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?

Specializes in Emergency Department.
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.

I tend to agree. If your patient complains of pain at an IV site, you should at least investigate starting a new line. I did that in the ER just a couple days ago. My patient was complaining of pain at the original site started in the ER just a couple hours prior. I looked, found a new site, started a new line and it flowed very well. Here's the key thing: I told the patient that I would look for a new site, and give it ONE go at it before I pulled the one that didn't feel so good.

Never ever pull a working line before you have established a new patent line. The day you do (because you think it'll be OK) the patient will suddenly code in front of you and you won't have an easy time re-establishing vascular access.

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Specializes in ER.
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!!

This is the same thing I always suggest. We did this with one of our new grads in our ED. She just started IVs for a full 12 hour shift & she go it in about 45 sticks or so.

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Specializes in Physical Medicine & Rehabilitation.

Yup yup, I agree with those that say you should have investigated the IV and/or should have gotten a 2nd opinion which is what I always do. Pain at an IV site is an indication of infiltration and/or phlebitis and should warrant DCing/new IV start. Just because it flushes with or without swelling/coldness, it doesn't mean the IV is patent.

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Specializes in Cath/EP lab, CCU, Cardiac stepdown.

Since I cannot be certain about how the charge addressed it, I will say that you should have probably started a new one. If the patient has something running like amiodarone or an antibiotic like vancomycin in a peripheral, and they're complaint about it hurting I would be very very worried and I would try to start a new line and run the vanco slower.

As a new nurse I can see that your first thought is oh it's flushing and running fine but you gotta think beyond that. Especially when a drug has a high potential of causing extravasation, if it's bothering them better to try to get a new iv in.

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Specializes in School Nursing, Telemetry.
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.

This is what I usually do. Then, I continue to closely assess the IV site to make sure nothing is going wrong. Chances are, though, if an IV is starting to really bother a patient, it is going to go bad (in my anecdotal experience) and I often regret not just popping a new one in. It is lame to have the IV go bad at change of shift! You'll get the stink eye for sure!

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I would say 75% of the IVs we get in OR holding from inpatients are not patent. I've seen infiltration, catheters hanging out, you name it. We pretty much expect them not to work which is not good because that means these inpatients are up on floors with non-working IVs! Anesthesia doesn't like AC at all so we use hand, wrist (if no art line being placed), and lower forearm. Unless they are renal on dialysis we need at least a 20 and an 18 if there is even a possibility they might be getting blood. Now all that being said... I would just learn from this and next time start a new one. Like others said, I would explain to the patient that you can take this one out but will need to start a new one first and that would require at least one more stick.

In the long run, just starting a new one will be easier and take less time than stressing over the state of an old one. Sometimes we get someone who has a working site but they are complaining of pain so we just start a new one. Plus the more you start, you will get more confident and quicker in your sticks. If you aren't 100% sure, grab someone experienced and just double check the vein that you plan to use. When I was first started, vein selection had a lot to do with how successful I was.

I wouldn't beat yourself up too much over it but definitely learn from it. Think about it from the perspective of the patient and the other nurses that have to take care of that patient in other departments and on your floor in other shifts.

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I was taught that any time the patient complains of pain, a new site must be obtained.

What was the charge nurses's rationale for a new site?

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Specializes in ICU.

I remember clearly sticking a patient having refractory seizures so I could sedate with diprivan and intubate. The patient was an on duty surgeon I enjoyed working with on a daily basis. I never provided direct care for him again. Two years later I saw the scar on his arm from where he said he declined to have an IV removed that appeared irritated to the nurse. I still get upset when I think of the extra pain I may have added while trying to help him.

I don't know what the right answer is to your question but I know you will remember this one instance and it will effect your practice just as my experience effected my practice.

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Specializes in Emergency/Trauma/LDRP/Ortho ASC.

Stick anyone and everyone you can. ED is the best place IMO because you will have the opportunity to stick frat boys with ropes for veins, 99 year old Nanas on Coumadin, babies, and everyone in between. Doing is the only way to learn with this skill.

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I get it wasn't your start but you must take ownership of your pt and once they verbalized discomfort...I would have stayed & tried. Even sought help. Nuguy is correct. Let it be an opportunity for growth...then move on.

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Unfortunately, starting IV's is such an emotional and psychological roller coaster for new nurses and even experienced nurses if they don't do it all the time.

In my book, pain = problem. The antecubital space and upper arms can hold a lot of fluid from an infiltration before it is addressed. Even if it looked okay, I would encourage you to restart any IV in the AC. Our hospital's policy is within 24 hours.

On a positive note, I applaud you for trying to improve your skills. While there is science behind starting IV's, most of it is practice and building up your confidence. Take all the time you need, sit if you can, talk with the patient (it will calm both of your), organize your supplies, build habits that work everytime, and offer to start every IV that comes your way. Soon you will be that nurse that everyone calls on because you're the expert.

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Carebear, I have been in your shoes many times. The only take away from your post is that your charge nurse is an idiot.

In an ideal ivory tower world you would have "slipped in" a new IV.

The the real world of a newbie on a busy unit uncertain of her IV skills you did the best you could do to survive the shift.

IV skills are the bane of most nurses existence. Unfortunately the only way you will learn, become proficient, is pull up your big girl panties, (even on a busy night on a busy unit), take a deep breath, and try.

Computers, (electricity, ha ha) weren't invented when I was trying to become good at IV's so I can't attest that this will help but there are excellent YouTube videos about starting IV's. Watch them over and over and over.

Bring home a tourniquet and feel you families and friends veins. Visualize over and over slipping in the IV. Practice pulling their skin taut after the tourniquet is on. See how the vein can disappear when you pull back on the skin. Put tourniquets on old saggy skin, (like mine). Put tourniquets on fat people. Take a thin clean blunt tipped object and run it gently along their skin above the vein as if you were putting in an IV

REMEMBER TO TAKE THE TOURNIQUET OFF, (we all, even years of experience nurses, have done that)!

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