Pretty bad at starting IV's

J&B-RN, BSN, MSN, RN, APRN, NP · Nov 21, 2012

Don't be so hard on yourself. Nursing is hard work and skills take time! Lots of time. Everyone struggles in the beinging. I only get about half the IV's I try and guess what, if the other nurses don't like it so what! We are a healthcare team and all need to work together. Keep trying and keep your chin up.

scb7620 · Nov 21, 2012

Keep trying! I still struggle too, but if my podmates have patients who need IVs, I always ask if I can help to gain more experience. Practice makes perfect. :)

SaoirseRN · Nov 21, 2012

Some people have a knack for them and some don't, and really it isn't an easy skill! My advice is to keep trying, but also to seek out those nurses who "have the knack" and ask them for tips, and if possible watch how they do it. Generally the nurses who are really good at IV starts also love doing them, and will be more than happy to give you some pointers.

GinaCat · Nov 21, 2012

is it finding the vein that's the problem, or physically starting the IV? maybe we can give you some advice

TheCommuter, BSN, RN · Nov 21, 2012

After being a nurse for 7 years, I am still terrible at starting IVs. I can insert a Foley catheter into any 95-year-old lady after several nurses with 30+ years of experience fail to locate the urethra, but starting IVs is not my forte.

We all have things we're good at. Practice makes perfect. In order to become good at starting IVs, you have to practice this skill repeatedly. Good luck to you!

akulahawkRN, ADN, RN, EMT-P · Nov 21, 2012

Hardest thing about starting IV's is believing you can start the IV. I've had days where I couldn't get a line on my first or second attempt to save my life. It can be difficult to find a good vein. I first looked and felt for them. Not only did I feel for them where I could see them, I would try to follow their path by feel even if I couldn't see it. Later I could just see the landmarks and use my fingers to "see" the location and size of those veins. As far as actually cannulating the vein, I found it easiest to visualize the vein as if it were a hollow pasta and I'm aiming for the middle of that pasta. However, I can't perf the other side... so I get through the skin at a relatively steep angle and then shallow the angle so that the cath is almost parallel to the skin, but at an angle where can advance right into the vein. My fingers and cath follow a "J" shape, with the letter on it's side. Kind of put your mind's eye right at the bevel and "see" it go right into the lumen, get the flash, advance an itch more to ensure you're really in, then advance the hub to skin. It's really not that hard.... but it's one of those skills that are devilish to perfect.

Just take a deep breath, find your calm place, believe you can do it in one stick, and get through the skin fast. While fishing for a vein can be uncomfortable, it's the first penetration through the skin that hurts the most. Never hurry. It's the old saying: slow is smooth, smooth is fast. And remember to breathe. Your patients will greatly appreciate the fact that their nurse isn't turning a nice shade of blue.

NurseJessie2 · Nov 21, 2012

I get the opportunity to start a few every day, plus some blood draws. I get a flash and then cannot advance the catheter, I guess because I went through the vein. Occasionally I will get one that I miss altogether because the vein rolled. I know that I will get better with time, I just hate being that new nurse that everyone has to help!

itsnowornever, BSN, RN · Nov 21, 2012

Without reading everything- I rocked IVs in the ER for preceptorship. Get to L&D and these huge IVs kicked my butt. I was depressed!!!!! Not to mention I could only stick hands not the AC like in the ER. My husband told me to focus, don't let it get to me. I tell each IV (in my head) "I got you. You won't fail me. I know how to do this" and now I'm good. Silently focus. Take your time. You can get it.

One1, BSN, RN · Nov 21, 2012

Without reading everything- I rocked IVs in the ER for preceptorship. Get to L&D and these huge IVs kicked my butt. I was depressed!!!!! Not to mention I could only stick hands not the AC like in the ER. My husband told me to focus, don't let it get to me. I tell each IV (in my head) "I got you. You won't fail me. I know how to do this" and now I'm good. Silently focus. Take your time. You can get it.

You used bigger gages in L&D than in the ED?!

flyingchange · Nov 21, 2012

I get the opportunity to start a few every day, plus some blood draws. I get a flash and then cannot advance the catheter, I guess because I went through the vein. Occasionally I will get one that I miss altogether because the vein rolled.

Based on what you said, I will provide 2 points of advice that helped me tremendously. I am a new nurse working in emergency and place at least 5 IVs q shift. Often more.

1. Don't forget to drop your angle and advance the needle 1/4" after you get flash. The actual cannula that you are threading is shorter than the needle tip - you need to get that inside the vein too! If it won't thread, you are probably butting it up against the outside of the vein.

2. Anchor those veins! Veins don't roll, they move when they don't have enough traction. Pin those suckers down and you will never have one "roll". Manipulate their hands to get the best traction.

Hope this helps. Once I mastered the above, I had a LOT more successes and now I usually get them first try. Knock on wood. lol

SaoirseRN · Nov 21, 2012

1. Don't forget to drop your angle and advance the needle 1/4" after you get flash. The actual cannula that you are threading is shorter than the needle tip - you need to get that inside the vein too! If it won't thread, you are probably butting it up against the outside of the vein../

I know they teach you in school to go in at 45 degrees or something ridiculous like that, then drop your angle. I swear this causes more punctured veins than anything! I prefer to start out with as small an angle as possible, not precisely flush with the skin but pretty close.

Also, when you get flash back, pause and don't get excited. Advance just a teeny bit more, then advance the cath slowly. Doing this step quickly or too hastily can be the downfall of many an IV start.

And my two biggest pieces of IV wisdom:

1) Have some one show you the tricks and specifics of whichever IV product you are using at your workplace. We switched from Insyte to Nexiva and there was a big difference in technique between the two.

2) Try using a manual BP cuff (inflated to around 90mmHg) instead of a tourniquet. I always use the BP cuff, both for comfort of the patient, and the fact that I've seen a dramatic decrease in veins blowing since I started doing that, oh, five years or so ago.