5 cm and you're good.

The one I got went in OK, got good blood return, but had to be floated in after that.

Honestly, most IV lines that I do are pretty easy. Occasionally there's some pressure to perform and be darned good right then or the patient is a known difficult stick. Keep practicing and you'll get reasonably good. Then one day you'll be the one being asked to start a line on a difficult/hard stick patient and you'll just nail it.

[Trauma_drama14, BSN, MSN, RN, APRN, NP]

Don't give up! It's ok, alot of nurses are not good at IVs. Right, most ICU patients do tend to have central lines, but you should still have a good amount of options in attempting IV starts (in my four months working on SICU, I have tried to do at least 7 IV sticks... Even though my old floor was very busy and had a little more offering for IV starts). You could always ask for another nurse to check out the sites and can always use a vein finder if you are able to. In all honesty, it takes a bit to get decent at IVs. It definitely takes practice so take any chance you can get! I feel like after years of trying you'll be better. I've hit a year and a half and I still get maybe half of my IV starts.. But it feels so great when you get them, especially if you get an 18g :)

[chanjyj]

Thank you all for your encouraging replies. I have managed to put in a few IVs recently, with around a 70% success rate. Not perfect, but much better than before. Why I "just couldn't" before I still can't figure out, and till this day I can't really identify what went wrong... or went right which bugs me.

And yes indeed. 90% of my ICU patients have central lines, port-a-caths, you name it. Those that don't come up from emergency with 18G needles in them already nice and patent.