IV Starts

[Mofe'ny]

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 to cry this morning when I left work, because after we had attempted 5 sticks, I called the NP. She came in to start the IV and I lost count of how many times she tried. I had to give report and the day shift nurse started helping her. Does anyone have any tips on starting IV's? WE could get flashback, but the catheter would not advance, the vein would blow. This is a term baby with pneumonia, so I am sure she will be on at least 10 day's of antibiotics and she is only 3 days old!

Also, do you use saphenous or Antecubitals? Do you use transilluminators when you start IV's?

[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,

PappyRN

[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...

[jknicuRN]

nevermind :)

[Bvmommy]

Amazingly enough I am a LPN, went to college 3 years in a completely different field before taking a LPN course very similar to an RN with an Associates Degree. I have 36 yrs of nursing experience; 13 years in adult critical care & 23 in newborn & Transition Care Nursery. I seldom miss an IV insertion & often called to other units to do it! It is all about skills!! Great Saphenous is first choice!