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

[moliuchick]

I have just got a new job that I have to put in 20 + IV a day.

I love doing it but I just cannot get the techique down. My chances of getting that IV in are about 10-15%. I suck, I know.

I had asked my supervisor to stand behind me to watch my technique and critique me and I had also observed many IVs insertion.

Sometimes, I see the biggest and juicest veins and I can still poke to the side of them and miss.

How long before I will be good at doing this? How long does it take you to be good at getting your IV in?

How come I got a flesh back and I advanced the catheter and the catheter would bent and coiled up? did I hit the wrong place?

I mostly would try the hands b/c AC was not a choice for our pt.

Can you give me some advice please?

[LaNICUnurse]

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.

You will never be 100%, no one is, and the ones that think they are will blow the next one. You probably got tired, and when you get mad, you never get it done right. Just listen to the ones that said rely on your routine, and relax. It takes lots of practice....and even then, it goes back to luck on some people, because of the status of their veins.

[Welshfyr]

Tip 1: Don't rush. Many nurses commented on how long I took to start and IV, but my success rate was 'almost' perfect (ok...I missed one person) Set your stuff up, warm the arm while doing your prep stuff, and 'feel' like you are going to be successful.

Tip 2: Don't be gentle or timid. When starting an IV, be sure that you will get the vein, and don't 'hunt' for it. Be assertive.

Tip 3: Take time to find a target vein. A few extra minutes just palpating will help with a successful insertion, cause less trauma to the patient, and help with confidence.

Tip 4: Ask everyone on your unit to do their IV's. Do as many as you can. Not only will the practice be good for you, but your coworkers will LOVE you for it.

Tip 5: If veins keep blowing, find the vein with a tournique, and mark that vein with a pen (beside the vein). Take the tournique off and insert. It's more difficult, but you will blow less veins. (Talk to the Pt... ask if they are doing Chemo or Rad. If so, then their veins are more fragile. Being prep'd for this will help you in the end.

Tip 6: TAP BABY TAP! Yes, I know it hurts the pt. Explain it to them. Tell them that you know it hurts to slap their arm, but it's helping you find a vein. ***On this one, I really suggest doing it to yourself first. Tap yourself on your inner wrist. Hurts eh? If you know what it feels like, you will understand more what the pt is going through. Remember, the less you hurt the pt, the better it is.

Tip 7: When inserting, be fluid, steady, and don't be tentative. Think one motion. It causes less trauma to the pt. and you will get more veins.

Tip 8: Warm is better. If able, ask the 'hard start' to go wash their hands/arms in hot water for 5 or 10 minutes. It helps. If they are not able, then wrap both arms in hot blankets. Basically cook the pt. for a while. Most pt.s actually like all the warm blankets anyways :)

Tip 9: Once you get blood return and the IV canula in, get that dang tournique off!

Tip 10: Don't rush at this point. I've seen more IV's go bad when people rush to attach everything.

Ok...those were all the tech tips.

Now the 'feeling' tips...

Common sense tells us that there are veins in there 'somewhere'...

Talk to the veins and tell them that they will go thru less trauma if they work with you.

Tell the Pt. the same thing.

Feel/Sense/Imagine/Hope where the vein is.

Don't second guess yourself.

Practice palpating your own veins or someone that doesn't mind your sudden sick facination with veins. Feel the difference in the spongy vein vs the area on either side of it.

I really hope some of this helps.

[Welshfyr]

Excellent advice!

[clee1]

IN starts are a skill that takes time to develop. Keep at it!

[nuangel1, BSN, RN]

i agree with the others .you have been given good advice .all i can add isgive it time ,nore practice ,the confidence will come and noone is 100 % .its a learned practice and has a learning curve like anything else.relax.