IV Insertion Problem

Nurses General Nursing

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I worked three years in a hospital where I was able to experience IV insertion to different kinds of patients from newborn, toddlers, obese, and geriatrics. Although, there were times I missed, and had two or three attempts before successfully inserting the cannula, I know it was normal and experienced by everyone because not all veins are good, plus some other external factors. But this time, I feel like it's no longer normal. I was transferred to another area for eight months, where all I did was to assist my doctor with several procedures. I rested from pricking for a good eight months. Then, I was assigned to Pediatric ER now. I was confident at first knowing that this is my forte. But, all my confidence vanished and came down to zero after consecutive unsuccessful attempts of IV insertion to several patients. And to think that those patients I pricked were at about four to six years old with good veins for their age. It may be hard to admit, but I really screwed up. I failed and I'm so embarassed. Just last night, the last patient I pricked was a six-year old girl with good veins. On my first try, I pricked confidently but all of a sudden the girl squeezed her hand tightly that's why I missed it. I tried again on the other hand. I pricked and saw backflow coming out. I adjusted my needle and advanced the cannula but to my surprise blood stopped flowing. I tried to flush it but there was a resistance. I felt ashamed of myself and was so disgusted. I can't bear to not make a successful one, so I tried one last time. Luckily, I hit the vein successfully this time after a series of hide-and-seek. That didn't make me feel good, though. It was a three-attempt. I feel so depressed with this things happening to me. I wanted to know if others also experience the same thing. I wanted to get some good advises from other nurses too that's why I tried searching on Google. Then, I found this site. I hope, you guys could help me out with my problem. Why did I fail several times now? On several patients. To think that this had been my expertise just eight months ago. Please help me get my confidence back because right now I'm so depressed and feel so useless.

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::hugs:: same thing happened to me when I came back to the hospital after a couple years. Now, over six months in, I just now feel like I'm getting my groove back. Don't give up! A few smooth starts and you'll be back in the swing.

Offer to start IVs for your colleagues..tackle this head-on! You can do it!

P.S. Bless you for working with the kiddos. The very thought terrifies me.

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Specializes in Geriatrics, Cardiology..

You just need to polish your skills.

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Thanks for responding @kiszi... knowing that there's someone out there who experiences the same thing gives me a little relief.. and thanks for the encouragement.. i hope i'll do better on my next tries...

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@blondebabe0625 - do you have some tips for me on how I can polish my skills?

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When I was in band in school we used to call it "getting our lips" (played saxophone). If you did not practice regularly, like daily, your lips would lose the feel even if you remembered exactly how to play and you would sound terrible.

I think the same thing happens in vascular access, without regular practice you lose "the feel" and are less successful despite having full knowledge of the task. The good thing is the fix is easy, just slow down and keep practicing and you will gain back "the feel."

Personally I like the method of teaching/learning by starting IVs on yourself. I know, I know, sounds macabre but it is the only way to really feel simultaneously what the inserter and patient feels at the same time. It allowed me to help develop my assessment skills to understand what was happening as the inserter and what the patient might be feeling with my manipulations.

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First and foremost, in any peds patient, get someone to help you hold the child's arm in position. Do NOT rely on a kid to "hold still" because most will not, even if the intent is there. So get your tech, another nurse, someone else. Even the most seasoned nurse can not hold and stick at the same time with kids. Make sure your positioning is good, and you are not going to blow the vein, and you are in a place that is not going to be impossible to keep the IV open and running--use an armboard if it is in the ac, that kind of thing.

Secondly, make sure you are really getting that IV vein feeling back. Do not look for veins you can see, feel for them so that you are back to where you were when you were doing them every day.

And be sure to get a feel for the IV catheters themselves. Sometimes, facilities change them--and what was an easily handled IV is not so much anymore. So you have to get used to your hand positioning, at what point the needle needs to be withdrawn and the catheter advanced, that type of thing.

Best wishes, and you will find before you know it that you are right back on the bike! HAHA!

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Specializes in Emergency Department.
When I was in band in school we used to call it "getting our lips" (played saxophone). If you did not practice regularly, like daily, your lips would lose the feel even if you remembered exactly how to play and you would sound terrible.

I think the same thing happens in vascular access, without regular practice you lose "the feel" and are less successful despite having full knowledge of the task. The good thing is the fix is easy, just slow down and keep practicing and you will gain back "the feel."

Personally I like the method of teaching/learning by starting IVs on yourself. I know, I know, sounds macabre but it is the only way to really feel simultaneously what the inserter and patient feels at the same time. It allowed me to help develop my assessment skills to understand what was happening as the inserter and what the patient might be feeling with my manipulations.

This is very true! Quite a few years ago when I worked as a Paramedic, it was a rare day when I missed more than once, let alone more than twice, thereby having to stick someone 3 times. Most of the time, I'd plant that catheter solidly in the vein the first time. A year ago (after about a 12 year hiatus) I started doing IVs again and while I know how to do it and many of the tricks and techniques to use, I'd definitely lost the feel needed to be that good.

Now I'm working in the ER and I'm relatively rapidly re-learning the feel and now it's becoming more and more rare that I have to do multiple sticks on a patient. I'm getting better at it, but I'm not yet as good as I once was.

Just keep practicing and feel for the vein and try to track it's course. You'll get the feel back soon!

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Awww... So nice of you all for responding to my post. I felt relieved somehow knowing that I'm not alone who had suffered from this problem. My mind is like being tortured everytime I miss or blow a vein and I feel like so stupid. You are all right, I really need more practice. It's the repeated experience that makes an expert. Thank you all guys.

And to Asystole, hilarious as it may sound, I've tried doing it to myself just so I can practice. It's just hard pricking yourself 'cause you can't have a good position while pricking. You can't manipulate it well.

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Specializes in Pediatrics, Emergency, Trauma.
Awww... So nice of you all for responding to my post. I felt relieved somehow knowing that I'm not alone who had suffered from this problem. My mind is like being tortured everytime I miss or blow a vein and I feel like so stupid. You are all right, I really need more practice. It's the repeated experience that makes an expert. Thank you all guys.

And to Asystole, hilarious as it may sound, I've tried doing it to myself just so I can practice. It's just hard pricking yourself 'cause you can't have a good position while pricking. You can't manipulate it well.

I work in a PediER and I JUST started getting babies; I haven't started IVs since I worked in an Acute Rehab, and never got the hang of Peds pts until now.

I used a banana to practice on insertion; I also started bigger kids to get a feel of the vein...some days I feel more confident if the vein is sitting up; I'm still working on the deeper veins.

I also warm them up before inserting if needed.

Hope this helps!

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@Ladyfree28

- How does a banana help?

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A lot of it is confidence. Practice on your co-workers.

I haven't drawn blood/started an IV in 2 years. I'm sure I would play so many mind games with myself that I would miss. The nurse that taught me to draw blood always said, "make sure you have them lying down, that way YOU have the control." I've never forgotten that, and when in doubt I did lay my patients down.

I've never drawn blood/started an IV on anyone under 18. Kudos to you!

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