Links/Guidance of Great Nurses here willing to teach new grads a few of their tricks?

mwboswell · Jun 1, 2008

To help build your confidence, make sure you are usually the FIRST one to try a pt. Don't let your co-workers come to you and say "three people have already stuck this pt, you wanna try?" - it will be SLIM pickings!!!

There is also a device made by I forget, that uses a RED LED light to light up hard to see veins - I'm sure you could google it.

Anyways, DON"T give up!!!!

Congrats on your new job and new role!!1

northshore08 · Jun 1, 2008

The LED is called a transilluminator. My ED here has one, but I've never used one.

The only suggestion I can give you is to keep practicing. It's difficult for us to give tips since we don't know what your problem areas are. It was a big transition for me when I started putting lines in based on what I felt with my finger instead of what I saw with my eyes. Now I find the bouncy place, visually mark the spot with my eye (like a freckle or something) or mark it with my fingernail (through the glove) if I am worried about it.

I would suggest you find an IV therapy team in your hospital or hospital system and work with them for a week. If there is not one in your facility, the surgical team sometimes can be a good resource. And it is always great to get to know other nurses in other areas of the hospital.

Good luck!! We are rooting for you and you will get there!

mwboswell · Jun 1, 2008

One technique that I have used all my career is to think of an IV stick as two sticks...the first one is to puncture the skin, then pause for just a sec, then the second move is to get into the vein; I've always done it that way - been pretty good so far if I do say so myself!

Also, (assume you have the IV cath in your R hand), with my other hand (the L one) I stretch the skin (not the vein) taut with the thumb and index finger of my L hand. My index finger is on the vein (tamponading it) and my thumb is just a little to the side of the vein - not on top of it. This helps quite a bit too.

Good luck!

suzanne4, RN · Jun 1, 2008

Best suggestion would be to get a day shift in the Pre-Op holding area where the patients are usually coming in to the hospital in fairly good shape. These nurses in that unit are also inserting IVs all day long so that is the best place to get really good expereince.

In the ER, many of the patients are dehydrated and in pain, so not always the best place to use as a learning experience. This would me my first suggestion to you and without seeing your technique, it would be hard for any of us to give you any feedback.

But be aware that this is a skill that needs repetition over and over again.

Best of luck to you, I am sure that you will be just fine with it.

rjrule · Jun 5, 2008

Hi, I always get the patients hand hanging over the bed whilst I prepare my IV stuff, this often brings the veins up nicely. If not remember patience is a virtue!!! Also if no veins are felt on the distal areas of the arm just go for the cubital and be done with it!!! Also say in your head (not out loud) "go in ya bugger!!!" this works great for me!!!

vampireslayer · Jun 11, 2008

I remember going through this! EXACTLY THIS. Thinking "this is not brain surgery, why can't I get these?" I hate to admit, but just getting practice is the big key, but for some pointers, first off, make sure you're holding down the skin below the stick point so the vein doesn't roll away from you, and make sure that stick is fast, it can roll away so quick, you need to be quicker!

Also, check out the vein you're going for while it's still wet from the alcohol or chloroprep. What I do when I can't find one is rub several common sites, (the AC, the hand, the thumb side of the wrist, you'll usually find a big one there) with alcohol first, just to see what it looks like wet (with a tournaquet in place). Then use the cholorprep or whatever is your protocol prep, and let that dry. Veins show up much better when they're wet so that's a good way to find them.

And finally, I think what my biggest mistake before I finally got good at them, was I didn't know where the vein was going. I was "aiming" at the bulge I could see or feel, but you really need to see or feel the course of the vein, figure out which direction it's heading or you'll go right through it at a right angle to the vein! I know that sounds stupid, but I really think that I just assumed I knew, from the small section of bulging vein I could see, that I knew which direction it was heading. Feel it, look close, if you aren't sure, start lower so that the last 1/2 of your catheter ends up in the section of vein that you can see, in case it bifurcates right at the point you're entering. Not sure if that's clear, but I remember MANY times getting in and getting flash, and I couldn't advance the catheter...my preceptor would take over, redirect the catheter a good 45 degrees one way or another and it'd slide right in!

And one last thing, don't give up if you get flash then get stuck...either it won't advance or it won't give blood...maybe you did go right through, you can salvage that without a 2nd stick. Pull the catheter out SLOWLY until it starts to bleed for you...draw the labs you need, if you need them, then flush it in with a saline flush and it often will just slide right in. Either you'd hit a valve, so it wouldn't advance, OR you'd gone through the other side, but pulling out you'd ended up in the vein and the 2nd puncture (if you went straight through) will seal itself quickly.

Good luck! I really honestly remember feeling so helpless, when I couldn't get my IVs. Can't get anything going, no meds, no labs, until you get an IV, and it took me so long to master this! But you will do it!

VS

stumillardkm · Jun 26, 2008

Hi Christy - I will be starting in the ER as a new grad in about a month, but I spent my last semester of nursing school in the ER and it took me a bit to get good at IV's too.

Like you, I did really well for a little while, then I swear it was the alignment of the planets because I COULD NOT GET ONE - even on men with these gorgeous veins!!

I finally figured out I was doing wrong. When I first poked in and got flash, I kept advancing the needle AND the catheter - not JUST the catheter - For some reason I thought I had to keep pushing the needle in a bit more - WRONG - So I ended up always blowing through the other side of the vein and of course, the cath wouldn't advance - even though I initially had a flash.

So, what I would suggest if you are still having problems, as soon as you get a flash, hold the needle still and just slowly slide the cath on in.... if you do get some resistance, make sure the vein isn't turning, if it is, sort of angle the needle and cath - you can probably make the turn. :)

And like other posts - Practice makes perfect. I practiced a few times on other nurses and techs - that was great because I wasn't worried about hurting someone who was already in pain! LOL!

Good luck - Wow, Trauma Level 1 - brave person! I'll be starting at Level 4, and did my last semester at Level 3 - will be lots of fun and loads of learning!

Good luck!