IV Starts

Once you see flash back, make sure to advance the needle some more into the vein. Then slide the catheter over the needle. Most people stop when they see flashback and try to advance it too early.

Once you see flash back make sure to advance the needle some more into the vein. Then slide the catheter over the needle. Most people stop when they see flashback and try to advance it too early.[/quote']

But...make sure you aren't advancing the needle too far. I've blown veins by trying to advance the needle when I really should have just advanced the catheter. I had a hard time finding the happy medium.

You are going to have days when you can slip a 16 gauge into the hand veins of a diabetic, dialysis, chemo patient...you are also going to have days when you can't pop a helium balloon with a steak knife. Keep practicing, have confidence, have a coworker check out your technique and give you tips, and always take time to look for the BEST vein, not just the first one you see.

Most larger hospitals have a hour long class on IV's. I took one several years ago (it was a requirement for new grads) and I found that it helped me. You will eventually get the hang of it. And do your floor nurses (and patients) a favor and don't put them in the AC unless it's the only place.

Michelle

how did you do it? i have not tried to insert an IV to a patient. it scares me lot and it seems that i forgot the learnings i have when i was a student. i do not know how to insert the needle and what to do if you will insert an IV to a patient. i just hope i may be able to enroll myself in IV training.......soon...

rita

And do your floor nurses (and patients) a favor and don't put them in the AC unless it's the only place.

Michelle

... also the reason why most ER sticks don't have J-loops. :)

cheers,

When I did my ER rotation, I was taught that most patient get the IV in their AC in the ER because if you suddenly want to dump large amounts of fluids and meds - you do not want to be trying to shove 'em down a hand vein....

... also the reason why most ER sticks don't have J-loops. :)

cheers,

I agree- as an ER nurse the FIRST place I look is in the AC- in the ER we go for the bigger veins- not only for giving fluids/blood fast, but because we're usually drawing a bunch of tubes of blood off of the IV start, and bigger veins usually give better blood return. Also, if they are going to be having any kind of CT or nuclear med scan that requires contrast, the AC is the best place for this.

When I see the flashback I wait to see if the chamber will fill completely. If it does not I advance just alittle, or sometimes pull back alittle, until the chamber fills, then I advance the catheter.

I think it's all in repitition. The more you do the better you get. I used to be awful, really awful. I'd say it took me a good 4-6 months to get proficent.

When I did my ER rotation, I was taught that most patient get the IV in their AC in the ER because if you suddenly want to dump large amounts of fluids and meds - you do not want to be trying to shove 'em down a hand vein....

... also the reason why most ER sticks don't have J-loops. :)

cheers,

So very true and understandable yet still so very irritating to floor nurses

Just go for it. Take the challenge every time. And be sure to find out the good IV stickers on your floor and do them some favors and ask them for help when you dire need of it for back up.

PS Remember to undo the tourniquet before flushing..:-0 a big oops that garaunties the blowing of veins. and once in a vein lower the needle to allow the catheter to run into the vein quickly.

PS PS...if you see a successful veinous start on one arm try to mirror the stick on the other arm. Works like a charm! Cause the anatomy from arm to arm doesn't vary very much....enough said.

PS PS PS confused patients are the best patients to practice on ;-)

[banana]

So very true and understandable yet still so very irritating to floor nurses

So very true and understandable yet still so very irritating to floor nurses

In fact, more vexing than the fact that the IV is there in the AC is the way some people tape the bloody things! I tell you - doing Sudokku is probably easier than un-taping some of those IVs when trying to convert them to J-loops!

But I also use this as a chance to do some teaching: Explain to the patient why that happens. Why I start a new line and not use that one in their AC (long term comfort measure - patient prefers forearm IVs vs having to hold elbow straight).

As my instructor repeatedly drummed into our heads - "Teach! Teach! Teach! Knowledge not passed on is lost!" My patients usually appreciate me taking the time to explain it to them :)

Also, if they are going to be having any kind of CT or nuclear med scan that requires contrast, the AC is the best place for this.

Learn something new every day

and when you teach a patient this...there ususal response is why didn't the ER put it in the FA to begin with. It's a judgement call. I wasn't talking about Trauma patients that need the largest bore IV available. Blood can be drawn and contrast can be infused into a FA IV.

Michelle

and when you teach a patient this...there ususal response is why didn't the ER put it in the FA to begin with. It's a judgement call. I wasn't talking about Trauma patients that need the largest bore IV available. Blood can be drawn and contrast can be infused into a FA IV.

Michelle

It's not just trauma patients that may need blood or fluids fast. Anyone who might have a drop in BP might need a fast bolus- GI bleeds, syncope, dehydration, etc.

I cannot tell you how many times I have had pt's return from CT with blown hand or forearm IV's from the contrast- it's injected by a machine, and it's pushed FAST. Also, if we are giving meds like adenosine, it needs to injected FAST in a vein as close to the heart as possible, it's half-life is so short, if it is injeced into a hand, it may not work. A lot of smaller veins can't take the pressure.

Also, at many hospitals, depending on the rad tech, they require nothing less than an 18g in the AC for some scans, especially nuc med scans like V/Q scans.