Humiliating IV questions

Specialties NICU

Published

Hey, y'all.

I have an embarassing confession to make. I've been in the NICU, student and RN, since March of 06. In that time, I have successfully started ONE IV. One. Now, I'm really good at venipuncture. Good enough that I help out other nurses when they can't get their labs. But I have some kind of psychomotor disconnect when it comes to advancing the catheter and flushing. It's truly pathetic. I know that it's hard to say what I'm doing wrong when you haven't seen me do it, but does anyone have tips? I just can't advance that d(&* catheter properly! It bends, it kinks, and if by some miracle I get it in all the way, it's gone straight through the vein and it blows, or it just won't flush.

thanks :sniff:

Specializes in Vascular Access.
Hey, y'all.

I have an embarassing confession to make. I've been in the NICU, student and RN, since March of 06. In that time, I have successfully started ONE IV. One. Now, I'm really good at venipuncture. Good enough that I help out other nurses when they can't get their labs. But I have some kind of psychomotor disconnect when it comes to advancing the catheter and flushing. It's truly pathetic. I know that it's hard to say what I'm doing wrong when you haven't seen me do it, but does anyone have tips? I just can't advance that d(&* catheter properly! It bends, it kinks, and if by some miracle I get it in all the way, it's gone straight through the vein and it blows, or it just won't flush.

thanks :sniff:

One thing you may try is this: Once you obtain that initial flashback of blood into your flashback chamber, lower your angle then advance a mm or so more. Then using the two handed technique, advance only the IV catheter while your dominant hand holds steadfast onto the flashback chamber, thus dissallowing the needle from moving with the catheter.

Then remove the needle and hook your extension set or IV fluids directly to the IV catheter.

Holding traction below the VP site is important to aide in stabilizing the vein and keeping it from rolling, and it aides catheter advancement.

Hope this helps. DD

Specializes in NICU, PICU, PCVICU and peds oncology.

That technique will work well on cooperative adults but no so much with toddlers who really don't want to be touched at all, never mind have an IV put in. To do something like you've suggested, the person doing the VP will need at least one extra pair of hands, maybe two! Don't let kids fool you, when they don't want to cooperate, they're stronger than Hercules and more determined than a mama bear.

We only have BD Insyte angiocaths, 24g. We do have 0.56 and 0.75 lengths, but if I'm not getting the 0.56's in, I'm certainly not going to get the 0.75, KWIM?

Only 24g??? How in the world do you get a 24 in a micro?? We use the Insyte angiocaths 24g, I think they are the .75, and I don't remember the brand on our 26g, but the needle doesn't retract, (its still exposed :no: ) but the catheter is much shorter. I'm not fond of our 26g and usually don't get it. But there are some kids I don't even think about using a 24g on!

Our educator uses a 1ml to flush with instead of a 3ml.

I am TERRIBLE at them. Granted I only have 9 months experience but it never fails that when a kid has one go out on me they are ALWAYS a tough stick. I have started ONE myself. But, we always do them in teams....so 1 person is the stick person and another is the hold them down/cut the tape/etc etc person. So I have no tips....just know you are not alone...whenever I have a new stick to do or an IV go out my stomach starts doing bubblies.

Specializes in NICU, adult med-tele.
With the BD's it is somewhat helpful to twist the angiocath(take the wing and spin completely around) around the needle to loosen it up a little. When we went to those years ago the company rep recommended that. Also, stick just below where you see the vein well, and just off to either side of the vein. I am a newbie in NICU, but those tricks have helped. The twisting the angiocath part I learned in adult nursing.

Oh man! Always do this, you will be really mad the one time you don't do it if it gets stuck. Trust me I know.

I love starting IVs :) Practice is what you need, though. You have to jump in with confidence and learn from that...here are my pointers:

1. I hate those Insytes...it's hard to have to hold onto the needle while you are advancing. I prefer the Protect caths.

2. Always try to see where your vein is going. Is it straight? Is there a biforcation? Does it disapear? This is important to know when you are advancing. If you don't know where the vein is headed, chances are you will thread right through it.

3. Always advance the tiniest bit forward after getting a blood return to ensure the entire tip of the cath is in the vein. If not, blood could leak around it and blow.... or at least make you think that. It will cause a bruise for sure. Once you get the return, STOP!

4. Advancing... sometimes they just slip right in. Pull the needle out enough that the tip is inside the catheter and always advance slowly. You need a feel for it... if it glides in, glide it in. If not, you have to figure out why it wont. Sometimes in that case, I will take the needle out completely and then try to advance, because it's hard to hold onto both.

- You might be against a valve if you feel like you are hitting something. DONT continue to poke at it! Insert your needle back into the cath and gently insert the cath a little farther. The needle tip will go through the valve. Then try to advance. This is when knowing where your vein goes comes in handy. You need to know where to advance :)

-Sometimes veins are just small or a pain in the butt! If so... just very carefully thread the cath into the vein, while visualizing it. This is especially so for micros.

It's definately something you have to learn for yourselves. You have to realize that these veins are very fragile. If you thread the cath too quickly, you could tear the vein and blow it. I see people ruin perfectly good veins that way and for no reason!

I hope this helps! Good luck!!!

Those are great tips. I'm getting better at IV's, but I've still got a long way to go!!

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.
Insert your needle back into the cath and gently insert the cath a little farther. The needle tip will go through the valve. Then try to advance. This is when knowing where your vein goes comes in handy. You need to know where to advance :)quote]

ummm, you are not suppose to reinsert a need through an IV catheter as you could shear the catheter off and into the patient. I know many people still do this anyway, but I would not reecomment it especially on small gauge.

sweetooth

Ya I know.... that is why I hate the Insyte caths. They always do that. The Protectives slide very easily in and out of the caths, and since they are a closed system, it stays sterile. So yes, it is a risk, but of the cath gets punctured, you'll know right away cause it won't thread right. I would never not re-thread if I though I could save the vein.

I'm opposite, lol! I can usually start an IV but my luck is not as good when doing venous sticks with a butterfly. In fact, if it's a kid I just *know* I'll have a problem with, I'll stick for labs with the angiocath, withdraw the needle and drip the blood into the microtainer (or suck it out of the hub with a sterile syringe/blunt tip needle for a blood culture.) I think it's just one of those things that becomes easier with practice. I was in NICU for almost a year before I even attempted starting an IV without backup standing by to help me hold or flush etc. - I was just so awkward with it I'd get it in but then blow the vein or pull out the catheter when trying to advance or flush. Practices makes it better! Volunteer to start IV's for other nurses. A new admit (non-volume depleted!) with "fresh" veins can be a real confidence booster! My one "real tip" - try loosening the hub before sticking, it makes it easier to advance!

My instructor in nursing school told me I had "psychomotor deficiency", so I know how you feel. The only answer is to keep practicing and also to observe other people who do it well often. But all of us have good days and bad ones when it comes to skills. After several years, you'll just have more good days than bad!

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