New to er and iv question..

Specialties Emergency

Published

I am new to the ER.. and I'm slowly evolving... I have an issue with starting IV's for some reason... I am fine to start one on a patient that has nice bulging or obvious veins.. but once I see someone whom I can only "feel" the vein.. I get nervous.. How do I overcome this? I feel like when I try.. maybe I don't go deep enough or what..? Any pointers on IV start?

Thanks,

Jamie

Up Vote Up Vote ×
Specializes in ICU, Telemetry.

For rolling veins, get a big paperclip, place it to the left side against the vein, and stick from the right -- not a 90 degree angle, just enough to make the vein bump against the paperclip. Keeps it from rolling. For the "invisible veins" I try a variety of things -- inflate a manual BP cuff to 100 and lock it off, wrap the site in a warm towel, or let the arm dangle over the side of the bed for a few minutes. And realize, there are going to be days when you can stick everything, and days when you can't stick anything. There will be people that no one can get, and you'll end up putting in a central line. Practice, practice, practice is the only thing that helps you get good at it.

And we've all got our thing. I've seen folks that are great at "sticks" but run gagging from the room when someone's got a goopy trach. I can do trachs and GI bleeds, but burns make me puke. We've all got what we're good at, and nobody is good at everything. Find your niche, and dig in.

Up Vote Up Vote ×
Specializes in Trauma/ED.

Just force yourself to try the hard starts as well as the easy ones. Some people who think they aren't very good find others to start harder IV's but how will they learn without trying? Also watch the "all-star" IV starter in your dept to see how they do it and talk to them about their techniques.

There are a lot of threads on here about IV start tips...try a search.

Up Vote Up Vote ×

thank you !!! =)

Up Vote Up Vote ×

Ask your co-workers for all their easy starts. The more mileage on easy starts, the more confidence, as well as familiarity with the tools.

Good basketball players shoot a lot of foul shots. Repetition makes you good.

Up Vote Up Vote ×
Specializes in Oncology, LTC.

Oh goodness, you sound like me! I would always panic when I needed to start an IV because I'm not good at them, but would just make me miss even more! Just relax, and if you don't get it, you don't get it. It can take years to get good at it. I work with nurses that have been in the field for over 20 years that are still horrible. I don't have any good 'sticking' advice, but I just wanted to say hang in there!

Up Vote Up Vote ×

I have started IV's for the last 23 years! The key is practice, practice and more practice! You will eventually be able to get blood from a stone.

Up Vote Up Vote ×
Specializes in Emergency.

I agree to go for all the easy ones first. They get you confident and used to how it should feel and how it should go. Als, this might sound horrible but try to get practice in on hard veins on people who aren't going to complain. The hard veins on a whiney pt who is puking or crying as you try to focus are a challenge for the most experienced nurse, oooh especially if they have an overbearing family standing over you and criticizing. Therefore, it may be good for you to practice on the dead, the near dead, the comatose, the sedated, the nonverbal, etc. I also recommend this for NG tubes. They are terribly difficult on someone who is awake and alert enough to cough, gag, grab, cry, etc. But you feel less pressure when you do it to someone who is intubated and sedated.

Up Vote Up Vote ×

Find a male co-worker with great veins and study his hands and forearms so that you have a solid understanding of where to feel for viable vessels. I think this has helped me more than anything. Once you understand the vessels in the upper extremities, you can move on to the more challenging sites; e.g., pinky fingers, dorsal surfaces of the foot.

I also use the phlebotomists' trick for tough starts: Fill a glove with very warm water and have the patient hold it on the site for a couple of minutes while you set up for the stick. It'll make the vein dilate and be easier to hit.

I started in the ER as a relative newbie earlier this year, and I really struggled with IVs at first. On some nights, I still do -- but the tough starts have gotten easier and easier, and now I'll occasionally go up to the floors to help nurses who haven't been able to get lines going. That's a great feeling.

One other piece of advice: Take every opportunity to start an IV, no matter how difficult the start may seem. You might surprise yourself. I'm at the point now where I'm more confident feeling for a good vein than seeing one.

Up Vote Up Vote ×
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Has anyone used the AccuVein? That thing is amazing!!! It's a vein illuminator. We're test-driving one in our ED right now. It's pretty neato.

Up Vote Up Vote ×
Specializes in ER, ED.
Has anyone used the AccuVein? That thing is amazing!!! It's a vein illuminator. We're test-driving one in our ED right now. It's pretty neato.

We just got on in our Pedi ED that I have used on both peds patients and hard adults sticks - it's amazing! I'm a new nurse (started in July) and in the ED - so I've only been starting IV's for a couple of months, but every time I've used the AccuVein I've gotten a line :).

Up Vote Up Vote ×
Specializes in ER, IICU, PCU, PACU, EMS.
Has anyone used the AccuVein? That thing is amazing!!! It's a vein illuminator. We're test-driving one in our ED right now. It's pretty neato.

I haven't heard of that. How does it work?

Up Vote Up Vote ×
+ Add a Comment