IV starts - anyone get better?

[krenee]

I have been in the NICU for about 16 months now and I just haven't gotten the hang of starting IVs. Not sure what the problem is! Possibilities: 1) the catheters - definitely not the whole problem but all the nurses complain about them. 2) We just don't start them enough for me to get proficient. Of course we start them on virtually all our admissions, but we are a fairly small level 2 NICU and often run with a very low census. The most I've seen in our NICU are 10. We've been down to zero babies once since I've been there. Of course the 3rd option is that I just suck at it . I try as often as I get the chance but after the admission the babies often already have a bunch of blown veins from the first IV start so it only gets harder to find a decent vein. And I am feeling guilty for blowing the veins by practicing, which makes it harder on my co-workers who have to get it after I've tried.

What I'm wondering is - should I just accept that I'm bad at it? I really *want* to get good at it. Would it help if I practiced on other populations? I'm sure L&D would let me try on their patients, all of them get IVs. But I'm not sure practicing on adults would help me with the neonates.

As far as technique, I often (but don't always) get the flash, it's advancing that kills me. I try to advance the entire unit after getting the flash but I always, always blow the vein. If I try advancing just the catheter, well, it won't advance, the catheter is too flimsy. And sometimes it seems like I get the flash so quickly, the needle is barely in, so I have to try to advance with the needle.

Any encouragement? Anyone start off bad but actually got good at starting them?

Thanks!

[CoraBeth RNC-NIC]

Are you using the pre-filled syringes? Those require more pressure to flush and often cause more veins to blow.

Also, do you have a posi-flow on your IV extension tubing? That also causes you to need to use more pressure to flush. Can you flush without a posi-flow, and once the IV is taped and secured, add the posi-flow?

Another tip (which someone already posted) is to not push the catheter all the way in, but rather "float" it in the vein as you flush.

Try not to get discouraged. Even the best IV start nurses go into slumps.

You'll get it!!

[krenee]

Thanks for all the advice & tips! I did get one last week so I felt a little better . . . but I still blew 2 veins getting blood cultures. About floating it in though . . . we always draw our labs when we start our IVs, so I don't see how I could float it in. We get the IV, get the labs, then attach the syringe to flush.

[prmenrs, RN]

In both the hospitals I worked NICU, we did not get labs via the IV start. Yes for Umbi lines, not for peripherals. It's too much pressure, imo, for those fragile veins + the small gauge IV device. Obviously, the pros @ your hospital do it and more power to 'em, but I can see how a newer practitioner might have problems.

It's done all the time on adult pts, esp in the ED. Great. Their veins have lots of layers of cells constructing their integrity. Newborns and premies. Not.

Look for customers who need an IV, but no labs @ that particular moment. Might increase your success and confidence. Then learn the more complicated technique. I wish you all the best! :)