just a little vent

[MIA-RN1, RN]

OK so they don't teach us IV's in nursing school.

And the IV part of my orientation involved a booklet and a big rubber hose-type thing to practice on.

And I am on a floor where we rarely if ever put IV's in, meaning only a couple nurses know how to do them anyway.

And during mandatories last week, there wasn't anyone showing how to do IV's.

So today I have a pt who HAS to have an IV stat to start some mag.

So, because I have done all of ONE IV in my life, I go to the labor floor, where they put them in all the time.

I say "you guys are the pros. I need help. I've only done this once before"

What do they say?

"No."

I gulped back my tears (yeah I was a bit stressed at this point, pt was NOT doing well.). "But I've only ever done one"

"We were told that you (collective YOU meaning all the PP nurses) have to try first."

FIne, I said and went away. Meanwhile wondering how the HE** I am supposed to try without even knowing WHAT FREAKING SUPPLIES I need to start the damn thing, what size catheter, and how the heck to put that tape on the right way over the wingy-things.

So I go to one nurse on my floor who is usually quite willing to teach. And she said "Have faith in yourself and try"

Well, she must have seen the look on my face because she made up an excuse to come into the room and talked me thru it.

I don't mind poking people, I love drawing blood. But I didn't know what the heck to do after I got the catheter in. I haven't mastered the four-hands needed to hold it still and then get the little blue cap on and all that damn weird way of taping.

So then I find out ok, I have to hang a bolus dose of Mag Sulfate, which I have NEVER done and I am NOT going to risk doing it wrong. Luckily a labor nurse was manning the nursery and said she'd come help me. (I love her). (Labor nurses are the ones who usually start the mag when the pt comes to triage)

Anyway, she said, first get an extension tubing set on there.

And more near-tears "A WHAT?" I said.

She talked me thru it, showed me how to program the bolus and then how to switch it to continuous (did I mention we rarely if ever use pumps but for mag. pts?)

Oh man, I felt like crying for that whole time and even now. Its just so frustrating not knowing how to do something and having people tell you "Just do it". SUre fine whatever. I have no trouble trying. But I didn't KNOW how to Just do it!

there. I still feel frustrated but a little better.

[truern]

But you did it!! Congratulations!!

And you'll do it again..and again..and you'll get better each time. :)

[Franksters]

I'm sorry. I've been a nurse for 17 years. When I was coming up, once you were out of orientation you had to rely on co-workers. For example: I learned how to do CVVH when I came on shift. The nurse I followed spent 30 minutes explaining what to do. If you have ever had CVVH, it takes that long to explain how to calculate you hourly I/O.

If these nurses are long term vets, that is not an unusual response. I am not making excuses, just stating a fact. That is why I push my team toward looking out for the new guys. You come to the field with the most up to date information!! Evidence based practice, new nursing approaches, electronic documentation, etc. We NEED you guys!!! Hang in there, once you claim your spot, they will be your sisters. Again, not justifying just stating a fact.

[KellNY, RN]

Honey, if you can draw blood, you can do IVs! The only real difference is advancing the cath and securing it down (yes, i've simplified, but we're talking basics).

You can practice the taping down on anyone, just pop the needle into the plastic end so all you have is the cath (ie-no one will get stuck), and just tape it down to a coworkers arm-give it a tug to make sure the cath doesn't move. Develop a technique--that way you can see which method works best for you and you get comfortable with it (I find that pre-ripping diff sizes of tape and sticking them lightly to the rail or IV pole works well--less fumbling with sticky tape when you have gloves on). Practice hooking up the tubing, attaching Y tubing, stop cocks, getting out air bubbles, etc at the sink. Familiarize yourself with the equipment (what I mentioned in previous sentance, plus the extension tubing, saline lock tubes, pump tubing, etc).

Not to sound harsh, but that should all be done before you walk into a Pt's room. Not only will you feel more confident, but you wont be stumbling and bumbling in front of your pt-which will make them feel a lot safer.

And talk to your nursing educator! Tell him/her that you'd like more IV training-that it would benefit you as well as your Pts. If yours is worth anything, s/he'll appreciate your desire to learn and improve your skills.

good luck!

[LeesieBug]

During my orientation they let me spend a day with iv therapy. That Helped A LOT because I got to do IV starts for 6 hours straight, with someone directing and helping me the whole time...undivided attention. Also had someone help me juggle everything.

I agree that the hardest freaking part about IV starts is juggling all the stuff....the only way to get better at it is to do more. I agree that the best thing to do would be to ask if you can arrange time to get some more IV experience, if you are going to be expected to do IV starts without assistance.

I'm sorry for your co-workers lack of assistance...our unit is all about teamwork and it must be frustrating to have others refuse to help when you know you need it. Part of being a competent, safe, new nurse is knowing your limits and when you need help. You did the right thing by asking for it and persisting until you found someone who WOULD help.

Good job!

Oh, and did nurses on the labor floor understand that you just needed someone WITH you while you were doing it, guiding you along? It almost sounds as though they thought you wanted them to do it FOR you since they said you needed to try first. It is true that you should be attempting ANY IVs that need started...tell everyone you need IV practice...don't just wait for your own patients to need one. That will help, also.

[MIA-RN1, RN]

I'm sorry. I've been a nurse for 17 years. When I was coming up, once you were out of orientation you had to rely on co-workers. For example: I learned how to do CVVH when I came on shift. The nurse I followed spent 30 minutes explaining what to do. If you have ever had CVVH, it takes that long to explain how to calculate you hourly I/O.

If these nurses are long term vets, that is not an unusual response. I am not making excuses, just stating a fact. That is why I push my team toward looking out for the new guys. You come to the field with the most up to date information!! Evidence based practice, new nursing approaches, electronic documentation, etc. We NEED you guys!!! Hang in there, once you claim your spot, they will be your sisters. Again, not justifying just stating a fact.

Thanks and after a couple days to let it go I am feeling better. I also know who I can and who I can't ask for help at work. I really really wish that we'd been allowed to learn IV skills in school tho!

[MIA-RN1, RN]

Honey, if you can draw blood, you can do IVs! The only real difference is advancing the cath and securing it down (yes, i've simplified, but we're talking basics).

You can practice the taping down on anyone, just pop the needle into the plastic end so all you have is the cath (ie-no one will get stuck), and just tape it down to a coworkers arm-give it a tug to make sure the cath doesn't move. Develop a technique--that way you can see which method works best for you and you get comfortable with it (I find that pre-ripping diff sizes of tape and sticking them lightly to the rail or IV pole works well--less fumbling with sticky tape when you have gloves on). Practice hooking up the tubing, attaching Y tubing, stop cocks, getting out air bubbles, etc at the sink. Familiarize yourself with the equipment (what I mentioned in previous sentance, plus the extension tubing, saline lock tubes, pump tubing, etc).

Not to sound harsh, but that should all be done before you walk into a Pt's room. Not only will you feel more confident, but you wont be stumbling and bumbling in front of your pt-which will make them feel a lot safer.

And talk to your nursing educator! Tell him/her that you'd like more IV training-that it would benefit you as well as your Pts. If yours is worth anything, s/he'll appreciate your desire to learn and improve your skills.

good luck!

Thanks! I have talked and asked for help. I've asked to be allowed to spend a day in labor triage so that I can get lots of practice, asked to follow the SWAT team, asked to spend time in the same-day surgery unit...they just don't schedule it and I work 40h as it is; I can't imagine going in extra although I think its going to come to that.

I am great now at hanging fluids and running them. I guess its just the practice that I need as well as the knowledge. I am still not so sure I understood what she meant by priming the extension tubing. It seems to me that I would just hook the extension tubing to the primary tubing, priming it and then attaching it to the IV site. ?

[MIA-RN1, RN]

During my orientation they let me spend a day with iv therapy. That Helped A LOT because I got to do IV starts for 6 hours straight, with someone directing and helping me the whole time...undivided attention. Also had someone help me juggle everything.

I agree that the hardest freaking part about IV starts is juggling all the stuff....the only way to get better at it is to do more. I agree that the best thing to do would be to ask if you can arrange time to get some more IV experience, if you are going to be expected to do IV starts without assistance.

I'm sorry for your co-workers lack of assistance...our unit is all about teamwork and it must be frustrating to have others refuse to help when you know you need it. Part of being a competent, safe, new nurse is knowing your limits and when you need help. You did the right thing by asking for it and persisting until you found someone who WOULD help.

Good job!

Oh, and did nurses on the labor floor understand that you just needed someone WITH you while you were doing it, guiding you along? It almost sounds as though they thought you wanted them to do it FOR you since they said you needed to try first. It is true that you should be attempting ANY IVs that need started...tell everyone you need IV practice...don't just wait for your own patients to need one. That will help, also.

I have no idea what the nurses on LF thought. I thought I made myself clear that I just needed help doing it, but then I was so close to tears I couldn't clarify further since there were like 8 of them looking at me. Sitting around while on postpartum we were all with too many couplets and high acuity. (ok thats another vent thread lol).

I do need to attempt to start IV's but they are once in a blue moon...as I posted above, I've tried to get the practice.

It is one more little bump in the road sending me off to another floor sooner rather than later but we will see.

thanks for the post!

[NotReady4PrimeTime, RN]

I am still not so sure I understood what she meant by priming the extension tubing. It seems to me that I would just hook the extension tubing to the primary tubing, priming it and then attaching it to the IV site. ?

Are you using the straight 32 inch extensions or are you talking about what we call a T-piece? (A misnomer, since it isn't really a T, more like an L; it's got a Luer lock at each end, a slide clamp on the six inches of tubing then a port at the patient end just above where the Luer lock attaches to the catheter.) If you're talking about that, then you can preprime it with a 10 mL syringe of NS, leaving the syringe attached while you get your catheter in place. Stabilize the catheter, remove the stylet and attach the T-piece to the hub, then flush with your syringe and close the slide clamp. That acts like a saline lock, which will keep your vein open while you finish securing the catheter. Once you've got it all taped sown, open the slide clamp, give it anther little flush to make sure you didn't accidentally move it, then close the slide clamp again while you attach your main tubing. Presto! Another thing you can do with the tape is put a narrow strip about 2 1/2 inches long on the wings of the catheter before you poke instead of trying to slide it underneath after the fact... Once you've advanced the catheter you have the tape already in place and can just fold the ends over the wings for your initial stabilization. Next I put a piece about 2 inches long over the ends of the first strip of tape just below the insertion site but not touching it. On kids I put a second thin strip over the wings after that so that it's really sturdy. A transparent dressing goes over top of all that. Secure the tubing to the skin or the tape, whatever seems to work best. I like using T-pieces much better than attaching the IV tubing directly to the hub. I lose far fewer with than without!

[MIA-RN1, RN]

Are you using the straight 32 inch extensions or are you talking about what we call a T-piece? (A misnomer, since it isn't really a T, more like an L; it's got a Luer lock at each end, a slide clamp on the six inches of tubing then a port at the patient end just above where the Luer lock attaches to the catheter.) If you're talking about that, then you can preprime it with a 10 mL syringe of NS, leaving the syringe attached while you get your catheter in place. Stabilize the catheter, remove the stylet and attach the T-piece to the hub, then flush with your syringe and close the slide clamp. That acts like a saline lock, which will keep your vein open while you finish securing the catheter. Once you've got it all taped sown, open the slide clamp, give it anther little flush to make sure you didn't accidentally move it, then close the slide clamp again while you attach your main tubing. Presto! Another thing you can do with the tape is put a narrow strip about 2 1/2 inches long on the wings of the catheter before you poke instead of trying to slide it underneath after the fact... Once you've advanced the catheter you have the tape already in place and can just fold the ends over the wings for your initial stabilization. Next I put a piece about 2 inches long over the ends of the first strip of tape just below the insertion site but not touching it. On kids I put a second thin strip over the wings after that so that it's really sturdy. A transparent dressing goes over top of all that. Secure the tubing to the skin or the tape, whatever seems to work best. I like using T-pieces much better than attaching the IV tubing directly to the hub. I lose far fewer with than without!

oh wow thank you! Yes, I am talking bout a T piece. maybe I will practice at work tonight if I can find some time....and a willing 'victim' lol.

Thanks so much for this info; it makes sense! :)

[vamedic4, EMT-P]

CoopergrrlRN...

First off, I'm very sorry for your experience. I can't believe someone would have just flat out refused to help you...oh, wait, yes...I can. Had someone done that to me long ago when I needed help with my first IVs, I probably would have cried...most certainly cussed too.

Good for you for getting the job done, though!!! I'll find a link of things I've learned over the years and PM you with it!!

Good job.

vamedic4

It's cold here. I don't like cold.

[UnidentifiedNurse]

I know that feeling. I haven't had much experience with IV's either. Only had the chance to do 1 IV as a student...and as a RN, only had a chance one other time. The other times I had patients who needed IV starts or needed an IV site changed all had really difficult veins that I really did not feel comfortable even attempting on my own and other nurses are really busy on the floor as well to talk me through it. It is just so impossible to master every skill while on orientation. There are too many things to know and very limited amount of time. Once off orientation, it is harder to find people to help since everyone is busy with their own patients as well. I have never ever done a blood transfusion before other than platelets. Hopefully the day I have the opportunity to do well, there will be people on my floor available to help.