Losing confidence in new job b/c of IV insertion?

glenwood · Jun 24, 2006

It takes a lomg time and a lot of practice to get good. Calm down. Try to work with a nurse who is an expert. every floor has someone they call into start IVs no one else can start. find her and see if you can work with her. In a couple of months your sucess rate will go up to 50%.

LaNICUnurse · Jun 24, 2006

One reason for getting a flashback and still missing, is that you have to advance the needle just a little more to get the catheter into the vein. I hope this helps.

Look at an angiocath before you put it in, and you will see that the catheter does not go all the way to the end. So, you get the needle in far enough to get flash back, and then push the catheter against the outside of the vein, and bend it or blow the vein.

Good luck.

Jamesdotter · Jun 24, 2006

What worked for me (I was lousy at IV starts):

My institution had a video that we were to view when we started doing IVs (prior to that we had an IV team). I watched it several times. Then, before I went to the bedside to start an IV, I would collect the equipment and would mentally review all the steps that I needed to take, eg select the site, place the tourniquet, clean the area etc. clear down to taping the IV and removing the tourniquet. Going through these steps helped me in starting the IVs and it also helped me to not forget any equipment!

Daytonite, BSN, RN · Jun 24, 2006

it took me 6 months and that was after i took the 30 hour iv therapy class the lvns in california take to become iv certified since i was already an rn at the time. i have since worked on iv teams and been nationally certified in iv therapy with the intravenous nurses society. it takes a lot of practice. but if you are determined, you'll get it. there is a reason for everything you are doing that is going wrong. nothing that you screw up with an iv is ever unexplainable. the answer just isn't findable when you need it. i've spent my whole career, years, looking for the explanations to some of my questions. check out this thread in the er nurses forum. it's getting rather long, but there is a whole lot of good advice in there.

https://allnurses.com/forums/f18/iv-tips-tricks-3793.html - iv tips and tricks

TazziRN, RN · Jun 24, 2006

Be patient and calm, you WILL get it! Are you anchoring the vein before you poke? That can help with "rolling" veins to keep them in place. With your nondominant hand, place the tip of your index or long finger on the vein above where you intend to poke, and do the same with your thumb below the insertion site. Pull thumb and finger apart slightly to stretch the skin a bit and don't go until the needle is in the vein.

Something else to try with older people who have what looks like good veins but they blow almost right away: don't use a tourniquet.

Tweety, BSN, RN · Jun 24, 2006

It will come. I understand the feeling. I got the first IV I tried, and then missed about the next 100. It was demoralizing but eventually I got it, by being persistent. Try not to loose your confidence. That's half the battle.

Noryn · Jun 24, 2006

I agree with one of the above posters in that you have to advance the needle just a bit further. That was one of my early mistakes. It is almost 90 percent technique as you dont want to advance it too far or you will go through the other side of the vein.

IVs are crazy and can be demoralizing. I once worked in a coronary care unit and would go around to the other floors and surgical intensive care unit to start IVs for very experienced nurses who were unable to stick a patient. I then went to a new job at another facility and their equipment was just a bit different and guess what I had to get help for a month. Nothing like IVs to take you off of your high horse.

gonzo1, ASN, RN · Jun 24, 2006

My first week in the ER I was 0 for about 30. I couldn't get a single Iv. Boy was I humiliated. Watch everyone else, read all you can about technique and practice, practice, practice. After 18 months in the ER I am getting much better, but we all still have days when we can't hit the broad side of a barn. My favorite technique is bringing my needle in/down on the vein as if it were a plane coming in for a landing.

Last night at work a very experienced nurse was trying to get an IV for me on a diabetic patient. She missed x 3, then I tried, missed 3 or 4 and another nurse came and got it on her first try.

Two other things that work nice are to warm the arm up with a warm blanket and use a blood pressure cuff inflated to about 90 instead of a tournequet.

Also, never take a vacation because when you come back you are rusty and it takes a week to get good again.

tattooednurse · Jun 25, 2006

IVs are like anyother skill in nursing... just be patient and relax. I t will come to you and remember even the best will miss every once in awhile.

I was horrible at them before I came to the er also. But the more that you do the better that you will get.

My first preceptor in the ER made me start almost every IV for two straight shifts to get me comfortable.

JMBM · Jun 25, 2006

Yep, getting good at IVs is 95% experience, measured in years, not weeks. IV skills are also notoriously streaky. There will be a week when I can thread veins the size of a human hair and then a couple days when I couldn't hit a garden hose. There are a couple things that helped me. First, confidence. Don't think - just do it. If you go in thinking miss, you'll miss every time. One technique that helps me is to have a routine. I was trained by an Army nurse - the tape goes here, the 2x2 goes here, the setup is always the same. Having a routine allows me to chat with the patient, which distracts both of us, and a relaxed patient will always be easier to hit. Second, once you get a flash, stop and breath. Now, drop your angle (so you don't go through the vein) and advance the whole unit about an 1/8". Getting a flash just means the tip of the needle is in the vein, the catheter could still be outside. If you don't advance alittle before advancing the catheter, the catheter will just push the vein right off the needle and blow. Next, if the catheter doesn't want to advance, withdraw the needle, hook up your flush and gently inject some saline while softly advancing the catheter. More than half the time, this "floats" the catheter right in. Finally, if it doesn't work, its not your fault; its not the patient's fault, it just happens sometimes. Keep on trying.

Luvbuble · Jun 27, 2006

Yep, getting good at IVs is 95% experience, measured in years, not weeks. IV skills are also notoriously streaky. There will be a week when I can thread veins the size of a human hair and then a couple days when I couldn't hit a garden hose. There are a couple things that helped me. First, confidence. Don't think - just do it. If you go in thinking miss, you'll miss every time. One technique that helps me is to have a routine. I was trained by an Army nurse - the tape goes here, the 2x2 goes here, the setup is always the same. Having a routine allows me to chat with the patient, which distracts both of us, and a relaxed patient will always be easier to hit. Second, once you get a flash, stop and breath. Now, drop your angle (so you don't go through the vein) and advance the whole unit about an 1/8". Getting a flash just means the tip of the needle is in the vein, the catheter could still be outside. If you don't advance alittle before advancing the catheter, the catheter will just push the vein right off the needle and blow. Next, if the catheter doesn't want to advance, withdraw the needle, hook up your flush and gently inject some saline while softly advancing the catheter. More than half the time, this "floats" the catheter right in. Finally, if it doesn't work, its not your fault; its not the patient's fault, it just happens sometimes. Keep on trying.

Thanks for your encouragement. Yesterday, I did about 20 and missed 6 which is a pretty good record for me. I just don't understand why I missed more towards the end of the day. I got one really juicy vein and I couldn't even get a flash back. Is it b/c I didn't even hit the vein? I had the needle in and I was fishing for the vein but couldn't get it to cooperate. It made me so mad! How come sometimes I see people stick their needles to the side of the veins instead of the middle of the vein? Do they hit the side or am I blind and couldn't see the location of the real vein?

I pray to God that I will get 100% soon on my IV.