New Nurse; To start a New IV or not?

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Just got off orientation on a busy med-surg unit. :) So I admit I have not had much experiance or practice with starting new IV's but have been succesful at it when I have done it in the past. My experience with starting IV's is this, 0 in nursing school, 2 hrs starting IV's with a RN for pts. about to have a colonoscopy maybe a total of 15 pt.s, 3 successful IV starts with my preceptor, 2 succesful IV starts and 1 fail on my own after orientatation. Also it does take me quite a bit of time to gather equipment, apply warm blankets to the pt.s arms, set up, etc.

I had a crazy busy shift on 11p-7a and a pt. said to me while I was in their room hanging antibiotics that there IV site was hurting, and they were tired of having to keep it straight so as not to cause the IV pump to start beeping. I assesed the site for infiltration, redness, heat etc and flushed it and there was no pain while flushing with normal saline. So I felt the site was fine it was just irratating the pt. because of it being in his antecubital fossa or AC. I would have changed it if I had had time or asked another nurse to help, but I had neither. Also the pt. didn't mention it again and so I thought it wasn't a problem, and I was so busy I was grateful not to have to find time to start a new IV.

Then just before I left the floor to go home my charge came running up to me and said that he had been rounding on all my pt.s. He let me know I should have started a new IV and did it in such a way that it left me feeling like an incompetent jerk for not doing it. :o I later looked up the policy and didn't find anything that specifically stated I had too start a new IV. But still now I feel horrible, that I was uncaring to the pt. by not starting a new one, and maybe that I am a little incompetant.:sorry:

What are your thoughts? Anyone in similar situations? My question is to everyone and all the experienced nurses out there what would you do? Also given the situation, was what I did really wrong?

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Specializes in Psychiatric and emergency nursing.

I don't think you did anything wrong pee se. If I had checked the IV site and didn't see any hints of infiltration (coldness, swelling, etc), I probably would have left it alone too. IVs are inherently uncomfortable...you have a foreign body sticking out of your arm for pete's sake. That being said, you may want to find better areas for IV starts in the future. I usually try to put it in the forearm somewhere for extended stays, but I have been known to employ ACs, hands, shoulders, forearms, and EJs when the need arises. I might also say how your CN approached you was unprofessional. Always praise in public, chastise in private, and then so, do it with a cool head.

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Chg. prob just afraid they'd have to restart it! Does facility have cont. ed lab where you could practice? Watch as many other starts as you can, ask ques. You may not get everybody on the 1st stick. Some are harder than others. Anything in AC gets too much motion, gets sore. Same w/ bk of hand. Just keep trying!

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Specializes in NICU.

Stay away from joints to prevent the pump from alarming, AC and wrist. The best place is top of hand or forearm.

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While I don't think your charge nurse was very professional, you also have to look at what you did. The patient was uncomfortable - maybe an IV in an AC to you is just mere inconvenience, but for somebody else, it could be much more. It's like people who take too long to do a manual BP and start to hurt your arm. They're standing there thinking it's "just" a BP cuff meanwhile you're sitting there in pain cause your arm's getting no circulation. And from what you wrote, it really appears that you were hoping the patient's silence = comfortable, even though they told you they were uncomfortable. I really think you should reflect back on your actions instead of focusing on your charge nurse's behavior, which appears to be what's really grinding you.

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I agree the AC is not a great IV area. I did not start this IV the pt. had it in already upon my arrival.

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Specializes in PACU, pre/postoperative, ortho.

In those situations when a pt c/o an IV site which is irritating but healthy, I ask the pt what they want. Do they want a new one? When it is explained that the site is ok, just in an uncomfortable spot, most pts I've encountered would rather not be stuck again once they know there is nothing really wrong with the existing site (especially if they know they are difficult stick). If they want a new one, then they get one; if I'm swamped, I may tell them I have a few things to catch up first or I will check to see if someone else is free to start it.

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Specializes in Trauma Surgical ICU.

OP, the fact that you posted so much back information on your IV skills or lack there of makes me think you avoided changing it. It's a skill that takes practice. If a pt complains of pain with a IV it is best to just change it. You blew the pts complains off. She or he probably didn't say anything again because you brushed them off the first time. I know it's hard when you have a ton of other things to do but you just make time and do it. Same thing applies to dressing changes or cleaning pts. It never happens when you have extra time lol.

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Sun0408,

"OP, the fact that you posted so much back information on your IV skills or lack there of makes me think you avoided changing it."

When I think back to it, I agree I may have been avoiding it. In my thoughts I resist this idea but it has merit.

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Chorr,

I didn't think of that. I think I will approach my hospitals RN educator and see if I can get in some more practice, maybe another couple hours in Endo would help build my experience and confidence.

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Specializes in Trauma Surgical ICU.
Sun0408,

"OP, the fact that you posted so much back information on your IV skills or lack there of makes me think you avoided changing it."

When I think back to it, I agree I may have been avoiding it. In my thoughts I resist this idea but it has merit.

It happens, move forward and get lots of practice [emoji6]. I've seen new grads do the same, not because they didn't want to do it but they lacked confidence and skill. I've done the same thing. My coworkers knew it and wouldn't help unless I stuck the pt first. Now, I'm the one the floors call for IVs.

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Also ask your manager of they can send you to the ED or same day surgery for a shift to only start IVs- those departments get a LOT of IVs and you could get a chance to start 15+ of them and get some confidence - that helped me a TON - and the nurses there were able to give me great little tips to get faster at it too - good luck!!

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