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IV Starts

Nurses   (2,414 Views 17 Comments)
by ashleyjean3 ashleyjean3 (Member)

ashleyjean3 specializes in Emergency Department.

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I am having trouble with my IV's.....I can hit the vein no problem...great return but I go to thread the catheter into the vein and blow it 9 out 10 times. What am I doing wrong??? Any tips???? I just started in the ER and hate having to get someone else to stick my patients with great veins

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48 Posts; 1,611 Profile Views

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.

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Once you see flash back' date=' 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.

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97 Posts; 1,558 Profile Views

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

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78 Posts; 2,827 Profile Views

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

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Roy Fokker is a BSN, RN and specializes in ER/Trauma.

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

Michelle

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,

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ERRNTraveler is a RN and specializes in Peds, ER/Trauma.

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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.

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DutchgirlRN is a ASN, RN and specializes in OB, M/S, HH, Medical Imaging RN.

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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.

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DutchgirlRN is a ASN, RN and specializes in OB, M/S, HH, Medical Imaging RN.

1 Article; 3,932 Posts; 21,635 Profile Views

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

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CaLLaCoDe is a BSN, RN and specializes in Cardiology, Oncology, Medsurge.

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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
[/banana]:yeahthat: :yeahthat:

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Roy Fokker is a BSN, RN and specializes in ER/Trauma.

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So very true and understandable yet still so very irritating to floor nurses
Oh as a floor nurse, I totally agree. ;)

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! :uhoh3:

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.
Oooh yeah. Never thought of that....

Learn something new every day ;)

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97 Posts; 1,558 Profile Views

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

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