New to L/D

htrn · Oct 2, 2006

First off - Congratulations!!!:biggringi and welcome to L&D.

Can't help you with spec exams as I work in a small hospital and our MDs feel that nurses should not be doing those, AROMs, FECGs, IUPCs..... They should be doing them.

IV starts - 1. Learn how to use lidocaine, it makes the experience so much better for the patient - esp. the needle phobics out there. Most hospitals do have a policy that allows lidocaine for IV starts so you don't have to get a specific order for it, but do check on it.

2. Try and get a day down in surgery where they start IVs all day on many people. They are probably the ones that can teach you how to use the lidocaine as well.

3. When looking for a vein and not having much luck:

a. wrap the arm in warm blankets for several minutes

b. have patient laying a little flatter, helps to plump up the veins

c. have the patient dangle the arm off the edge of the bed

4. Develop your own 'ritual' for starting IVs. Get your equipment out and ready, rip off your tape and have it close, etc...

5. GO IN WITH CONFIDENCE - in other words, fake it till you make it. You WILL get the IV in on the first try.

Depending on what type of IVs you are using, there are some special techniques that work better with some IVs than others. We switched from Jelcos to Accuvances and all had to change our technique a little bit with the new IVs. With Jelcos you can feel the 'pop' when you get into the vein and have to go in at a little steeper angle than with the accuvances.

And, practice makes perfect. There are still times when even the most experienced nurse cannot get an IV in - it just seems to go that way. The more you do it, the easier it will get and the more confident you will feel. Until then, fake it till you make it.

Good luck

SmilingBluEyes · Oct 2, 2006

Hi and welcome to OB and our forum!

The simplest answer to your question lies in PRACTICE PRACTICE PRACTICE. These skills take time to master and perfect. Be patient with yourself and allow yourself plenty of time to practice and ask lots of questions.

Take care of yourself and take it slow. Rome was not built in a day, as they say. And neither are good, experienced OB Nurses!!!!!

mitchsmom · Oct 2, 2006

We don't do sterile spec exams... we just use nitrazine paper to determine ROM. I was told that we used to have a microscope to test for ferning but there was some kind of issue with JCAHO (have any of you had to remove yours?)

I've been at work for about 10 weeks and I'm just now starting (no pun intended) to get most of my IV's & to get more comfortable with it... I don't know if there are really many hints besides continuing to practice and go with your instincts - you probably know more about finding a good vein than you think (like for example once I thought there would be a valve but my partner said to pick that one... should have gone with my gut there).

Different people like to do it different ways but the original person who taught me said she likes to always get a stool and sit and when she's doing it in the hand she really anchors the vein well and slides her anchoring thumb down below the knuckle so it's not in the way of getting the needle in (I hope you can get a visual... kinda hard to describe in writing).

I make sure I gather every item that I may possibly need and put it all on the bed by me and I also put a quarter-folded chux under moms arm in case I make a mess. I initially wanted someone there with me to help me pick a vein or whatever but I figured out that I actually did better by myself (no one looking over my shoulder I guess). I also have to use 6 1/2 gloves because ill fitting gloves make it harder and distract me.

But before I get to that, I take my time looking and feeling around for the vein I want without gloves. If I remember I may ask them to position their hand downhill while I get the supplies. Sometimes I ask the pt if they've had IV's before and if they had any problems/ if it went fine; I usually find out if they are going to be easy or not or sometimes they know their better arm or whatever. If they act fearful I'll try to talk about something more distracting "do you know if you're having a boy or girl? Do you have other kids, what do they think about the new baby coming?" blah blah blah).

Of course, you can use a transilluminator or call the IV team if you have it - but we don't have either so we rely on each other. I wish we used the buffered lidocaine but we don't do that either. See if some of the good sticks / good teachers on your unit will let you watch them do some.

This link has some good ideas, as well as the second link they give at the bottom (the first one at the bottom is to an article you have to pay for but it is good if you can look it up- in the May 2005 Nursing magazine):

http://enw.org/IVStarts.htm

There are probably some good threads here at AllNurses too if you search!

I look forward to seeing ideas too :)

q12RN · Oct 4, 2006

Im getting ready to transfer to ob in a couple of weeks.. i have been on a med/surg/peds unit for almost 3 years. So I have lots of sticks under my belt. Its actually one of my favorite things to do. I dont like to stick the kids/babies but when theyre dehydrated thats a challenge. Now, I never went into the room and appeared nervous. I always made it a rule to go in as if I was the top notch IV person....even if it was my first:)

OUr hospital has a policy in place that you are required to offer the lidocaine at every stick. So I use it every time except when they refuse and it makes the patient more relaxed. Good luck to you, and remember experience counts alot in sticks, but even the most experienced person still has a hard one from time to time, I have even had to call in the anesthesiologist a few times to start one.:wink2:

bignursenancy · Oct 6, 2006

I've been a l/d nurse 25+ years. My advice on sterile spec exam is get a bedpan and flip it upside down. Lay the patient supine with HOB flat. Slide the bedpan upside down with larger part under her buttocks. Smaller end should be just under the perineal area. This allows the cervix to be brought up toward the front of the lady partsl vault. Get you a good flash light and get someone to hold it. Warm the speculum in your blanket warmer for a few minutes and your k-y jelly too. This makes it easier for the patient and less traumatizing. Good luck. Like the above post, practice is what makes you feel comfortable.

Ivs; I like to use jelcos if I have the choice. The pop makes you know you are in. I also like to put the fluids when I get blood return and 'float' it in, especially if it is a rolly vein. Just go very slow and the vein seems to open up. good luck and after 25 years there are days when I couldn't hit a 10' rope and then you call the newbie and bam they get it on the first try. So stay calm and you will learn tricks you will be telling us!

Nancy