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Discussion

IV problems

I am a junior at my school and just learned to start IV's Today during our clinicals, i was sent to an area to start IV's on outpatients. The problem here is that i attempt IV"s on five different people and failed on all of them. On one of the attempts, as i was puncturing the pt skin, there was a popping sound on top of the skin, no blood return was seen. I told the nurse okay, i can't do it, can you take over now. She did and she started working with the needle to get into a vein and never did. Well when the catheter came out, the tip looked jagged and torn, my heart just sank. the nurse started a new IV and let the patient go. I told her, you sure the tip didn't break off? and she told me she couldn't give me a for sure answer and that it has happen to her before and nothing was wrong with the patient. Well I definitely did not want this to come bite me back in the butt and reported to my nursing instructor what happened and he reported to the head nurse on our floor and she said " it could had been just the needle rubbing against the tip, 98% chance the tip didn't break off and she was confident in the nurse overseeing me that if she thought something had happen, then she would had done something about it. But I just have a bad feeling...IDK!! I'm scared to start an IV now :(

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    Make sure the TK is on reasonably tight. Have the patient open and close their fist a few times. Feel for a good vein. It should feel kind of spongy, like a very soft noodle under saran wrap or something. Once you've found it, prep the site, put on some gloves if you haven't already, and get rolling... Imagine the structures under the skin that you'll have to get through to enter the vein. Then, as you do it, imagine you have an eye on the tip of the cath and you "watch" the catheter penetrate those structures on the way to the vein. You're aiming for the middle of the lumen, which is full of blood and about the size of a small hollow pasta noodle. You can do this.

    Oh, and we all pretty much have difficulty at first getting a line. I've done a few hundred and before this past spring, the last one I'd done was about 12 years ago. I'm pretty rusty... but give it time. Eventually you'll be one that they come to for the difficult starts.

    If the veins seem to roll, anchor the vein to one side. It'll only roll one way if you do that. Then enter the vein from either on top or just to the side away from where you're anchoring the vein. Again, you're not aiming for the vein wall, you're aiming for the middle of the lumen just past that.

    It really is doable.

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    always check the tip of the needle to be sure the cathlon has not migrated over it, as the needle will shred the cathlon and may create a thrombus. You did the right thing in reporting the incident.

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    Lucky girl! I only get to practice starting IVs at work, and only then when they pull me to the ED (I'm a nursing student/PCT.) It's scary, I know, but take advantage of getting to practice in school! Most programs (from what I have been told,) do not offer that opportunity. Mine sure doesn't. And most people miss their first few times - anxiety only makes it worse. Try to take each chance to practice as a completely new experience. Just because you didn't hit it the last 5 times, does not mean you won't hit it next time. Every time you miss, you feel it a little differently - too shallow? Too deep? A little off to the side? Fed the cath a little too quick and went through the vein? I have faith in you :-) Keep practicing, you WILL get this!!

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