My IV Skills are Terrible!!!

Nurses General Nursing

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So I’ve been a nurse for 5 years. And my IV insertion skills are horrific. I was an inpatient nurse for 3.5 years, but I always wheeled and dealed with other nurses to insert my IVs. And now I’m been in an outpatient setting for almost a year.

Now ive been moved to a position (still outpatient) where I need to insert IVs every day. At first I wasn’t getting a couple, Now I’ve just been missing. It makes me feel like I’m not gonna make it in this position. Should I take a course? Not really sure what I can do. My confidence is tanking. Any ideas on how to better my skills and calm my nerves?! Any ideas ( other than keep trying lol) would be appreciated? Thanks!

Two other very common mistakes involve the stylet - advancing it too far before trying to slide the catheter off, or not advancing it far enough (and at a flattened angle). When people are struggling I try to demonstrate (through my crappy drawings or something) how you will get a blood return as soon as the tip of the needle enters the vein - but you will need to go that millimeter or two further in order to advance the actual catheter into the vein. Typically I advise doing this at a flattened angle to avoid poking through the other side of the vein.

If you're not in just the right spot (with the tip of the needle and the catheter, both) in the lumen of the vein, you will not be able to slide the catheter off properly.

I'm sure there are probably YTs that demonstrate these errors.

I do encourage just asking some kind soul to watch you. When working with people who need to learn, I'm pretty good at picking out patients who are game for allowing the process of instruction and this helps too. There comes a point where anxiety itself gets in the way, so its nice to have a patient who says, "go for it, everybody has to learn." Then you are free to relax a little, just be upfront about the fact that you're learning this aspect of care, and have that second nurse coach you in real time.

Good luck! You'll get it quicker than you think ~

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I seriously thought I was the only one that felt this way! I could not believe when I had a patient with no IV that had pulm embolism and I got the IV on the first try.

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It is actually good that you need to insert them every day, because now it is only a matter of time till you become a pro.

What I found helpful for myself:

1) do not look for a veing, but feel for it; it needs to be nice and "plumpy" or collapsible. Once you feel it, move around and try to trace which direction it goes. Don't trust your eyes! It could be misleading if you don't feel it. I don't ever poke if I don't feel it.

2) If the patient is a hardstick, or if someone is asking you to start an IV, because they couldn't - bring a hot pack with you and place it on the AC or wherever you are aiming at (antecubitals are usually the easiest and fastest). While you are priming tubing and unwrapping the packing, the warm pack will do its job.

3) If the patient is, let's say, somebody with fragile skin, bruising from coumadin, or you have a feeling it may burst - don't use a tourniquet.

4) If the veins are too tiny - try ripping off the glove on your index finger (left finger if you are right-handed) and after using alcohol swab on the finger, feel for the vein again.

5) if you don't need a large gauge - go ahead and use a 22 of even a 24.

6) never be in a rush, it only makes things worse

7) don't feel bad if you haven't found a vein on one side and had to switch sides a couple times.

8 ) Distract the patient, don't be nervous and never feel bad if you didn't get it, because you really tried.

Maybe you could also talk to someone on your unit who is really good at it and ask for their advice, or maybe they could show/guide you?

I was super scared to try an IV in the very beginning, but now I really like to start one and always up for the challenge.

Good luck!

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Specializes in Geriatrics, Dialysis.

IV's are nursing kryptonite for me. Would you believe I've been a nurse for 25 years and have never started one? Yep, not a one. In school we had one practice session using a fake rubber arm filled with beet juice. In clinical's students weren't allowed to start IV's, heck the floor nurses didn't even start them as every hospital we did a clinical rotation at used a dedicated IV team. In my working career I've exclusively worked in a SNF where peripheral IV's aren't terribly common, the few times we get one ordered thank goodness I've always been working with somebody else that is good at it. Hopefully that continues to be the case. I'm pretty good with blood draws so I'd try it if I had to but boy would I feel bad for the poor guinea pig of a resident that got stuck with me.

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On 3/4/2019 at 4:06 PM, Jory said:

Oh, nobody was worse at these than me. It was a running joke. I used to say, "Can you go your whole career and never learn to start one?"

Even today, I can stick by sight, I can't do by feel. But this is what helped me.

I wasn't retracting the needle soon enough. Push it in just a tiny bit when you get a good flash, push the button to retract the needle. Hold steady and push it the rest of the way through. Have your flush ready OR use your finger at the cannula base to momentarily stop the bleeding until you can connect it.

Tip: I see too many nurses lose the IV because they allow the cannula to manipulate too much after placement--that is how you lose it. Always have at least one piece of tape ready, secure the end first, then put on your tegaderm, flush again and then continue

How do you factor in the degrees of the angle of the needle?

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Just keep trying just trade out after 2 attempts . But only trial and error is the best teacher . Don’t get discouraged

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Specializes in ICU, ER, Home Health, Corrections, School Nurse.
On ‎3‎/‎5‎/‎2019 at 7:01 AM, OldDude said:

No one has yet to mention mojo, cosmic upheaval, supernatural interference, disturbances in the "force," and other negative effects of the universe. You'll get there...just keep on keeping on!!

I would go through periods where I could start an IV on a 1 month old with my eyes closed and wearing boxing gloves...and then I'd go through periods where I couldn't get a vein if it was like a water hose laying on a concrete driveway!

Hang in there!!

Just picturing the boxing gloves ?

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Specializes in ICU, ER, Home Health, Corrections, School Nurse.

One thing I don't usually see addressed is the position of the arm. Let gravity work for you...keep the arm as low as you can so that it fills with blood, if the arm is elevated (up on a pillow, etc) the blood drains out, and veins disappear. I also will try to cushion the tourniquet by placing it over clothing, so that I can make it that much tighter. Then I tell the patients ahead of time that I always spend a long time looking so I can find the perfect vein...that puts them at ease if you end up taking forever because you're scared.

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Specializes in NICU/Neonatal transport.

I'm a little different, since I'm solely a visual IV placer (yay for babies being see through :D ) but I am a "floater" for IVs typically. Once I get the tip of the catheter in, I don't try and advance it until after the flush is hooked on and flushing properly in the vein, then push the catheter the rest of the way in while you flush. Helps especially if there are valves.

If the patient tells you they have a good spot or a bad spot, listen to them. I have terrible ACs. I have great hand and forearm veins though.

Definitely agree with anchoring the skin. With babies, I use a finger as a tourniquet if needed, because I usually have more blows with tourniquets.

Depending on the patient, if you need to place in the hand, a transilluminator may still help for some big people

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Okay...I will give two big hints. WARM UP THE EXTREMITIES...it does take more time...finding and getting a warm blanket....CAREFULLY warming a washcloth with warm water placing it over the hand or potential vein...and dangle the extremity down. But this extra time you take saves 3 - 6 IV pokes later on.

Look at your own hands...put them in cold water, hold them up, you won't see much...put them in warm water, dangle them down..even put a mild tourniquet around a arm you will see veins pop up. Or do it to your friends or loved ones.

And when you get in with just a little flash of blood (an IV addict taught me this) if the blood just makes a little peak in the chamber...just a little blood flows in but kind of stops....gently tap tap tap on the skin above where the tip of the needle/catheter is, you may have to approximate where it is...just a gentle tap tap tap on the patients skin. may encourage the needle to completely enter the vein, a slightly stronger blood flow may appear...gently thread the catheter over the needle.

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Specializes in Urgent Care, Oncology.
18 hours ago, TigraRN said:

4) If the veins are too tiny - try ripping off the glove on your index finger (left finger if you are right-handed) and after using alcohol swab on the finger, feel for the vein again.

Please do not do this. A nurse at my facility did this when the Joint Commission came through. It did not go well.

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Specializes in Urgent Care, Oncology.

Hi!

This was me two years ago and now I'm a pro. You could probably actually find my thread from two years ago as it had plenty of good tips. I still miss but everybody does. I'm not the best on my unit but those who are have been nurses 32 and 20 years and IVs just come naturally to them. We keep track of our attempts and mine is great so I'm happy with that!

It would help to know what brand and style IV you use. I'm "fluent" on four devices and don't like them all equally, so knowing what you're working with would help.

I'm also a big fan of "virgin veins" on the back of the forearm.

Heat packs and warm blankets definitely help.

Double tourniquet can be done but I don't do this on fragile skin or with those on blood thinners.

I don't tap veins but rub them in the direction in which way they are going. I find it leads to less hemolysis (I don't know if this is true or not so please don't put that in stone). Patients don't like being smacked, either. I assess to feel two finger widths to ensure I had enough room for a catheter and to see which direction the vein is going and if there are any valves. Valves are not always palpable but its good to know where they are.

As someone already suggested, you can try to float it in. I'll take the tourniquet off and attach my flush and attempt to float it in by anchoring a bit tighter with my thumb.

For hand IVs, I have them grip the edge of the chair or their side table. It helps to anchor the vein and I find it is comfortable for the patient.

For a difficult stick, it is ok to have someone come in and do a two person IV start. For example, today I had a patient who has essential tremors. So I focused on starting the IV while the other nurse kept the patient comfortable and keep the arm stable.

Definitely have someone watch and critique you. Practice, practice, and practice some more. Good policy is not to stick more than twice per nurse unless in an emergent situation and/or with patient permission so it doesn't hurt to get fresh eyes.

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