Starting IVs!!!

nurse4theplanet, RN · Jan 28, 2006

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.

One nurse was from Canada but she was extremely knowledgeable...a real sharp cookie. That's why I asked about consistency between institutions. As far as I know nursing schools are similar if not more advanced in Canada. And the other nurse was from up north (her accent really stands out in TN:p ). I don't think it has anything to do with where they are from. Each used a 22G IV start needle...the kind that are about 2 inch in length with the button that automatically retracts the needle. And each time they threaded the needle completely into the vein to the base of the catheter. They both seemed completely baffled that they did not get the line, so I assume they were instructed differently or they may have been misunderstood.

nurse4theplanet, RN · Jan 28, 2006

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so-called safety cannulas that cannot be manipulated or will shred the cannula, once the needle has even slightly been withdrawn.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.

That is exactly why I said nothing. What do I know right because I have no experience. I haven't walked in their shoes for a very long time. But I do know that it is common sense....if you stick a needle completely through the vein you won't get a line. But I will continue to keep my mouth shut in case I encounter a nurse like you that will think my interest is in showing how much I think I know instead of sparing the patient needless multiple sticks.:)

caroladybelle, BSN, RN · Jan 28, 2006

That is exactly why I said nothing. What do I know right because I have no experience. I haven't walked in their shoes for a very long time. But I do know that it is common sense....if you stick a needle completely through the vein you won't get a line. But I will continue to keep my mouth shut in case I encounter a nurse like you that will think my interest is in showing how much I think I know instead of sparing the patient needless multiple sticks.:)

Since I do not stick people more than twice ( I generally get mine on first tries), it would be irrelevant per sparing needless sticks.

But as a traveler, I know that going in to a place, thinking that my way is the only way, is certain to alienate fellow staffers, and is highly unlikely to change their practice.

They first have to see that I know what I am doing, then observe me to improve their own practice.

It is like religion...if you shove it loudly in their face but do not display it, people are alienated and will avoid you and you will garner few positive results. But if you display it quietly and confidently, those that are likely converts will be drawn to you and more likely believe what you say.

clee1 · Jan 28, 2006

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

Uh huh!

Once you've done a few hundred in a bouncing, vibrating helicopter, you can start a 14ga in a coffee stirrer.

nurse4theplanet, RN · Jan 28, 2006

Since I do not stick people more than twice ( I generally get mine on first tries), it would be irrelevant per sparing needless sticks.

The needless multiple sticks occurred with the nurses that I am posting about. The comment was directed towards my experience with them only, not encompassing you or other nurses in some general assumption. I don't understand your point.

But as a traveler, I know that going in to a place, thinking that my way is the only way, is certain to alienate fellow staffers, and is highly unlikely to change their practice.
They first have to see that I know what I am doing, then observe me to improve their own practice.

I am certainly not trying to alienate anyone, hence the reason I posted my experience here to find advice about how to approach the topic. I never said that I think my way is the only way. I did say that what they did was incorrect for the patients in these situations. It was so obvious that the needle had gone completely thru the vein yet they seemed oblivious. Being a traveler and being a nurse tech are two different functions. I do not have a license and I am following an RN to observe and learn. It is uncomfortable to be in a situation where you feel it would be in the best interest of the patient to correct the nurse, but at the same time you do not want to offend the nurse who is helping you gain experience. It is even more disheartening to see a response that seems to pass such judgement on my intentions and attitude.

It is like religion...if you shove it loudly in their face but do not display it, people are alienated and will avoid you and you will garner few positive results. But if you display it quietly and confidently, those that are likely converts will be drawn to you and more likely believe what you say.

I don't think that this is anything like religion but if that is the analogy you feel comfortable with then so be it.:rotfl: If you read my posts more closely, I think I made it clear that I was way too timid to correct either of these nurses or offer to try myself out of fear of offending the nurse or seeming like a know it all. I wasn't shoving anything loudly into anothers face. I can display my skills confidently over time when I am afforded the opportunity, but it does not resolve the immediate situation at hand. My concern is being able to have intervened in the moment to prevent the patient from having to be stuck multiple times while not offending my nurse. So if you have any advice for how I should have handled the situation, should it arise again in the future, rather than telling me that I would have come off as a know it all and should not shove my ideas in others faces and alienate my coworkers...please feel free to share.

zacarias, ASN, RN · Jan 28, 2006

When I had to do an IV for the first time on a patient at my first job, the nurse wanted me to advance the needle all the way in. I did only because she was insistent. I did get the IV but in the future, I always did the way I was thought originally. In just till flash, advance slightly, and then retract the needle threading the catheter all the way in.

mayo6 · Jan 28, 2006

Well, I know my 2 cent is not much but, I wish we did have more practice in starting IV's but we don't. And if you think for one minuete that the nurse wants to hear your two cents then you are prob. wrong. In times like that, all you need is support. We, that means you and I and the rest of all nursing students need to hold our tongues until we have been on the other side of the bed. In our last 8 weeks we get to say where we want to have clinicals as far as departments so you can get more experience that you need.

MsDemeanor · Jan 28, 2006

Personally, I think those nurse would find it amusing and entertaining on a good day that a student would want to enlighten them...even if you are correct. On a bad day?

I realize you are only trying to help, but that would be the role of the charge nurse, educator, or the manager.

Really I must agree with Carol- none of us really know exactly what that nurse was doing, until you have done it 100-200-300 times. Even then, it is pretty hard to really tell what someone is doing/feeling when inserting an IV just by watching. I've many a time misjudged a poor Paramedic students IV start and told him/her similar things, about pushing through a vein, only to go and have the same thing happen on the same patient with a different vein. Through that, I've learned to be very careful about things I see and what I say.

At times I insert the catheter the entire length, This is so I can approach a very short vein and have the catheter seated properly. No, this is not the best approach, but it is a good one for specific patients in specific situations....

One thing that would be interesting would be to say, "I noticed you threaded the entire needle, is that how you were taught?" Or "I noticed you threaded the entire needle, whats the advantage in that?" You might be surprised at their reasons.

And for sure the baffeled look comes from having a technique that has worked well in the past. I know because I have had it a few times on my face, when sticking an easy vein and nothing comes out. It happens to everyone once in a while. If these nurses always missed IV's there would not be that look of absoloute surprise on their faces....It only comes from being a pretty decent sticker and flubbing it. :chuckle