IV insertion problems

[nursing_problem]

hi guys. just want to ask how do you deal with relatives who demands nurses to make sure they can insert or start iv just once esp. in pediatric patients. we all know that we dont like failing an iv to any ptient but their are times that we have bad luck on starting one. The relatives kept on telling me that i dont know how or im not good at inserting an iv for failing once.i tried again and i succeeded.

It bothered me how they yelled at me infront of other and told that i dont know how to insert an iv.

[Ciale]

I was wrapping an ace bandage around my bf's wrist yesterday. He said "make it tighter". I quit wrapping and said "Do you want to do this then?!?! Gawd, you sound like one of my patients!"

Just be confident. You're the boss. You know how to start the IV and Uncle Billy Bob doesn't. If they say "well they can only get it in my right hand" look there first, but if it's not promising, assess and go with where YOU think you need to stick.

[hiddencatRN, BSN, RN]

I usually just say "OK." Chances are I do get it on the first stick and if I miss we can have a conversation then about what our options are. I find being nonchalant about it is often calming.

[klarity, BSN]

I'm still learning my IV skills since I am a new grad. I get about 1/2 of them. Most are difficult sticks. Usually, I tell the patient (I'm very friendly and nice to the family and patient from the beginning even if they are a little difficult with, which sometimes "chills" them out a little more), "I need to give you an IV, I know that it can feel uncomfortable and can be a little painful. I'm going to try here (point to the area Im going to jab), if I can't get it. I will try here ( point to another spot). If I still can't get it, I will get another nurse to try, OK"? So far, I haven't had any problems. I think the patient and family feel better when you have informed them..BUT..I am aware I dont have 30 years experience of dealing with patients.... and I know that the days are coming where I will have the patients that will be pushy and complain about even the first stick that I get in. :):). Just my two cents...

[Poochiewoochie]

I had surgery a week ago tomorrow. I told the nurse about my valve problems in the top of my hand yet she sticks me there anyway then proceeds to tell me , yes, you are pretty valvely. A few seconds later the site is all swollen and she says she doesn't like how it looks and takes it out. Stick number 2 is in the place they usually draw blood. The lidocaine made the vein roll so for approximately 10 minutes she keeps digging in the spot hoping it stops rolling causing me immense pain. She eventually takes it out and sticks it in the other arm in the spot I originally told her usually works fine. Guess what? She gets an IV in the first try.

So besides my swollen eyes from the surgery I also left that day with 3 IV insertion sites that hurt like heck and were badly swollen. Almost a week later all 3 are still bruised. Maybe the next time a patient tells her what I did she will take their word for it instead of deciding the patient is full of it and she knows best because she is the nurse.

[Sassy5d]

For those that don't typically work in the ER, just a reminder that based on the chief complaint, may not be able to stick you where you request.

If I know you're getting an abd with contrast ct, sorry, the 24 in your hand you're requesting isn't going to apply. Unless you don't mind me sticking you twice.

[Rhi007]

For those that don't typically work in the ER, just a reminder that based on the chief complaint, may not be able to stick you where you request.

If I know you're getting an abd with contrast ct, sorry, the 24 in your hand you're requesting isn't going to apply. Unless you don't mind me sticking you twice.

True dat! Antecubital fossa is the normal placement for abdo contrast CT!

[Sassy5d]

I remember floor nurses making, although valid, complaint about all the patients having ac iv's. they eventually infiltrate, you can't go lower and then you're 'screwed'

It's unfortunate that a majority of the dx that get people admitted require a larger gauge iv, in a large vein like ac. They need ct's with contrast.

Or a blood transfusion ect ect.

If you're just getting meds and fluids, I try to start in the hand/wrist. But even many meds require large iv, large veins. Just saying

[Ciale]

For those that don't typically work in the ER, just a reminder that based on the chief complaint, may not be able to stick you where you request.

If I don't think you're going to be admitted or if I think you might need contrast, I'm sticking a 20 in your AC. Aint nobody got time to look for veins!!!!!!! -ER nurse

[BrooklynRN11201]

In my facility, we only get two tries on a patient before we have to grab someone else to try.

I had a patient who told me I only got two chances once - I told her okay and proceeded to use a pediatric angiocath. There's several reasons why patients have these demands but let's not forget, IVs do hurt (plus it's their way to try to maintain control over the situation). After the first fail, I called a trauma Dr over with an ultrasound and even he missed! The patient had this "I told you so!" attitude and we tried to get her to let us try again, but she refused. She was there for a mild allergic reaction and we told her that getting IV access is the best way to treat her, but she still refused. We told her that she would be treated much quicker and easier with IV access but refusing to give up control, she told us there was no way we were sticking her again. So we threw some benadryl at her and kept her there for several hours longer than she would have been had we gotten access. Sometimes there's nothing you can do to appease a patient, but in terms of the family members saying something to you, I have responded with educating them on the venous response to dehydration and they got real quiet.

[iluvivt, BSN, RN]

Sure I listen to the patients request for a specific site and if I can accommodate them I will. I will not however, put an IV in a specific location if I have a good reason not to to do so. I do consider the ph of the medications and IVFs the osmolarity,the current dx and tx needed,the overall quality of the veins and skin,any diagnostic tests or procedures or surgeries planned plus much more. I am more than happy to share my rational with any patient that asks. For example, if the plan is to administer a vesicant or irritating medication you can bet I will not be placings that IV in your hand or at an area of flexion.

[harrird]

If a patient requests a certain location I try to accommodate them, but if that's not where I want to go I ask them to not hold it against me. Sometimes it works out where they want it. Most times, I get the start where I wanted it on the second attempt. Just my experience.