IV start advice

Hi,

I'm a student and just started my first IV (on a fellow classmate) in 2 attempts, both attempts were in the cephalic vein in the wrist. I didn't try any on the hand. I was just wondering if anyone had some helpful hints (the kind they don't always teach you in nursing school) on how to start IVs. Our school doesn't promote using lidocaine so we just have the one bigger stick. Thanks!

I don't have any specific "tricks of the trade" just yet. I think the key is just experience. Good luck in mastering this important skill.

There are numerous threads regarding starting IVs. Here is the most current one (I thinK):

https://allnurses.com/forums/showthread.php?t=3793

you can also try a search on this bulletin board. There have been a lot of tips/tricks posted. Good luck. The biggest thing is practice, practice, & practice. Even when a patient says they are a hard stick, at least take a look at their veins, don't automatically pass it off to a more experienced nurse. Again, good luck.

When starting an IV, as a new nurse it is difficult to remember all the rules of infusion.....however, the one best piece of advice I can tell you is to be patient! You have to allow the vein to become engorged for it to be palpable. The hand is the easiest place to start until you get used to feeling deeper veins. There is usually no hair on the back of the hand and put the tourniquet tightly about 6-9 inches above the hand, let the hand dangle off the bed, and allow the veins to distend. This should only take a few minutes at most, although I remember sitting there thinking hours had certainly passed :) your skills will develop as your # of attempts increase! Next, use a little alcohol to wipe over the top of the hand when you do this, you will illuminate the vessels you can see them better. Next and very important look for a vessel that can accomodate the size catheter you are placing, avoid placing a 1.16" catheter with no more than .75" of vein that is without taking a turn (kind of looks like a fork in the road) if this process of selection has taken some time and the (patient/victim:) ) hand is changing colors, release the tourniquet for a few minutes allow circulation to resume and then reapply. Carefully assessing for a good site is essential to success! Your patient will prefer you take a little longer to choose the site, than to be stuck multiple times...trust me on this one, with more experience the time to select the vessel will almost become intuitive. OK, back to the process once you have selection, prepare your site, apply traction to stabelize the vessel you plan to stick, I would suggest using approaching the sidewall of the vessel until you gain experience to go on top of the vessel to prevent going completely through it, STICK it and pause, wait for the blood to flash in the catheter, then drop your insertion angle almost parallel to the skin, advance the catheter a little further into the vein and then thread off, release traction, tourniquet,apply pressure well above where the lie of the catheter tip is within the vessel to stop blood from spilling and activate the safety feature on the needle you are using then connect either your pre-primed IVset or extension set, and dress your site, then flush it.....Success!!!!! I work with alot of Nurses on IV therapy techniques and some of the observations I have made: Not waiting for the veins to fill up, releasing the traction on skin when they get a little flash, attempting to thread off when they see the flash (premature) instead of making sure the catheter is actually in the vein, sometimes the needle is in the vein, but the catheter (usually sits below the needle bevel by a small distance) is outside the vein, so when they attempt to thread off they are actually trying to push the catheter into the outer wall of the vessel, LOOK at your catheter be aware of the distance between the bevel of the needle and the catheter lie on the stylet....this will help you to avoid some of the pitfalls, but practice makes perfect, start with the most accessible veins first, as your confidence grows select the vessels higher up and those that lie a little deeper to get the feel of palpating for them, SOON you will be a FIRST STICK PRO, and everyone on the floor will want you to start their IV's!!!!

Best of Luck and I hope this helps........

LUCY

I wish WE could start IVs on each other before going to do it on patients! How cool!!

...hmmm a lidocaine with the little 25g vs. no lido with a 16-18 x however many attempts you require? I'm not sure I'm following your school's rational. Even if the fraction of the cc of lidocaine you inject just happens to be intravascular, you surely won't realize any CNS or CV effects.

A dab or nitro paste under a tegaderm for a few minutes works wonders on patient with little veins and/or are dehydrated.

Great post Lucy! That even helped this "not so new" nurse!

i don't have any specific "tricks of the trade" just yet. i think the key is just experience. good luck in mastering this important skill.

look at how a airplane lands on a landing strip. this is how i start iv's

also, it is just medical plumbing. pure and simple plumbing on a wriggiling

wiggling talking subject telling you how to do your job. so.. put everything out of your mind and think positive, pat the patient and explain you are going to start the iv and you stick twice. you don't "dig" everyone has a bad day and there are days i can't get some veins.

get all your stuff ready and get comfortable. look on the back side of the forearm, there is a lovely vein lurking back there and you have to stand/sit on the left side of the patient have the pt hold their rt. arm across their chest and voila there is the lower aspect of the basilic vein. tourniquet applied., if you feel it and don't see it, take your click pen, with out the ink exposed or fingernail and mark the vein with pressure. it won't wash off when you cleanse the area and gives you a great landmark. stablize the skin using your forefinger and thumb, watch what other nurses do, you will develop your own system.

now guide the tip of the cathether/ needle through skin and into the vein, flash, drop the angle of the catheter and advance the whole device a 1/16 of an inch or so, and slide the cath off the needle. you can even pick up a vein using the device. ( do the procedure using a drinking straw) don't fret you won't get everyone, but the more you do the better you will get. and steve told me, if you know you can get a 22 in there you can get a 20 in. i'd wait till you were on the iv team a while to start doing that. and, if they are just getting antibiotics, use a 22g. hey they aren't bleeding out.

The best advice I can give you is to go with an IV nurse or a nurse with a great deal of experience with venipuncture once you have graduated. If you learn from a pro you will start out with good habits and the whole process will be easier. PLEASE REMEBER that this is a skill that takes time to learn. First get through nursing school and worry about this later once you are able to make a plan to learn this incredibly important skill.