im in my last year of a third year program. And I SUCK at everything related to veins!
In total, I had 5 opportunities to draw blood and start IV's. And every single time I missed the vein and/or my clinical instructor had to help me replacing the needle. I have no problem finding a good vein, it's really about sticking the needle right in and replacing it after..
I have never been able to do one of these things by myself and I feel very behind from all of the other students of my clinical group are comfortable with those techniques.
Anyone was in a similar situation? Did it eventually got better?
Specializes in Med/Surge, Psych, LTC, Home Health.
This is my 11th year of being a nurse. 10 of those years were spent at the bedside in direct patient care.
I've always been hideous at IV lines and blood draws. I'm simply not a hands-on person and would rather pass these task on to someone who enjoys procedural skills. In exchange, I'd complete paperwork or some other task for them.
Out of thousands of opportunities, I've successfully started about 30 IV lines. I've successfully drawn blood perhaps twice.
This!!! Except I DO like hands-on type stuff, but I'm just TERRIBLE at drawing blood and/or starting IV's, after 13 years of being a nurse!!!
Now, it probably doesn't help that I've worked in several areas of nursing, including many years in both LTC and psych, which are two areas that generally do not require a lot of stickin'.
Now I'm back working on a Med Surge floor, where there are a lot of IV's, sticks,
but if there is someone else around who's not terribly busy and can start an IV for me?
I'm to the point in my nursing career that I don't care to ask someone who I know is better at it than I am! Saves the patient that extra bit of torture.
My advice? Same as others really; keep practicing and you'll get it!!!! :)
Wow that actually helps a lot! I'm starting a new med-surg rotation tomorrow and we will probably have to do a lot of these techniques so I'm definetely stressed out, just hoping I can finally get my first IV!
I felt really bad about my needle skills too. I started in an ER and let me tell you, the techs were NOT subtle or gentle in letting me know that my skills were sub-par.
At first I got maybe 20% of my attempts. Now, 8 weeks of practice later, I notice I can get all the easy ones and a surprise moderate one now and again. Eventually I hope to be able to get 75% of my attempts. It is just getting the feel of it and building the muscle memory.
One of my first mistakes was not laying out all my supplies in the order I'd need them, all ready to go: INT flushed and ready, tegaderm peeled and waiting, blood tubes standing by, gauze and tape ready. Once I knew exactly where to reach for my supplies once I got that flash, I was better able to concentrate on getting that vein
Don't worry about it. While you will need to learn skills once you are a nurse, you will be paid for your brain and your ability to anylize a situation to determine the best course of action, whether it be care, procedures, or calling the doc.
I had 2 IV attempts and 1 blood draw while in clinicals. Both IVs were failed attempts. The blood draw was partly successful but the vein blew half way through the second of 3 tubes.
I now work in an LTACH where we draw our own labs either by CVC or venous stick. I have had tons of practice and am still only just starting to get okay at it. Not even good. Just ok. Some people I can get their blood on the first stick. Some it takes 2-3. For IVs I'm about 50/50 on success.
What you will learn is how to save a stick by fishing. I don't like to hurt my patients too much by fishing all over the place and digging with a needle. If I miss on the first stick I leave the needle in and retaliate to find what's going on with the vein. If it rolled, I try to secure the vein a little better and go for it. If I'm just not quite deep enough or running along side it, I try to change my angle. I'm getting much better at saving what would have been a failed attempt before. But I am seeing that the more I do, the less I am having to fish because I'm getting better and getting it in one motion.
Keep in mind, I have just under a year of experience, only 2-3 in a hospital setting, and about 40 sticks between IV and blood draws. Give yourself time to learn. I've got a ways to go to become more comfortable and proficient but the only way to get there is to just keep trying.
I felt really bad about my needle skills too. I started in an ER and let me tell you, the techs were NOT subtle or gentle in letting me know that my skills were sub-par.
At first I got maybe 20% of my attempts. Now, 8 weeks of practice later, I notice I can get all the easy ones and a surprise moderate one now and again. Eventually I hope to be able to get 75% of my attempts. It is just getting the feel of it and building the muscle memory.
One of my first mistakes was not laying out all my supplies in the order I'd need them, all ready to go: INT flushed and ready, tegaderm peeled and waiting, blood tubes standing by, gauze and tape ready. Once I knew exactly where to reach for my supplies once I got that flash, I was better able to concentrate on getting that vein
Yes! This does help. There's a rhythm to doing an IV. Mine is pretty much like this, even in "crash" situations: I open my supplies, get out the tourniquet and apply it. I feel for a good vein, determine where it goes. I then grab my skin cleanser and apply that. While it's drying, I'll pull 3 pieces of tape, tearing the last one length-wise to make 2 long skinny pieces. I then pull the extension tubing and attach it to a syringe (empty if labs are needed, flush if not). Next comes the IV catheter and I remove it from the packaging and prep that cath for use. This all takes about 1 minute or so and the site is now dry. That's when I re-palpate the site, establish my exact point of entry and go for it. Here's the thing: everything I need is within reach and in basically this order: tubing, tegaderm, tape nearby. From start to finished, it's maybe 2 minutes. The key, though, is preparation.
Oh, and one last thing: My attitude in getting an IV line is simple. I'm 100% supremely confident in my ability. I will get that IV line. Sure, the AC is nice, but sometimes all you have is one little tiny vein by a knuckle and a 24g is all that will work... I'm going to get it done. I never give failure a thought. Even if I'm humbled by that patient... I stop because it's best for the patient.
Specializes in Infusion Nursing, Home Health Infusion.
You need to have someone that is awesome at IVs give you a lesson. In the meantime find a good you tube video that breaks down each step for you because all it takes is one little miscalculation to miss or one small mistake.All the liitle steps done correctly add up to a successful IV start.Please take the time to position your patient properly as the little time you spend on this can make the difference between success or failure.I had to chuckle the other day under my breath.They called me to start an IV on a pt and he was turned on his right side hugging the side rail.The nurse was on the right side of the bed and leaning over trying to poke the left arm that was resting on his hip.The first thing I said was that we need to reposition this pt to be successful.He had horrid veins..was very frail,with very thin skin and bruised all over his arms.Yes I got it after fixing that situation...a bunch of hot packs and double tourniquets and with one stick.
The two main mistakes that I see over and over again are: The initial angle of approach is too deep and nurses do a through and through puncture and with a sharp angle it's almost impossible to save the stick.The second mistake is that nurses DO NOT drop the angle once the flashback is seen or the pop into the vein or both is felt and they do not advance it further as a unit into the vein.With IV catheter the needle is a tad longer than the catheter over it so you can have the needle in the vein but NOT the catheter so if you pull back the needle you have lost you chance to advance the catheter and all you have is a hole in your vein.That is why it is so important to feel the vein and its course before you poke and select the exact spot you will make the attempt because when you hit the vein and get your flashback...drop your angle flush to the skin..you need to have some room to advance it without going through the side wall or back wall of the vein.If you think you hit it from the side and do not want to risk advancing it after the flashback you can very carefully stabilize the flashback chamber and slide it off the needle.That can be tricky because it's just a few mms that you need to inadvertently move it and it can be lost. If you tell me how you performing your procedure in detail I may be able to figure out what you need to work on but rest assured this is not an easy skill to pick up fast.
Specializes in Clinical Research, Outpt Women's Health.
I can only speak about blood draws as i do not have to do IV's. I had to learn how to do phlebotomy after being a nurse for 18 years and never doing it. Not even in school. I do it a few times a week and have for about 6 years now and get about 93-95% on the 1st stick.
What I have learned: those little flat veins you see are worthless usually. If I cannot feel the bounce when I palpate i just do not try in that location. Stabilize the vein firmly, go in slow and low. I prefer using a butterfly because I can see the flash, but all the phlebotomists tell me they have better control with a regular needle unless it is a tiny vein. I love my butterflies though. If the vein rolls I will try a tiny adjustment and see if I can get a flash, but no digging ever. That is what causes injuries and it hurts. Better to just withdraw the needle and try elsewhere. No digging!
A lot of it is mental. Like someone else said: think success! When I go in thinking failure that is usually what happens. It still drives me nuts when I miss one, but you have to accept it will happen, and sometimes it may even happen a few times in a row. That is just how it is. Everyone's veins are different. And the more you do the better you get so look for any opportunities.
Specializes in public health, women's health, reproductive health.
I left a hospital job and started working at a clinic where there are days when starting IVs is something I have to do several times per shift. I was pretty bad at it at first, as I'd had very little experience up until then. It really tanked my confidence level every time I knew it would be one of those shifts. I had to do a lot of affirmations on the way to work, lol. Also, just when I thought I was getting a little better, I would have a "bad IV" day. On one of these days, a nurse I work with let her annoyance be known. I allowed this to mess up my confidence for quite a while and dreaded working with her for weeks.
I tell you this to say how much your mental state counts. That is to say, confidence really has an effect on inserting IVs, as minor as it might sound. The problem is, you get confidence by success. And it's hard to have a lot of success at first. I had an idea that at the beginning of every shift I reserved a small piece of paper to make a mark when I was successful. Even if I didn't have a lot of marks at the end of the day, I concentrated on my successes. And soon, I actually had a day when I didn't need any help and got every single one.
After a while, I also realized that every nurse I work with, even the one who was annoyed with me in the beginning, has an off day...or at least has that time where they cannot place an IV. I no longer apologize when I need another nurse to come help. I do my best and that's it. I don't let one person who is a "hard stick" wreck my confidence for the rest of the day.
Btw, I have so many patients who sit in the chair and say that no one can get an IV in them, they have no veins, they require a tiny, tiny needle or they don't like needles and they are on the verge of passing out. I used to let this make me a nervous wreck. Now I take control of the situation and get them calmer. I project a positive, confident attitude and more times than not, I am successful.
It took me many months to stop dreading my "IV placement" days. I still have that little twinge in my stomach now and then when I am under pressure to do it quickly, which happens from time to time. But overall, almost a year after I began, I do pretty well.
My one advice besides being confident (fake it until you make it!) is to repeat: Have your supplies ready and in order. AND Go slowly when sliding the cannula into place. Once I slowed down, I did a lot better.
5 times is nothing! It takes a lot of attempts to become proficient. Give yourself a break and find a good teacher. Sometimes the best phlebotomist is NOT the best teacher because they can forget the little tips/tricks that they just implement on auto-pilot.
Another thing to consider is the people you are trying on. Have you tried drawing blood on a healthy person (i.e. another student)? I feel it is important to get confident doing some "easier" draws before trying a patient who might be sick, dehydrated or make you nervous.
Well put it this way, at least you get the chance to get the practice. Most schools don't teach IV insertion anymore or let students do them on actual patients. I have had the opportunity to do a few. Our instructor is there 100% of the time, helps us find the vein, and jumps in when needed. For the few times I have tried I have ended up right next to vein and my instructor has just made a small adjustment or wrist turn and goes right in.
Specializes in clinic, ortho/neuro, trauma, college.
You'll get it, I promise! You may never turn out to be a vein whisperer, but you WILL successfully achieve IV insertion and blood draws. I'll never forget how mortified I was when I messed up an IV on a young man who literally had highways for veins. Big, beautiful, juicy veins. Fast forward to a few months later, I was helping some of my less-experienced co-workers get "hard sticks." You just need the practice.
NurseCard, ADN
2,850 Posts
This!!! Except I DO like hands-on type stuff, but I'm just TERRIBLE at drawing blood and/or starting IV's, after 13 years of being a nurse!!!
Now, it probably doesn't help that I've worked in several areas of nursing, including many years in both LTC and psych, which are two areas that generally do not require a lot of stickin'.
Now I'm back working on a Med Surge floor, where there are a lot of IV's, sticks,
but if there is someone else around who's not terribly busy and can start an IV for me?
I'm to the point in my nursing career that I don't care to ask someone who I know is better at it than I am! Saves the patient that extra bit of torture.
My advice? Same as others really; keep practicing and you'll get it!!!! :)