really bad IV skills...suggestion?

patwil73 · Jul 19, 2008

This may not be the right forum for this question but I wasn't sure where else to put it
I've been working as nurse on med/surg floor for about a year and a half now, however for some reason I still have the most horrible IV skills. I usually have to get the charge nurse or another nurse who's good at IVs to start mine. I feel really bad for my patients having to stick them two or more times. I seem to go through phases where I get most of them, but I'd say the majority of the time I don't succeed. I feel like I'm the only one who has such a problem with it. My confidence was really shot the other night, because I attempted to start one on a patient with huge, easily noticeable veins, he should have been a real easy stick but I didn't get! So if anyone has any suggestions about how to successfully start IVs I'd appreciate is...thanks!

I will tell you what I do when starting IV's, but the best suggestion I can give is to find someone really good at it and have them watch you do it. If people on the unit will let you practice on them, then you can get really good feedback.

However, what I do is:

Find the vein I want to access. I will start with the hands and work up unless I need something for a CT angio or vancomyacin.

Once I have found my vein - I will apply the tourniquet. Then I calmly lay out my supplies, making sure everything is where I can easily reach it. This gives the vein a chance to plump up.

After preparing the site, I will take the needle and twist the cannula to make it easy to move. With the bevel (small opening in the needle) facing up, I grasp above the vein with my left hand (the one without the needle in it). You have to firmly grasp the vein and really lock it down - make sure it can't move.

Next I insert the needle through the skin, above but slightly to the side of my intended vein. The needle should be at an angle 20 to maybe 40 unless the vein is really deep. After I have inserted through the skin, I gently push directly into the vein. Move slowly here. Once you see blood flowing back up the cannula into the hub of the needle, drop the needle down to almost level with the vein. Push it gently a tad farther into the vein. Then advance your cannula as far as it can go into the vein.

You are almost home free here. With your left hand, place direct presure just above the cannula on the vein, retract the needle and either attach the tubing and draw blood or release the tourniquet and then attach the tubing.

The most common cause of failure to start and IV is not locking the vein down. If it moves around too much chances are you will push through it and blow it when attempting access.

Also think of relaxing things. I talk a lot with my patients, it relaxes them and me. Sing a song in your head, count sheep whatever you can do to relax so the needle is not vibrating in your hand.

Hope this helps

Pat

**canoehead, BSN, RN** · Jul 19, 2008

Sit down when you start an IV, especially if you are in a hurry or stressed, and act like you have all the time in the world. If you are lucky enough to see a bifurcation go right up the middle- they are hard to miss.

beachgirl17 · Jul 19, 2008

Pat, thank you for your informative post. I plan on reading the post over and over as I enter my first year as a RN. Thanks!

Altra, BSN, RN · Jul 19, 2008

The most common cause of failure to start and IV is not locking the vein down. If it moves around too much chances are you will push through it and blow it when attempting access.

I wholeheartedly agree with this.

Sit down if at all possible. Take the time to raise the bed to a comfortable level. Take the time to get a bedside table or other surface to lay out your supplies exactly how you like them. These details make all the difference in the world for you & your patient. :)

christine_chapel · Jul 19, 2008

Push it gently a tad farther into the vein. Then advance your cannula as far as it can go into the vein.

This was key for me; I used to blow veins all the time from getting the tip of the needle in, seeing my flash, and then trying to thread the cannula without pushing the needle in just a little tiny bit more. The whole bevel did not go in, and then the cannula wouldn't thread or would miss the vein entirely. After I started remembering to advance a little extra every time, things went much better.

anonymurse · Jul 19, 2008

My confidence was really shot the other night, because I attempted to start one on a patient with huge, easily noticeable veins, he should have been a real easy stick but I didn't get!

Don't be fooled. I have huge veins and thought I'd be an easy stick, but my nurse blew one after the other and finally got it on the 7th try.

medsurgrnco, BSN, RN · Jul 19, 2008

Those huge, easily noticeable veins are the ones that roll. Instead of going for them, I look for veins above the elbow on those patients.

Inserting IV tips has been covered several times in the last few months. Suggest you do a search.

patwil73 · Jul 20, 2008

Those huge, easily noticeable veins are the ones that roll. Instead of going for them, I look for veins above the elbow on those patients.

Big veins do tend to roll a lot more, however any vein can be locked down, just apply more pressure and pull upwards more. I also tend to go straight down into the big veins rather than the sideways approach I outlined before. They tend to wiggle less when pushed downwards rather than to the side.

Again practice is the best key to becoming better - but the practice must be guided. Starting a 100 IV's does no good to your skill if all 100 are done incorrectly. You might see if you can shadow a few days in the ER - you will get multiple chances to start IV's and hopefully someone will be eager to show the proper way. If you can't get your charge or the best person in your unit to sit with you while you start a few - trust me it will get better very quickly with someone to help.

Hope this helps

Pat

Ima Nurse · Jul 20, 2008

That's very good advice above! Very good advice. :nuke:

I got better after I had a nurse with excellent IV skills watch and critique me. It only took a few starts with her observing and troubleshooting for me to improve my skills. Good luck! You can do it!

Teleflurry, DNP · Jul 20, 2008

My tips. I call it the Tracey Method after the nurse that taught me.

1. Tie the tourniquet tight...dont be a wuss.

2. Feel the vein that is most tight rope like.

3. As soon as you get a flash of blood push the needle in only a smidgen farther and then thread the cannula in ONLY without pushing the needle farther in.

4. Bada bing!

- They dont call me the "one hit wonder" for nothing!

crb613, BSN, RN · Jul 20, 2008

Don't give up! Keep trying & ask someone that is good at IV starts to help you. Choose the right size angio for the vein.....have the bed to your level & don't try to start one in a position where you are not comfortable.

I start mine with bevel up....level with the skin/vein...enter the vein & the moment I get a flash.....stop......then advance a tiny bit....now I push the cath off the needle with my finger.....retract the needle.....done! On some people I use a tourniquet, some I will use a B/P cuff or nothing at all. It just takes practice...the more you do correctly...the more successful you will become & will that comes confidence! In no time others will be coming to you for help