So frustrated with IV starts!!

[NeoPediRN]

I just started in the ER and I can't get an IV to save my life!! Big HUGE juicy veins begging me to stick them and I can't do it. I came from a floor where I was THE go-to person for IV starts. LOVED starting them and only missed one in the past six months!! The new hospital I work at use the snap release angiocaths and butterflies, and I can't adjust. I'm used to the angiocaths you pull back until they click before releasing. I've never even used a butterfly. I'm psyching myself out thinking I won't be able to get one and then I end up not being able to do it. I absolutely hate not being able to do things and it's really starting to tick me off that I'm missing the easy ones. My preceptor actually stays out of the room when I try because I get more nervous when people watch me. She's been great but I'm sure she must be getting annoyed that she has to keep following up and start the IVs when I miss. Did any tricks work for you that you could share?

[usalsfyre]

I used to use the Protectivs as a paramedic and the BD Insyte Autoguards as an RN ... kind of annoying to have to switch back and forth on a regular basis, but I'm kind of glad because it made me more versatile! You'll get used to it ... relax and give yourself time! It's not easy to make the switch. (Personally glad to see that my Army ER uses the Protectiv catheters, yay!!)

Because of supplier changeovers, we've got both on the trucks right now, so it's a crapshoot what I'm going to pull out of the cabinet any particular time. We're going to the Protectiv, I can't wait till all the Insytes are gone!

[WorkingHard2bNurse]

Those snap release ones is all i know lol. What works for me is the first thing you must do when you first open up the needle slide the catheter slightly up and then put it right back (these are know to kinda get stuck and not finding that out till your ready to advance sucks! so just slide it up and back down so you know its ready) I enter the vein but not all the way. The moment I get a blood flash I advance LITTLE bit more with my needle, then with your index finger advance the catheter using that little ridge that sits at the top advance it all the way THEN push your button to safe your needle, do not push it till your catheter is off. This method has worked for me and I was taught this way for best results. ESPECIALLY the part about advancing the catheter with your index finger, good luck!!

Be careful about sliding the catheter up and putting it back as this can potentially shear off a small bit of the catheter and introduce it into the vein - we've been taught to twist the cather at the base to release the seal.

[NeoPediRN]

Thanks everyone! I appreciate the advice and tips. I've been sticking to the butterfly catheters and having my preceptor talk me through the starts as I do them and it's getting better. I've learned that I need to use more pressure when introducing the butterflies and advancing them a little bit further than I would with the angiocaths, and with the angiocaths I need to introduce them slower and back off on the amount of force since they're stiffer and tend to go through the vein.

[AlmostJesus]

I have noticed that if I start thinking that damn this guy has amazing veins that I end up becoming over confident on them and this leads to me preparing poorly for the IV and I am more likely to miss on easy IVs. Thus, I started to treat all IVs like when I am preparing for what I think will be a tough IV (spending more time looking for the best vein, preparing/anchoring the vein better, using my tough IV tricks) and I have found more success.

On my internship for paramedic, we used the protectivs and we use the insyte autoguards at the hospital I am at right now. I definitely like the protectivs more in the prehospital environment because you can lock them back and keep the needle on the hub until you are good and ready to switch over leading to fewer bloody messes. It takes a learning curve to switch from one to the other.

Hope that helps

[mkblakley07]

If it's the equipment that you're having a problem with more so than the procedure, why don't you ask your preceptor if you can take some supplies and go practice on some dummy arms or even just dissassemble them to see how to work em. I know at the previous hospital I worked at our orientation had a whole day dedicated to learning how to use the IV equipment, ports, insulin pens, etc. of course this was a bigger hospital, and I am aware that there are a LOT of hospitals that don't do that, but maybe if you express the need they will meet it?

[iamNurse23]

Be confident and don't give up!

[RoyalNurse]

I pretend I'm performing surgery on the vein, I visualize what the vein really looks like, and imagine sliding the catheter right in:). The visualization helps me with nerves and negative self-talk. Sometimes I'll talk myself through it like a golf announcer: "Okay, she's lining up the shot and measuring the angle..."