Starting IVs!!!

[nurse4theplanet, RN]

I am working mostly weekends as a nurse tech in the ICU. Since I have been there I have witnessed on two different occassions different nurses trying to start an IV. Each time the nurse threaded the entire length of the needle into the vein, obviously piercing through the vein, only to flush the IV and have it infiltrate. On both occassions these nurses blamed it on the patients veins and tried again only to get the same result and have to call someone else. I knew what was going on and felt horrible for the patient but I was too timid to try and correct the nurse. After all I am no IV expert myself and have not done any for several years until today. I had a very edematous, small veined geriatric pt today and I was nervous but I performed the skill exactly the way they taught us in school and had no problem getting a good line. Now I wish I had said something or offered to try to get the IV myself. Do you think that this would offend these nurses? Don't nursing schools unilaterally teach that you stop inserting the needle when you see flashback and then thread the catheter the rest of the way in? I hate to come off like a know it all, especially being new but I hate to see a pt be stuck multiple times and end up with lots of large, painful hematomas. Any advice?

[lpnstudentin2010, LPN]

I as a patient would be thankful if you said something. I HATE needles and if i need to be stuck multiple times used to get mad a the nurse even though i now realize that i should not blame them

[nurse4theplanet, RN]

i also want to add that I do understand that it is necessary sometimes to stick pts more than once....I watched as they had to stick my grandmother nine, yes nine times.....then we finally begged for a central line....but the nurses' technique was right on, my grandma's pressure was so high she was blowing them left and right. But these nurses techniques were so off that even if the pt had dream veins they would have been punctured.

[meownsmile, BSN, RN]

I dont think it would have been out of line or misconstrued as being a knowit all. Fact is,, sometimes you can hit your mark and sometimes you cant hit the broad side of a barn. I dont care how long youve been doing it.

Actually after the second attempt you should find someone else to try. Handled the right way, the nurses shouldnt have had any problem stepping aside and letting you try at least once.

[Antikigirl, ASN, RN]

I go half way or more being very cautious and slow...feeling everything I can via that cannula. I use my flush to help guide the cannula in the rest of the way...better to use a cannula than the needle at this point! I have yet to blow a vein this way!

Also depends on the person...elderly and fail vein tend to do better with this method..where as strong young folks (adult) tend to do better with a further stick then cannula advance. Also totally dependant on size of needle! Heck, if I know blood will not be needed, I tend to go smaller because my chances are better :).

I also take a warm wet towel, wrap that around the arm where I want it...cover with chucks...this really works well (vs other methods of heating). I use to do warm towels...but there is something to be said of warm moist getting to larger deeper veins!

ALSO..feeling is more a part of IV starts than seeing! The more superficial the vein, the more it is in tuned with moving...makes sense really...those veins move more because they are nearer to manipulation being so superficial! :)...

I too subscribe to the one strike your out theory...or sometimes I do two..but no more!

[Lorie P.]

standards of care say 2 sticks and that is it.........if after 2 attepmts and the nurse doesn't get it some one else should try...... i only stick my pt's 2x and if for some reason i don't succeed i get another one to try.

also for some strange reason, i usually get the very tiny viens that no one else seems to be able to get.....so my charge nurse and i have this deal..........if she sees a small one she will get me to try and if i see a large fat one......she usually gets that one.......so far none of our pt's have to be stuck more than 2 max of 3 times......

iv is a hands one and the more ya do the better you iv skills get.

just my 0.2 :wink2:

[purplemania, BSN, RN]

No, we do not get enough practice, in my opinion, on how to start IV's. Plus there are some people you can't teach anyway. They already know it all.

[KatieBell]

Were they, by any chance, foreign grads? WHen I worked overseas, ALL the nurses inserted IV's that way. Not surprisingly some of them were extremely proficient at starting IV's and some were not.

It was the way it was taught in many places in Africa- because in many places, they did not have the over the needle catheter, just a needle.

[Antikigirl, ASN, RN]

You want to know who to learn from??? PARAMEDICS/EMTs..anyone that can start those during a extracation or in the back of a bouncing ambulance ROCK!

Trust me, I learned from them!!!!!!!

BTW I am in chat if anyone wants to join in! :)...Just be patient since I am also responding to threads if no one is there

[caroladybelle, BSN, RN]

i also want to add that I do understand that it is necessary sometimes to stick pts more than once....I watched as they had to stick my grandmother nine, yes nine times.....then we finally begged for a central line....but the nurses' technique was right on, my grandma's pressure was so high she was blowing them left and right. But these nurses techniques were so off that even if the pt had dream veins they would have been punctured.

Please do not judge until you have walked in the shoes for a very long time.

Nurse frequently get taught different techniques...and are successful with those techniques. Just because they were not, does not mean that they have not generally been okay in the past. Which is why most of us will stick once or twice and then have someone else try.

I seen many nurse (IV team) use that and be successful. Especially, with some of the so-called safety cannulas that cannot be manipulated or will shred the cannula, once the needle has even slightly been withdrawn.

If you had said something, you would have probably been considered a knowitall, and it would not have been apreciated. One day, you will be on the other side, where you have trouble hitting an easy vein, with your tried and true technique, and somebody says the same to you.

[vampiregirl, BSN, RN]

You want to know who to learn from??? PARAMEDICS/EMTs..anyone that can start those during a extracation or in the back of a bouncing ambulance ROCK!

Thanks for recognizing EMT's IV skills :). You know what though, I've learned a few of my tricks from ER nurses.

[lpnstudentin2010, LPN]

Thanks for recognizing EMT's IV skills :). You know what though, I've learned a few of my tricks from ER nurses.

learning from eachother that is awsome