IV start advice

MCB43076 · Feb 28, 2009

Be carefull of your "angle of attack". Don't start at 30 degrees like they tell you in school. Get the angiocath down just above parallel to the vein and push in with a steady rate of entry. When you get blood, push a little further in. Look at the tip of your angiocath before you poke. You will see that in order to get the tip of the actual iv inside the vein the needle part has to go a little deeper. Remember, if the vein doesn't blow and you don't get blood return you are still "in the game". I have had a student I precepted (in CVICU) work for >5 minutes and get the IV. Be patient, it will work out for ya.

BeachyRNn08 · Feb 28, 2009

Besides the technical stuff, as mentioned above, it helps to go in there with confidence, the more you miss, the more you're gonna feel like you can't do it. Try to put all that aside, and take the time to look and find a good one, even if it's a patient you think you have no chance of getting, always try at least once. You'll get better with time! You'll be surprised at what you can do. I've been there!

Mommy_of_3_in_AL..RN · Feb 28, 2009

I just graduated, and only successfully started two IVs..the last one was my last day of preceptor in SICU and i volunteered knowing i needed the practice. I missed once, but the other nurses were supportive, as was the patient, and encouraged me to try again (usually as a student we got one try, then the nurse had to do it). I got it! I was on cloud nine! But, now I am about to start my first job in MICU and am scared to death!! We will se how it goes! A piece of advice i was offered by a very seasoned nurse is this (mind you i dont know if you can do this in all facilities, as sometimes the nitro paste is not available)..i was told that if you rub a VERY small amout of nitro paste onto the site, the vein will pop ou much better and make it easier to get..i have never done this, as i really dont know if that is even legal..just something i was told. Maybe i will ask in my new unit for opinions??

diane227, LPN, RN · Feb 28, 2009

I have been starting IV's for 31 years. I rarely use a tourniquet. I try to have the patient hang the extremity off the side of the bed and use gravity. This works especially well for the elderly because the back pressure from the tourniquet can make the vein blow because they are so fragile. I start low and work my way up if it takes more than one try. I avoid the AC at all costs. Don't use the inside of the wrist unless absolutely necessary. If you have to use the foot, use it for IV fluids only and don't give meds there (in my opinion) and take it out as soon as you can.

gendoRN · Feb 28, 2009

Not much advice here, but plenty of sympathy. I am into my 6 month in as a medsurg RN and you know how many successes I've had: 2 I did as a student, 2 w/ my preceptor, and only 1 on my own! 1!! You can't be as bad as me! I have such little confidence, I usually only try once and NEVER more than twice on a pt, depending on how good their veins are. I am incredibly dishearted. The best thing, which helped in school was I practiced on a nurse friend's boyfriend while she walked me through it. Most people just tell me to practice on people at home. Unfortunately, i don't have a volunteer. My biggest problem seems to be hitting valves where I can't advance the catheter or it bends. Don't know if anyone has advice on that, but it would be much appreciated.

Jean1313 · Feb 28, 2009

I've been a nurse almost 2 years and never started an IV! In nursing school we were told we'd be taught in orientation, but I went straight to Psych. We were not allowed to do them there. I started med-surg 6 months ago, and was taken to "fake" IV start class (they had the fake arm, but wouldn't even put 'blood' in the fake vein). So after that first week, I requested a morning helping out in short stay, for free, to learn. This has never been arranged, despite asking twice. An 8 pt assignment is too busy do my first ones on shift.

At least you've done a couple! I wish you luck!

Roy Fokker, BSN, RN · Feb 28, 2009

I avoid the AC at all costs. Don't use the inside of the wrist unless absolutely necessary.

I'm just curious - may I ask your reasoning/rationale for this? :)

cheers,

blondy2061h, MSN, RN · Feb 28, 2009

I'm just curious - may I ask your reasoning/rationale for this? :)
cheers,

AC will drive the patient nuts if it's there for any length of time. The darn pump will be beeping every time they try and move. Wrist hurts a lot more than other sites.

Roy Fokker, BSN, RN · Feb 28, 2009

Wrist hurts a lot more than other sites.

Frankly, in my personal opinion (and experience), hand/anterior-palm IVs hurt the most. I'd rather have the discomfort of ante-cube IVs versus hand IVs. I haven't had the displeasure of experiencing femoral sticks or an ABG but I'm told they're pretty darned painful as well.

AC will drive the patient nuts if it's there for any length of time. The darn pump will be beeping every time they try and move.

Agreed - but I wasn't doubting that either :)

As a former floor nurse, I often wondered/groused at the IV locations my patients would have upon admission from the ED; but ever since I started working the ED, I no longer wonder (for a more semi-passionate take on the matter, read this thread: There is a reason "why").

In any case, those were not the reasons I asked Diane that question. :) She says she's been starting IVs for 30+ years and she also lists ED and Critical Care as among her 'nursing experiences'.

As an ED nurse, my philosophy has always been "Any/some IV access is better than no IV access". I was simply curious as to why she chose to say "I avoid the AC at all costs. Don't use the inside of the wrist unless absolutely necessary" ... other than the known reasons of "the AC is a poor site because of arm movement and therefore IV pump alarms and/or general PITA" and "distal extremes [upper or lower] are generally less preferred by pts. because they are more painful due to lack of substantiative surrounding tissue".

I still remain curious...

cheers,

Roy

diane227, LPN, RN · Feb 28, 2009

Because patients bend their arms there. The line will clot off or the pump will be going off constantly. The only time I use it is when it is an emergency and I have absolutely no other choice.