IV Starts

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by MelissaCT
Sep 28, '02 Views: 2,344 Comments: 10

Any hints?

I am a new grad in L&D. When I have a few patients in a row, that require IV's, I am okay.

But when I go a few days without doing one, I blow it. Literally.

My experience is: when I get a pt who needs one, I do it. I know other hospitals send new hires to out-patient areas and they do IV's all day long for a few days until they're good. My hospital did not do this.

We have these safety needles that retract and they are tricky. Some of the older nurses hate them and use the older ones that anesthesia uses.
About MelissaCT

Joined: Jan '02; Posts: 134; Likes: 3
Family Nurse Practitioner
Specialty: 7 year(s) of experience in L&D, Ambulatory Care

10 Comments

Topic Closed
Sep 29, '02
Joined: Jul '00; Posts: 11,351; Likes: 387

Can't you ask for more IVs? Would your hospital be accomodating? Most places want their nurses to be up to par clinically, then they waste less money on the IVs you miss.
Sep 29, '02
Occupation: RN Joined: Jul '02; Posts: 175; Likes: 1

Mellisa
You hit the nail on the head when you said"They use the old ones that anesthsia uses." We used to useProtectiv by Johnson and Johnson. There is a major stash of them in OR as our "sleep gang " wont use the new ones. Our new ones are BD Vialon Insyte Autoguards. They are safe but they are much longer than the others and a lot of us feel they blow veins a lot more. I agree that practice is the main thing you need. Perhaps if the others let you start the pts for them you could aquire a bit more practice. Keep trying and remember---"Some days you can hit anything and some days you can't hit a garden hose."
Sep 30, '02
Occupation: Women's Health NP Joined: Sep '02; Posts: 107; Likes: 2

To expound on Fergus' response, you might try asking your fellow L&D nurses to "give you" their IV starts. Many experienced nurses would be happy to give up their IV starts. It's just another task that they have to do, and they have plenty of experience. Maybe you could trade a task that you need done in return for starting their patient's IV. But whatever you do, don't follow the nurses who refuse to grow and learn new skills. 10 years from now, we won't have any choice but to use the new needles! You're right, many of the new "safety" needles are more tricky, and require some skill. But "practice makes perfect", as Mom used to say! Just stick with it. 6 months from now you'll wonder why you were worried!
Oct 8, '02
Occupation: Staff nurse, Labor and Delivery Joined: Jan '02; Posts: 37; Likes: 1

Hmmm, I can't think of the name of our catheters , but I know that once you are in, you advance the catheter as you pull back until the needle completely retracts and clicks. I am pretty sure ours is the ProtectIV from J&J also.

If your device is like mine, one thing I found helpful when starting out is to look at where the end of the catheter is in relation to the tip of the needle. I used to puncture the vein, get good flashback, and then start advancing the catheter while pulling back on the needle. I would blow it every time. I figured out that once I punctured the vein, I needed to advance the whole thing just a little bit more before I started to pull the needle back and advance the catheter. I was not getting the catheter completely in the vein.

It is a skill that you will master with practice and getting "a feel" for how deep to go, when to advance, what angle to use, etc. My hospital didn't send us to other depts for IV practice either. They said that pregnant women usually have such good veins that they would be the best candidates anyway.

Like others have said, grab as many of your coworkers' IV starts as you can! Good luck!
Oct 8, '02
Occupation: Emergency department Joined: Aug '01; Posts: 509; Likes: 2

We use Insyte also, and I have only been doing IV's for the past year of my 15 nursing, since I have been working in A&E. Prior to that, everywhere I worked had IV nurse teams.

Anyway, I learned to cannulate with the Insyte catheters, and I must admit, I have had to use the old Jelco's a few times since I have been working agency. And guess what?? Can't do it!! I blow more veins using Jelco's than I ever have with the Insyte catheters.

I guess my point is, it depends on how you were taught. And the others have it right - PRACTICE, PRACTICE, PRACTICE!! Good luck.
Oct 8, '02
Joined: Oct '02; Posts: 139

melissa,
hi i'm frankie - i work in an IV clinic. i start ivs all day long. the others are right - practice is the key. we use 2 different iv catheters for pivs - protectives and intimas. i like both. the intimas are my favorite - they provide a bloodless stick, have a built in Y site, are make of vialon (great for decreasing phlebitis), and have a guidewire - and they are safety approved! stick with it, you will get the hang of it.
good luck
frankie
Oct 8, '02
Occupation: Family Nurse Practitioner Specialty: 7 year(s) of experience in L&D, Ambulatory Care ; Joined: Jan '02; Posts: 134; Likes: 3

Thanks for the advice, guys!

Yes I think I need to advance more after getting flashback.

But my newest problem: I haven't gotten many IV's lately.
And the floor has been too busy to have me steal other IV experiences. I'm in the OR for that part of the orientation now, so there is some opportunity.

But today: the woman was very obese, so my preceptor wanted to do it.
Oct 9, '02
Occupation: RN Joined: Jul '02; Posts: 175; Likes: 1

Hi Melissa
As a preceptor my self I can only think that time was of the esscence as an obese pt. is someone that you really need to know how to do. The percentage of obese pts. continues to rise. Hang in and practice as much as they will let you.
Oct 9, '02
Occupation: Family Nurse Practitioner Specialty: 7 year(s) of experience in L&D, Ambulatory Care ; Joined: Jan '02; Posts: 134; Likes: 3

Time was not of an essence, but the patient was an emotional wreck and if I missed her IV, she would be really upset (more than is expected) about needing a second stick.

She was crying already....

Anyway, today I got an IV in, and I was extra proud because it wasn't a big/on the surface vein. It was thick but somewhat deep. I didn't get it right away either but explored with the needle a bit (to my patient's chagrin). Then, when I was about to give up, I got blood return, advanced a little more, and got the catheter in!
Oct 10, '02
Occupation: Labor, Delivery, Post Partum and Newborn RN Specialty: 10 year(s) of experience in OB, Post Partum, Home Health ; Joined: Dec '00; Posts: 291; Likes: 34

CONGRATS!!! Your story brings back many memories for me. I was terrible at IV's!!! I missed everything when I first started! Now, however, I am the one that everyone calls when they can't get an IV in!! One thing that really helps me is, if I can't see or feel a really good vein right off, I hot pack their arm. I use a hot wet towel and wrap their arm in it, I of course wrap a blue chux pad around it too so I don't get the bed all wet. I wrap both arms and leave them wrapped for about 5 min. I unwrap one arm, put the tourniquet on. The heat usually coaxes the vein out. I always leave the other arm wrapped just in case I don't find something on the arm that I unwrapped.
Another helpful hint: sometimes you can feel a vein but can't see it really well , which can make it difficult to know exactly were to poke once you have prepped the area. I frequently will make a mark with my thumbnail along the vein before I do the prep so that I can see where the vein is. I hope this helps you. Hang in there, you will be the one that everyone is calling in no time at all!!!!

IV Starts

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