IV starts: Need tips!

[NurseBecky4]

I am getting so frustrated with IV starts.... I try to go in with confidence! However I have hit a dry spell and am looking for tips from my fellow nurses on what works for you. Also my hospital uses the catheters (BD Nexiva) with the small length of tubing connected. I have watched other nurses and some prime that tubing and others don't.... any suggestions and tips would be greatly appreciated!

[nursej22, MSN, RN]

Go to the BD Nexiva site for insertion tips. The tubing does not need to be primed because it allows for blood return.

[dah doh, BSN, RN]

Watch https://www.Youtube.com/watch?v=GeDcJdpp2K0

Wow! Those are gigantic veins!

[akulahawkRN, ADN, RN, EMT-P]

While I haven't used that specific system, the process isn't that much different from any other "standard" IV start. Palpate the vein, make entry into the vein, look for the flash, advance just 2 mm (yes, only that much) and then attempt to thread the catheter into the vein. Every once in a while I go through a "dry" spell. Believe it or not, I use much the same mental techniques as any high-level athlete does when they're getting ready to go again after "losing" a point or even a few.

I enter the room with confidence that I'll get it in ONE stick. I identify my primary and backup sites. For practical purposes, they're equal with the exception that the backup site usually hurts more. Then I do the stick. Most of the time, I get it. Sometimes I don't. If I don't, I shrug it off and proceed to my backup site. I usually limit myself to 2 sticks, very rarely will I do 3. I can count on one hand the times I've missed 3 attempts.

[Trauma_drama14, BSN, MSN, RN, APRN, NP]

It's hard, but you'll get there. It takes practice and I've heard years of practice too. I like those IV catheters and have just started to get used to them so it's unfortunate that our hospital is changing the catheters for us. You definitely want to be confident when you get in the room, don't say "I'm going to try to put an IV in" but say "I am going to place an IV". I have been told by an experienced "vein finder" (an ER nurse), sometimes feeling for a vein is better than sight. So I kinda have been watching and feeling for a right vein. Also, you may want to pull back the needle and readjust it back just to kinda "prime" the catheter prior to insertion (if that makes sense, just to make sure the catheter releases for the needle easily and doesn't kind of stick to it). Some patients have fragile veins, so use your judgement on how tight you want to make your tourniquet. Also, if you are visualizing a vein avoid any bifurcations. Oh and always bring two IVs and start kits with you just in case. As for IV choices, use your judgement. Our hospital prefers at least a 20g for patients who will be having surgery or possibly surgery at some point. In the ICU, if the patient's veins look great, I will place an 18g or 20g. If the veins are more fragile and a PITA IV stick, I will use a 22g or maybe even 24g if they are like a little old lady and just needs fluids. Hope these tips work for you :)