New ER nurse...is there any hope for me?!?!

MereSanity · Jul 3, 2013

They are Protectiv IVs ... Thank you all for the encouragement! I asked my preceptor to start an IV for me today because I was doing something else (he can get any stick)..2people and over 2 hours later with an ultrasound he finally got it....really made me feel better...lol.

Guests · Jul 3, 2013

Something very important out of the last few posts: Everybody has better days and worse days... sometimes you're on a roll... and there is an element of luck to the whole thing.

Also, if there's ANY chance of the patient moving at all, get someone to secure the arm, leg, hand, or foot for you. Nothing worse than getting a flash just as the patient jerks away and you lose it.

docomo · Jul 3, 2013

Here's a my time tested IV insertion technique that rarely lets me down. Make the TQ on the arm very snug and keep arm lower than heart for the veins to puff up. (forget all that slapping and thumping, irritated veins are more likely to blow) When searching for a vein try to make your choice within 15 seconds. Remember that your sense of touch is far superior to what you see, (just like the Jedi say, use the force). If there is any doubt about what you are about to stick, palpate the vein and then release the TQ to feel the vein deflate.

When you do poke, keep level of the needle as close to that of the vein as possible. (if you come in at more than 30 degrees, you'll almost certainly blow the vein by stabbing through the back side of it.) Once you see the flash go forward a tiny bit and gently push the catheter forward with one finger. if you meet resistance back up a tiny bit and move forward or tape it down where it is if its at least 3/4 inserted. (for elderly with thin skin, avoid using a TQ if you can easily find a vein without one) Finally, be sure you are pulling the loose skin on both sides of the vein towards yourself with your thumb, by pulling the skin and inserting at a very low angle, you'll never have an issue with rolling veins.

Sassy5d · Jul 4, 2013

I agree with above. Some days you are like Annie Oakley with iv's.. Then next day you can't get a single one. Most patients are patient, sometimes not.

It's frustrating when you finally get that hard stick and you ask them not to move and they do and boom.

Saflanut · Jul 6, 2013

I too have similar issues with IV insertion. Nothing more frustrating than getting 3 patients at once with tons of blood work orders and all the other tests that you have to do and you are still trying to start an Iv on the first patient. Yesterday, I had a dialysis patient, homeless IV drug user and really skinny older lady with veins that rolled. I had to ask MD to start IV on two of them because even very experienced ED tech could not get it. Everything was backed up, I was running around crazy trying to complete the orders. Got yelled at by MD and everything went downhill from there.

I finished my Fellowship program a month ago. So I am not experienced and still trying to get used to being in ED. I have good days and bad days, but IV skills are so crucial in ED in terms of completing MD orders in a timely matter.

I appreciate the tips on hard sticks. I have no problem getting the easy ones, but a lot of times we are faced with hard sticks in ED.

Anyhow, I would love to hear more tips from the experienced ED nurses.

Editorial Team / Moderator · Jul 7, 2013

Protectiv is my favorite brand of IV, much better than the autoguard and the introcan safety, in my opinion ... unfortunately our stock is very limited over here in Afghanistan! Seriously, the more you stick, the better you'll become. Don't turn down any opportunity to stick, even on those 550-lb patients ... you might surprise yourself and boost your confidence! Good luck.

Saflanut · Jul 7, 2013

LunahRN,

I salute you and women who are in the Army! Stay safe! I have two girls who are doing Army ROTC! Army strong!

MereSanity · Jul 16, 2013

Now that I am using them I really like them too...just had to figure them out. I would say I'm getting 90% of my sticks now....just those little old people that are killing me. Now to figure everything else out!

Guests · Jul 18, 2013

If you have the opportunity to learn to use an ultrasound for IV placement, jump at it. Not only can you find a whole mess of veins that you can't feel, it also helps develop a keen understanding of what's really happening as you try to access and cannulate the vein.

theatredork · Jul 18, 2013

I'm in the same situation as you if it makes you feel better! I recently switched from ICU to ER after 7 years, and I cannot tell you how many times I have left feeling like an idiot. It's confidence-shattering. Things are slowly getting better, and I'm not going home with a raging headache every night from mental exhaustion.

The key is to not be too hard on yourself, which is what my problem was initially. You're on orientation for a reason, and now is the time to look like an idiot. :)

LilgirlRN, ADN, RN · Jul 18, 2013

ER is different than any other place in the hospital. You have to know a little bit about everything. You also have to give up the feeling of control that you have in the OR. Accept that you aren't going to know everything. Forget that there are things that you've forgotten from nursing school and now you have to relearn them. The ER can be total chaos.