IVs

Starting IVs is a technical skill and is one you can learn quickly. There are a few rules for starting IVs for anesthesia that are different than IVs for other situations.

1. Use local to make a skin wheal before inserting the bigger bore angiocath. Use your brains on this rule. If the patient is in shock, needs an IV quickly, etc, then you should skip this step. But for elective surgery, the patients love it and don't listen to anyone who says a needlestick is a needlstick. In anesthesia, we are held to a higher standard on all of these technques and our job is to take away pain. Remember that.

2. Use as large a bore cathether as is practical.

3. Tape it in well.

4. Consider the type of surgery and surgical site when selecting a vein.

5. If it is not threaded up to the hub, don't use it. Start another one. Doing an IV induction requires a GOOD IV. If it infiltrates while doing an induction, you could have a partially anesthetized patient who is paralyzed.

6. Remember with a good IV and an endotracheal tube in the airway, you can handle just about anything in anesthesia.

7. Check you IV frequently duing a case. I saw an anesthesiologist forcefully push 2 liters of fluid in an infiltrated IV leading to a severe compartment syndrome.

8. I use a heating pad, or make sure the patients' arms are under the bair hugger to distend the veins.

9. Don't go digging around for a vein unless you can see or feel it.

10. After 3 attempts, let someone else try.

Usually, I am not a big rule person, but these have worked for me and other anesthetists.

AE

I'm starting anesthesia school in August (MSA as well). I have no experience starting IV's since every hospital I have worked at has an IV team. Oddly enough, this it what I am probably the most nervous about. However, I don't think we are alone....5 of my coworkers are also attending MSA and they have little or no experience with IV starts. Another coworker that started last August said MSA sets you up with IV nurses and she shadowed the iv nurse for 3 hours, and then started IV's for the last 5 hours. I think the experience is all on your own time and its only for those not comfortable starting IV's. You can probably do that as many times as you need, or have time for. I just think, if everyone else can learn that skill, why wouldn't we be able? It will just take time and practice like everything else.

I'm starting anesthesia school in August (MSA as well). I have no experience starting IV's since every hospital I have worked at has an IV team. Oddly enough, this it what I am probably the most nervous about. However, I don't think we are alone....5 of my coworkers are also attending MSA and they have little or no experience with IV starts. Another coworker that started last August said MSA sets you up with IV nurses and she shadowed the iv nurse for 3 hours, and then started IV's for the last 5 hours. I think the experience is all on your own time and its only for those not comfortable starting IV's. You can probably do that as many times as you need, or have time for. I just think, if everyone else can learn that skill, why wouldn't we be able? It will just take time and practice like everything else.

I agree with you, I know that eventually I will become proficient. And I am okay at it now, but just okay. The hard sticks I'm still uncomfortable with. But I know what you mean, seriously that's what I'm most nervous about at this point, too. Go figure:) Thanks for the info about MSA, that's reassuring, makes me feel better. See you in Aug!

You will very soon be an IV expert...even called to start IVs when the IV team cannot. Do not fret over it.

Our crnas are not responsible for starting ivs in our units. They help out with A-LINES or Lps. Havent seen any PIV unless the pt is post op.

Being IV competent is critical to being a CRNA. Many times we are the most qualified and experienced person in a facility to start IVs and we are called to start others and our own.

You will learn and do great, it is like any technique, learn the tricks and get the experience.

Another difference you will find in anesthesia, the size and location of the catheters are judgment calls in the surgical setting. Those of us experienced in anesthesia will tell you that a good working IV is often life saving.

A little tip I found useful: If after putting up the turniquet you don't see any prominent veins, drop the turniquet for a few seconds and put it back on. I almost always do this when starting i.v.'s as it makes for a better target.

Ed

Being IV competent is critical to being a CRNA. Many times we are the most qualified and experienced person in a facility to start IVs and we are called to start others and our own.

You will learn and do great, it is like any technique, learn the tricks and get the experience.

Another difference you will find in anesthesia, the size and location of the catheters are judgment calls in the surgical setting. Those of us experienced in anesthesia will tell you that a good working IV is often life saving.

Thanks, this is good information to know especially coz i pernonally tend to shy away from the hard sticks. I will use this time to improve on this skill before starting crna school. Suen

A little tip I found useful: If after putting up the turniquet you don't see any prominent veins, drop the turniquet for a few seconds and put it back on. I almost always do this when starting i.v.'s as it makes for a better target.

Ed

Please explain why this works so i can make it work for me! Thanks

Why exactly it works I can't say. Not that it's a secret, I just don't know, maybe some kind of histamine release or some such thing. Just hang pt hand /arm in dependent position and pump fist. Give the usual pat pat pat and then let tourniquet down for 15sec and repeat above. The preop nurses are supposed to start iv's when they can but look to me specifically if they are having trouble. I make a point of having an iv in all my pts before they go into O.R. so they don't have to lay wide awake in a cold O.R. waiting to be jabbed. I promise them they will be nice and mellow almost as soon as their head hits the pillow. That's what I'd want. Ed

Sometimes IVs just need your best juju-medicine man dance and howl at the moon. Damn things can seem difficult and they slide right in (I just placed a 16 g this afternoon) and other times the vein is staring at you, doing a little dance and you can't thread it if your life depended on it. Who knows. Pray for a full moon! (When I was in school in SoCal, we had to place a minimum of 100 PIVs. ) Is that still the policy?

I'm starting CRNA school this Fall and I recently became an IV therapist to deal with this issue (and have an ICU break). Basically after 1 day of starting 10 or so IVs, your golden! If you that worried about it, spend a day in the ED and start IVs for them, you'll be a pro. Good luck.