Quote from Mrs.S
I am an RN 2 years out of school but new to L&D, and I just recently found this site. Yay! What a wonderful resource!
I am currently experiencing a very long, bad run on IV starts. I used to think I was fairly talented at them; used to do Mom/Baby and Peds at my old job and seldom had a problem, even on the kids. But since starting a new job in May I don't think I've gotten one on the first try yet! Not only do I feel bad for my poor patients who have to endure all my poking, but it makes me feel so incompetent having to always be asking other nurses for help!
I'm wondering if it's due to the size of the angio's we're using? At the old hospital we were pretty lax about that and mainly used 20's on adults. At the new place (as well as at most other normal hospitals I suspect), 18's are the hard-and-fast rule. I don't know really how much difference that makes, but it's the only thing I can think of that's changed!
I've talked to some of my new co-workers about it, and they each seem to have their own special trick, none of which has worked very consistently for me. (even had one very experienced nurse simply say "no *****-footing around.") I have no problem getting into the vessel and getting that return, but then I either can't thread the catheter, or it immediately swells up like a little purple balloon, or just won't flush for heaven knows what reason.
Anybody have any suggestions I maybe haven't tried yet? My confidence is really shaken!
I'm about a year and a half out of school myself, and also new to L&D. I came from a CCU at a different hospital, where we used Introcans all the time (basically just the cathlon without an extension set). I was pretty decent, not the gold standard, but not too bad. Now, here on L&D, we're using Intimas (with "butterfly" wings and a mini extension). I found in the first few weeks of orientation, I was so flustered about doing things well and giving a good impression to my preceptor, that I couldn't hit the broad side of a barn, even when she and I went hunting for Introcans in the supply room for me to use. We finally figured out that I was having stage fright, and she left me alone for my IV starts after that - guess what, I've hit them on the first try ever since, and am even starting to get used to the Intimas.
If I have any suggestions, it would be to clear the room of unnecessary folk, take a deep breath before you start, and remember: This is something you can do. You know that you can do it because you have done it before. No wait I do have one more suggestion. and it is a practical one.
When you get your flash, advance the needle just a l-i-t-t-l-e more, like 1/8 inch. This will ensure that the entire bevel of the needle is actually in the vein. as opposed to being halfway in the vein, giving you a good return, and then blowing when you try to advance. that was what helped me make the transition from 20s to 18s a little easier.
good luck to you!