Need advice on dealing with missed IV's and what to say to the patient...

Jules A, MSN · Sep 21, 2008

I don't have years of experience but I have always done what your supervisor is doing when it comes to procedures. My first subq shot I told the patient "I'm really good at these, you will hardly feel it". It put her at ease and also made me feel like I had better deliver on what I promised. When I was working with a student recently who was giving her first IM shot I told the patient, "no worries she is great at these". It put the patient at ease and the student later told me that it helped her feel confident. There are definitely times when veins are hard to get for a variety of reasons so I personally would try to keep my patients confidence level in you up.

lunden · Sep 21, 2008

take a deep breath and go in when you know you have a vein. you may get it and you may not, count the good days and don't worry about the bad, good luck

Lurksalot, BSN, RN · Sep 23, 2008

IV placement really is a skill that gets better through practice, lots and lots of practice. Don't be too hard on yourself, you will get the hang of it. If I miss a stick on a patient I usually look them in the eye and say "I'm so sorry, this one is not going to work. Let me grab another set of eyes so we can get that line placed." I don't make excuses. Sometimes the patient will say, "Oh, no one can ever get me, my veins roll/blow/are crap" and I will smile, pat their hand, and say "Well, you certainly have been through it enough, let's get another set of eyes to help us out."

Perhaps you could ask to go to the ER and place lines for a shift or two, and get a massive amount of practice to help your confidence. I feel for you. Starting IVs as a new nurse was my biggest fear. I had to do three preceptor-observed successful sticks to be allowed to do it independently, and I placed all three of mine on the first shot. Of course, then I went onto miss about the next 10 or 12 (but who's counting??!!) and had to ask for help over...and over again. :rolleyes:

Good luck. I think more practice will give you more confidence, and soon you'll be the one others go to for help.

lola80 · Sep 23, 2008

I am a new LPN, and have been working for almost 2 months. I have to start IV's on our first patient of the morning, and the first patient after lunch. I have never taken a class, never received any formal training or had any type of experience with venipuncture. When I first started the job, my "training" was to start an IV on the nurse who was training me. I got her on the first stick, the first time. It helped that she had veins like earthworms! After that I was turned loose. My patients are coming in for colonoscopy's, and are dehydrated, so that doesn't make it much easier. I generally miss most of the time, and have to hang my head and go get my supervisor. The problem I am having is this...what do I say to the patient when I miss? I'll say things like "It must not be our lucky day" or "Let me go get the experts so I don't make you look like a pincushion"....i try to stay humorous all the while faking confidence. My supervisor comes in to do the IV and says things like "Oh, she's a great nurse and she's been doing this a long time (I haven't) or "She's not new at this, she's been at this a long time (I haven't)". It makes me wonder just what should I say when I miss? She makes me feel like I am telling the patient that i suck and am no good at it...I would rather a patient think I missed because I am still a little inexperienced than to think I have been at this a while and just suck at it....Any advice on how to effectively handle this type of situation? What do the seasoned nurses say when they miss (cause I know y'all do sometimes )

i think honesty is the best way to go. patients will appreciate your honesty and your warmth more than a lie. your supervisor maybe says this in order to not embarrass you and to make the pt feel a bit more at ease. so, i think that both work, but dishonesty never does. what you do is good, it lets the pt feel a bit more comfortable with you because you're being honest, and they feel okay that you went and got help, and they feel reassured that someone CAN get a line in. honesty is best, in my opinion.

truern · Sep 23, 2008

i think honesty is the best way to go. patients will appreciate your honesty and your warmth more than a lie. your supervisor maybe says this in order to not embarrass you and to make the pt feel a bit more at ease. so, i think that both work, but dishonesty never does. what you do is good, it lets the pt feel a bit more comfortable with you because you're being honest, and they feel okay that you went and got help, and they feel reassured that someone CAN get a line in. honesty is best, in my opinion.

When doing something I've never done before I say "I can't count the times I've done this."

Not being dishonest *exactly*.

iluvivt, BSN, RN · Sep 24, 2008

First of all your so-called training was inadequate. I hope you have an IV team. Either way you need to request more training. You need to spend one or two shifts with an IV nurse or in ED with a nurse that has excellent venipuncture skills and your facility should pay for that. Next look for a community or hospital based IV class. Once you fix this problem your success will increase and you will not need to worry about what you say b/c you will feel and be confidant and be getting the IVs with much more ease. I Simply tell the patient the truth in simple terms. That one did not work and I will need to find another vein. If they are stressed about it I add I will try and make this as easy as possible for you. More.importantly if you take a class you will learn lots of tricks of the trade and as you are doing these things to increase your odds at success your patients often recognize the efforts you are taking. On difficult patients I often spend 15 min or so just looking,applying hot packs,double tourniquets..ect...but then I poke once and get it.

Medic2RN, BSN, RN, EMT-P · Sep 25, 2008

Good advice as previously stated, request more training and practice, the ER is a great place to practice.

What I say to the patient after being unsuccessful...."I'm sorry!"

lpnflorida · Sep 27, 2008

Number one, unless you have taken an IV certification class you should not be starting IV's at all. It is your license. Ask your co-workers or contact a school near you to find out when you can sign up for 30 hour IV certification class, there is also an 80 hour class in some areas. also make sure you take a phlebotomy class, our hospital had them on campus.

It will once you have had the classess, get easier with practice.

MB37 · Sep 28, 2008

This is something I'm nervous about! I'll be an RN next week if I pass my NCLEX, and we learned IVs in school, but I got almost no chance to practice them in clinical. We couldn't start them until a third of the way through our second to last semester, and I happened to spend the vast majority of my remaining clinical time in areas where most people had central lines. I got 2 ER days, but one was in Pedi and the other in "intermediate care" (read: headache, cough, couldn't get appt w/PCP and needed more pain meds, etc.) - we were assigned by the ER coordinator and not allowed to request where we wanted to be. I've started exactly one successfully, failed on my 3-4 other attempts. We were forbidden to take any supplies home or to practice on each other, on penalty of expulsion. I'm going into a pretty intense critical care internship - where I imagine again that most pts will have central lines. I was up front during my preceptorship last semester about my dire need to practice IVs and a few other skills, and my preceptor and other nurses on the unit were great about looking for opportunities for me - there just weren't that many, unfortunately. I don't start for another week, I'm really hoping there'll be a way for me to spend a day or two with an IV team or in part of the ER where pts need IVs started - I'm so eager to learn, and I really need to build my confidence in this area. Thanks for the tips already posted, and in advance for those to come!