IV Starts - page 3

Help! How many times do you all try to start an IV on a baby? I get so frustrated sometimes. We will normallly try a total of 4 - 6 times(different staff RN's) before calling the NP's. I was ready... Read More

  1. by   KRVRN
    I rarely try IV's on big babies without a transilluminator. How funny that we all do it different.
  2. by   Candace
    We do 2 attempts each on our unit, preferably using sucrose prior to the stick. I will occasionally (few&far) leave one catheter in and restick with a new catheter parallel to the first unsuccessful one. It seems to always work if you have a baby that's blowing or rolling. We also use surgilube on the scalp as a base then tape with cloth tape.... it dries like cement and when it's ready to be d/c'd, wet, and WALA!, off it comes with the baby's hair still attached to her scalp! Any other tricks you have to share?
  3. by   nurseiam
    I think that we are now using InStylet? They retract for safety. We will try three times in our unit.
    The best way I have found is to put the catheter in the pull out the needle and try to float the catheter in. Then you dont go through from going in to far. We will also try heparin if the clot easy and if their hct is low there might not be a flash. I like to try the vein on the outside of the foot. We are not allowed to use ANY major veins, they are saved for PICC's
  4. by   NICU_Nurse
    Dumb question, but what is surgilube and how do you get it on the NICU? That sounds perfect...I hate seeing their hair come off when we d/c an IV, even if you try and try to keep it intact, it seems like we never quite get it all. :>( We get, technically, three tries per person before moving on, but unfortunately, some people are better at IV's than others, and some babies are horrible sticks...you get where I'm going with this (although technically, since it *is* the rule, we try to stick to it as much as possible). We use the Jelco catheters, and I find that they work well. I always float in because I don't want to go in too far and damage the vein on the other side. We try to save the a/c veins for PICCS, even if the MD hasn't mentioned wanting one, as much possible.
  5. by   gauge14iv
    I use a few drops of mct or corn oil (which we always seem to have hanging around) on the tape on sites when I want the tape to come off but the hair (or skin) to stay! Just moisten the tape or place a few drops under the edgeof a clear type dressing, wait about 10 min and everything should should fall right off. This also works great for taking the very adheseive dots off the cheeks that we use to hold the nasal cannulas.

    I usually have to wash the hair afterwards, but at least it all stays on their head!
  6. by   Mofe'ny
    Wow I just read this thread again for the first time in months. Just wanted to pass on some encouragement to those of you still struggling with IV's. For me it seemed that once I was able to get a few IV start in a row, I haven't really had much trouble with them. I'm not intimidated by IV's anymore!! So it does get easier with practice!!!
  7. by   nell

    surgilube = Ky jelly.

    Sure are a lot of good ideas here! Too bad we got "stuck" with catheters that are waaay too long and seem to blow and leak more than any we tried before.....
  8. by   cindylouwho
    3 times and I'm done...I love scalp veins....parents do freak out...only use them after the hands are gone....love PICC lines even more when appropriate...we've had excellent luck with our PICC lines....
  9. by   love4neos
    I would definetely be suggesting a PICC line for this baby. Everywhere I have worked has only allowed anyone 2 tries each, it is recommended that you get an NP before there are NO veins left! Any vein that looks good and refills we try, except of course jugular or other major access in case sugery is needed.
  10. by   NICU_Nurse
    Okay, forgive me if this sounds stupid, but IV starts remain my poorest skill. I have improved dramatically since I first began working in the NICU (approx. 16 months ago), but I am still disappointed that I still struggle with this. I seem to be hitting the veins but blowing them almost as soon as I get them. My facility is horribly poor when it comes to providing reference materials and inservices/education regarding this issue. I am left to look it up and learn on my own, which is fine, but I don't know where to go! Any suggestions from the pros? I have my basic diagrams of adult venous structure- are these basically applicable to the babies as well? It seems like, after studying these pictures, I go for a vein that I may not be able to visualize well, and it's just not there for the babies (or I'm simply missing it), which increases the number of sticks needed to obtain IV access. I've gone to the bookstore and looked at a couple of phlebotomy books, but they mostly pertain to adults. The sections on infants are very small and have virtually no information. Is there a book('s) about IV therapy for infants? One specifically designed for NICU nurses or neonatal nurses? If anyone knows of such a thing, I'd be grateful if you'd let me know. Anything I can do to continue improving this skill is at the top of my list. ;>)
  11. by   pappyRN
    The pediatric hospital where I worked neonatal services before an on the job injury took me out had a policy of three sticks and then another person tried. After 6 sticks, the baby was to be given rest if possible and either a transport RN or an NNP would attempt to get IV access. We were encouraged to report and/or write up anyone who abused the three sticks rule by attempting the IV more than three times. Prior to this, I witnessed numerous times when nurses just kept repeatedly sticking and sticking because their pride wouldn't allow them to admit they couldn't access the vein. The babes would get wiped out and stressed from all these attempts.

    I always looked to see if the big vein right behind the ear looked like it was suitable for the type of IV catheter and the type of therapy being delivered. Other than that, I just made sure that whatever I was sticking could be visualized or felt so that I was sticking just for the sake of sticking.

    The only hints that I can give to you Kristi is to just make sure you are not trying to stick and advance the catheters too quickly since these vessels are so superficial and fragile. It used to make me flinch when I'd see a nurse stick and try to advance the catheter quickly. IV access can be and is a slow delicate process for neonates. However, don't take so very long that the catheter has a chance to clot off. Remember, only stick what you are confident you can access. Their veins are very superficial. Select the appropriate size of catheter. It's unlikely that you will be able to place a large bore catheter in a thread of a vein. Take the time to restrain the babe adequately so that movement doesn't interfere with your attempts.Have all your equipment ready and the tape torn so that valuable time isn't wasted while someone tears the tape and the catheter doesn't clot off while you are waiting.I don't specifically know of any books to recommend. It has now been almost seven years since I practiced but it seems like yesterday to me. I was fortunate to be a technically competent IV starter but I also had a lot of experiences since I worked in a tertiary referral center and our patient census was consistently high. I worked neonatal services for 13 years before my injury put a stop to it. I miss it terribly. Shortly before I left there was a lot of discussion regarding using heparin flush solution in the catheters before inserting them. It was done infrequently in our unit but not as a general practice.

    Be patient. I wish you the very best in your pursuit of technical proficiency at starting IV's. Many nurses try without success and instead of trying to take action to improve their skills like you have they just keep sticking in their ususal manner.

    Warm personal regards,
  12. by   cindylouwho
    kristi....all it takes is time and patience....I've been in nicu for 24 years and there are some days I can't hit the broad side of a barn.....and then some days I'll get 3 or 4.......hang in there...
  13. by   jknicuRN
    Last edit by jknicuRN on Aug 15, '10