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starting IV's, pesky valves, just a rant

Nurses   (24,307 Views 8 Comments)
by brownbook brownbook (Platinum*) Platinum*

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Just a rant, where I currently work we do a lot of team work, yeah!!!!:) One nurse might be doing the paperwork, the other starting the IV.

At other jobs I used to float a lot, went through times of seldom starting IV's to my current position where we start IV's a lot. I overcame my 90% psychological, 10% technique related, issues about starting IV's. I feel comfortable now but of course do blow them sometimes.

It cracks me up, I just do a mental head shake and eye roll, when co-workers who I know are better at IV starts than me, blow it but say to the patient, "Oh I hit a valve, I got in, you can see the blood, we just can't always see those pesky valves etc." I honestly wonder to myself if the nurses say that to assuage their own ego? Or do they say it to reassure the patient "my technique is beyond question, you just had a pesky valve in the way".

I have started enough IV's, I know how it feels, the catheter advances, the fluid runs then stops, etc. when you hit a valve. To me it an IV acts and feels different with you hit a valve versus you just blew it. We all know, these nurses sometimes even say, "sometimes you can float the catheter past the valve." I think they just blew it.

I always tell the patient if I blew it. I just say I blew it, sorry. I assure the patient if I don't see what really looks like a good vein for my second attempt I will ask a co-worker to start the IV. It isn't written in stone, but we try to limit attempts to two sticks.

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Agreed. Pesky valves my arse. You blew it, you should own up to it.

I'm usually the one that gets called after someone has tried twice and not gotten it....and I'm gonna say this too....for crying out loud, if you are no good at starting IVs and the patient looks like a hard start, will you PLEASE not stick both ACs and blow those before I can even get into the room?

(My own personal pet peeve -- can I tag along on your rant?)

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DebblesRN has 16 years experience and works as a Registered Nurse, Nursery/NICU II/L&D.

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I can say that in my ten years of starting IVs, I have encountered veins that blow when you hit a valve. Sometimes, you can poke through them, sometimes, you can float the catheter in while you flush, sometimes, you can only get the catheter partway in and it isn't going to budge anymore, and sometimes, you blow the vein.

I always apologize, and try to explain if the vein does blow because I feel bad for the patient and don't want them to feel like I am playing pin cushion with them. I think it also makes the person who has already stuck twice feel a little better that hey, it's not their technique, it's the anatomy. It has nothing to do with making myself feel better.

Everyone has an off day starting IVs. It's frustrating.

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11,542 Visitors; 1,037 Posts

Well said Deebles, I agree and this is after 30 years of it lol.

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I work on a pediatric unit. I can't tell you the time we spend just looking for an IV site sometimes. There are nurses better than me. If I don't see anything I dont' stick. It takes at least 2 nurses sometimes 3 nurses to start IV's on infants and children. Talk about time consuming. We wouldn't make it without teamwork. Someone sets up the room, someone put's in orders, then at least 2 of us start the IV. One to start it, one to hold the pt still.

I've hit valves and I blow veins. The times it goes off without a hitch I count as my lucky day. I do also think you just have off days. Not sure why.

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I currently work on the IV/PICC Team at my local hospital. I know that a lot of the times we can tell if we hit a valve or if we just simply blew the vein. sometimes you can pop through the valve and be fine. other times, when you pop through the valve you blow the vein as well. If you haven't blown your vein and you are just unable to advance your catheter, sometimes you can push the plastic catheter in past the valve if you pull your stylet out of the plastic catheter (if that makes sense?). other times you if you pull the stylet off of your catheter and leave it in place and you have blood flow, you can attach your flush and try to flush the valve open while you hold tension and advance the catheter through the valve.

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IVRUS has 32 years experience and works as a Clinical Infusion Specialist.

20,125 Visitors; 1,020 Posts

Just a rant, where I currently work we do a lot of team work, yeah!!!!:) One nurse might be doing the paperwork, the other starting the IV.

At other jobs I used to float a lot, went through times of seldom starting IV's to my current position where we start IV's a lot. I overcame my 90% psychological, 10% technique related, issues about starting IV's. I feel comfortable now but of course do blow them sometimes.

It cracks me up, I just do a mental head shake and eye roll, when co-workers who I know are better at IV starts than me, blow it but say to the patient, "Oh I hit a valve, I got in, you can see the blood, we just can't always see those pesky valves etc." I honestly wonder to myself if the nurses say that to assuage their own ego? Or do they say it to reassure the patient "my technique is beyond question, you just had a pesky valve in the way".

I have started enough IV's, I know how it feels, the catheter advances, the fluid runs then stops, etc. when you hit a valve. To me it an IV acts and feels different with you hit a valve versus you just blew it. We all know, these nurses sometimes even say, "sometimes you can float the catheter past the valve." I think they just blew it.

I always tell the patient if I blew it. I just say I blew it, sorry. I assure the patient if I don't see what really looks like a good vein for my second attempt I will ask a co-worker to start the IV. It isn't written in stone, but we try to limit attempts to two sticks.

Ahhh, BUT IT IS WRITTEN "IN STONE"... You see Infusion Nurses Society (INS) sets standards for Infusion Therapy and one of their standards is that one nurse should make NO MORE than two Venipunctures on one patient and there should be NO more than TWO floor nurses who try to get the IV catheter in before a Vascular Access Nurse, or other infusion expert is called. (So, 4 total tries)

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akulahawkRN has 3 years experience as a ADN, RN, EMT-P and works as a Emergency Department RN.

27,136 Visitors; 3,435 Posts

I spend quite a bit of time looking at all the options before I stick a patient even once. It's far better to poke around with a finger to find the vein and where it goes. Then when I do grab a catheter, I know where to poke and in what direction. Just the other day I had a patient (or 3) tell me that they were a hard stick. With a little persistence of looking at all options, I found some veins that were less traveled and quite large. Between the 3 patients, I stuck them a total of 4 times. It's not that I'm that good, it's that I'm just persistent in looking for veins. I'm also well aware of my own limitations and I will not poke a patient if I can't feel anything.

Oh, and that one missed IV? That one was a wide but very shallow vein. It felt like a big pipe, but it was really nothing more than a slightly inflated ribbon. When a vein isn't willing to play with me, I tell the patient that, apologize for it and the fact that I'm about to poke them once more. My goal for IV starts is very simple: One stick, One working IV. Usually that goes according to plan.

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