IV start help!


Hi, I'm a new nurse and have been having trouble starting IVs. I have no problem getting a flashback of blood, but it seems like I bust the vein every time I attempt to advance the catheter. I always feel like I have to force the catheter in as it doesn't slide easily and it is so awkward for me. Can anyone give me some advice as to what I may be doing wrong as I'm advancing?


652 Posts

If you get a flash of blood you should then advance the needle FURTHER STILL and THEN thread. This is because the needle protrudes unsheathed out of the catheter a little so when you hit the vein, you'll see blood but your CATHETER IS NOT YET IN... only the needle. If you start to thread from that point, you're jamming the catheter on the outside of the vein while your needle is inside; make sense? If you flush, who knows where your catheter is or how jacked your vein is now... so the saline infiltrates elsewhere.

Hope that helps!



Specializes in NICU. 297 Posts

^ totally agree ^

jadelpn, LPN, EMT-B

51 Articles; 4,800 Posts

And make sure the arm is positioned as straight as possible. And sometimes you need to come up under the arm and hold the skin slightly taut. (slightly, not tightly). Either the positioning is not straight, so you are going in and straight through the vein, or you are in but the skin is wobbling around and you can't get a smooth thread. Get the IV, get the flashback, advance needle JUST a tad, and inch forward the catheter. Good Luck!!



209 Posts

YES, what the above poster said.... once you get a flash....advance the NEEDLE just a pinch more BEFORE trying to advance the cath. AND make sure you UNTIE tourniquet before trying to flush. I personally untie as soon as I get a flash, then continue to advance needle & cath.

Second piece of advice would be to keep trying, try often, and try to learn to LOVE it! I notice some people dread having to start and IV and they tend to be the ones that are not getting better at it.

wish_me_luck, BSN, RN

Has 6 years experience. 1 Article; 1,110 Posts

undo your tourniquet. I have had a couple blow and I will admit, it was because I forgot to undo it before advancing the cath. Also, I have seen experienced nurses get the IV in and the vein blows because it is a smaller vein. So, sometimes it just happens. Keep on trying :-)

BostonTerrierLover, BSN, RN

Specializes in Adult/Ped Emergency and Trauma. Has 16 years experience. 2 Articles; 908 Posts

Yep, Vespertinas nailed this one!

Also, if you having to "force it" something is wrong.

If you are using those pop button retract IV catheters, make sure it isn't pulling back when you disconnect the device from your catheter, You should be able to advance it before you take off the back part. Those are cool from stopping needle sticks, but give me an old fashion regular IV anytime without the fancy button retract, lol. (Boston is resistant to change)!


652 Posts

Oh also... when you do advance after the flash, do so at a very small angle. You already pierced the vein... now you want to advance inside.. not *through* it ;-)



Has 2 years experience. 304 Posts

Sometimes, too, especially on those fragile, elderly veins, the pressure created by the tourniquet is just too much and the vein blows out as soon as it is pierced. Try a BP cuff inflated to about 20 mmHg over systolic or forego the tourniquet altogether and see if it makes a difference.

imintrouble, BSN, RN

Specializes in LTC Rehab Med/Surg. Has 16 years experience. 2,406 Posts

:)Skill at starting IVs is part practice, part skill, part gift.

I'm never going to be the nurse they call when they can't start an IV.