IV Refresher Course

No, you are not on your own. Every hospital or unit has a clinical nurse educator to help provide an in-service on iv therapy. Some facilities has a lab just for practice. Just a thought.

I am not a nurse (yet) but I am a STAT tech at a large teaching hospital. I'm called in for difficult IV starts. This is what I tell the people that I precept. Just ignore me if you heard it all before....

1. Don't go for the vein that you can see, but can't feel. If it doesn't have that bounce to it, it's not worth poking. Especially if your going to run Vanco or K.

2. Instead of a tourniquet, use a blood pressure cuff. You only need to pump it up to about 80 mmHg or so. I find this dilates the veins better and as a bonus, the patients LOVE you because it isn't as uncomfortable.

3. Really old patients, frail skin, fragile veins. Don't use a tourniquet/blood pressure cuff at all. They tend to blow less.

4. Often I'm called to patients rooms who have these monster veins...and yet nobody can get access because the patients skin is "too tough and the veins roll." And then I find out they are using a 22 gauge needle. I personally LOVE a good 18. Often those tiny 22's are not big enough to puncture through the vein wall...and as a result, the angiocath just pushes the vein around. Anchor that bad boy vein down with your thumb and go fast. I always tell patients who are hesitant about the size of an 18 that it's akin to trying to hammer a needle into a 2 x 4. Sometimes a nail is better for the job.

5. The one thing I hate about all those IV insertion videos is that they tell you to enter at a 30 degree angle. Then you get your flashback. Then you lower the angiocath and advance some more. And then you eject the needle. I think this will blow a vein more often than not. I approach at a very small angle and most likely, that vein is never as deep as you think it is. As soon as I get a flashback, I slide the angio cath off the needle into the vein. I don't use that additional advance.

Anyway, I hope some of those tips are useful for you. I'm surprised your DON didn't have more helpful information for you. It's a shame that you and your coworkers are requesting to improve on a skill that would benefit patients and the response was to check out youtube. I'm sure the patients would be thrilled.

Happy Poking!

The only way to get better at IV starts is to practice. If your unit doesn't do enough of them, ask to be floated to a unit that does. I spent two days in outpatient surgery doing nothing but IV starts when I was a new grad/new hire. It helped a bunch, especially since most of those patients had much better veins than the ones I typically deal with in the ICU. I was still only passable at starting IVs until I started working on the rapid response team. When I do my preemptive rounding all over the hospital, nurses ask me for help with their difficult IV starts. At first I thought this was hilarious because I was sure that I was no better than they were at starting IVs, but I went ahead and tried every time. In a few weeks I was shockingly improved and now I can honestly say that I am one of the better nurses on my unit at starting difficult IVs.

I agree with the excellent advice akj777 gave, particularly the part about being able to feel the vein. I would rather stick a vein I can feel (even if I can't see it) than one that I can see but can't feel. But you need to practice, practice, practice! Tell your DON to send you where the IVs are. Her youtube idea is ridiculous imo, but a class probably wouldn't help all that much unless you all were allowed to stick each other repeatedly!

HAHAHA -Youtube!!! Do you get many CEUs for watching youtube?!!!

She should be ashamed of herself and her facility for even suggesting this. I am APPALLED.

If an outside agency does the teaching, they usually do it for free, because your facility uses their products.

Obviously, your DON doesn't want to pay you for the time the class takes! Shame on her!

I love the suggestions made by akj777. Another trick I have used is to wrap the pt's arm in a warm, damp towel or a couple of washcloths, and cover with a chux, about 10 min. Remove before it starts to cool. Remember WARM, not hot! This frequently will help expand some smaller or deeper vessels.

Best wishes!

thank you for the suggestions akj777, and everyone else :)

unfortunately i work at a small rehab facility (thank you CA for closing all the hospitals for us new grads..), i've been there for 10 months, and have done maybe 6-7 IV's. There isn't another unit for me to go to, otherwise I would.

I'll keep doing my research and try to find a class, or maybe a hospital has an open lab, as suggested.

Ok, ok, this has probably been addressed before. I'm just going to tag my own IV question onto this post. I'm a new grad, and I've gotten to the point where I usually do get flashback, but then blow the vein. I blank out about how to get the plastic cannula in. My coworkers say, "Just push, right away," but since I can't tell how much pressure is too much pressure to push with, or what angle I'm going in to the vein at, or how much push pressure the vein will take, I'm not confident at that point. Should I use one hand or two?

Oh, yeah, 'nother question; when a heplock/saline lock gives resistance, how do you know whether/how hard to push? Because sometimes it's just starting to clot, and you can clear that away with a push; other times, there's a clot, and I'm terrified of blowing it loose to go to the heart.

Assuming your right handed...when you get that flashback, use the thumb and forefinger of your left hand to advance the catheter in. Just make sure you are touching the hub and ONLY the hub. Not the angiocather itself or the end of the hub where the saline lock attaches. You don't want to contaminate it. You shouldn't feel any pressure at all when you slide that catheter in. If there is resistance, and you have to force it, it's not going to work. Your angle should be not quite horizontal with the vein. Flash back, slide catheter off the needle, eject. When you get better at it, you will then be able to just slide the angiocath off the needle with the forefinger of your right hand.

As far as resistance during a flush...I say if you have to question the amount of force your using, it's time for a new IV. Better safe than sorry! :)