Starting IVs

rachel0609, ADN, RN · Jun 17, 2014

Anytime there is a IV needed offer to do it. The more you practice the more you will feel comfortable with it.

RNlove17 · Jun 17, 2014

Im in the same boat. RN a little over a year and only a handful of IV starts. We don't learn in nursing school and I was not given training at my 1st job. I've learned hands-on from other nurses. But I feel like there's techniques and tips I'm missing. Plus I went per diem there so now it's been quite a while and I definitely couldn't do it on my own anymore.

amoLucia · Jun 17, 2014

Does your Staff Development Office have an IV arm simulator to practice on? I know it's not really close to the real thing. You could also just slip a tourniquet on some volunteer's arm and JUST LOOK for veins. No actual sticking, just looking!

For me, I always found the search for a vein the hard part. That and when I would have to pop the tourniquet, connect the tubing to the catheter, open the flow clamp, tape, etc. All the manipulations. My hands would shake and my fingers would be like sloooow to move. I could do the stick and the advancement well enough.

Another tip - always set up your stuff like your tape and opsite, etc. and always have plenty of stuff handy so you don't have to run out of the room for another catheter, more preps, etc. Get in the habit of picking a safe spot for the used stylus. NEVER plop it in the bedding, lest someone gets stuck or you forget it.

And don't feel rushed. I've started a gazillion IVs over the years. An extra 5 minutes to prepare helps to keep calm.

Scarlettz, BSN, RN · Jun 17, 2014

Thanks for the tips so far! I work on a crazy busy medsurg floor. So, I think that might be half the battle. When I inserted my 24 g, I was floating on a slower paced floor where I could actually relax and give it my all, lol.

A former coworker told me he practiced on a dummy arm provided by a previous hospital educator. I think I am going to get in contact with the current educator and see if it is something that is available to practice on. I am also thinking about asking some coworkers (who I know are good at sticks) to help me out.

Lucia...I find the search for a good vein a difficult part, too! And RNlove, I feel like I am clueless on basic tips and techniques I am missing too!

When you see a promising vein... where do you stick it? Close to the beginning of it? The middle? Angles? Tips! Please.

icuRNmaggie, BSN, RN · Jun 17, 2014

Ask an ICU nurse if you can start IVs if one of their intubated and sedated patients needs one.

That way you won't feel like your hurting someone while you learn this skill.

akulahawkRN, ADN, RN, EMT-P · Jun 17, 2014

Where I stick the vein really depends upon where the vein is located and whether or not it's likely to roll. Generally I try to stick as distal as possible so that I have LOTS of room. Sometimes I'll stick right on top of the vein, sometimes I'll start to one side. If the vein's going to roll I'll definitely anchor it on one side and then stick on the side just opposite where I'm applying the traction. This way if the vein's going to roll, it'll roll right into the angiocath. Once I'm in the vein, I'll advance about the same distance as the bevel to ensure that the bevel is completely in the vein and then I'll advance the catheter. A very, very few times I'll have perforated the other side of the vein, but usually the bevel (and tip) is in the lumen and then I can simply advance the catheter right to the hub without difficulty.

If I've pre-set all the supplies, it only takes a few seconds to remove the introducer needle and put the extension set or primary IV tubing on the hub and secure it. Usually it only takes about 2 drops to do it... and both normally get handled quite handily by the sterile 2x2 that I put under the hub before I remove the needle.

As to technique, there are lots of videos out on Youtube that show you how to do it... but the more practice you can get, the better. If you can't get live sticks, use a mannequin if available. If that's not available, your next best option is to find a willing volunteer for feeling veins and use mental imagery (rehearsal technique used by many athletes) to practice.

amoLucia · Jun 17, 2014

When starting IVs, I select veins more distal (lower) on the arm and then work my way up. But when selecting a vein, you need to see if there might be some 'knots' that might be sclerosed. You'd have to insert above that 'knot'. Otherwise, you may not be able to advance the catheter or blood flow will be blocked. It takes practice selecting a good vein.

My favorite tip - you can also apply a WARM moist compress for a few minutes to help dilate the vein. NOT HOT! I resort to this many times. It really, really does work. I'm sure there's info in IV books and on YouTube re needle angles.

You also need to know what gauge needle is appropriate. A #24 is a tiny needle and it may not last if there's freq ABTs to infuse.

Everybody develops their own technique. It comes with time & practice. Good luck!

amoLucia · Jun 17, 2014

Just checked out YouTube - they have lots of stuff including comments/tips by readers. Informative.

Make sure you always date your IV site. That way staff can tell when it next needs to be chgd.

One last thing - make sure you're following your facility's P&P; I'm thinking about how to dress the site (and the change dates). Some places use little gauze 2x2s, others use opsite. I freq had to change the drsg upon admission to my NH because the admission nurse didn't.

Our P&P required opsite. It also gave me the chance to observe the insertion site.

iluvivt, BSN, RN · Jun 19, 2014

One way I always learn well is to do the research first. First, buy a beginners IV therapy book. If you start out with an advanced one it may turn you off because you would be a bit surprised on how in depth IV therapy can be. I would start out with his one

Amazon.com: I.V. Therapy Made Incredibly Easy! (Incredibly Easy! Series®) (9781605471983): Lippincott Williams & Wilkins: Books.

Once you have accomplished that it will be a lot easier because you will have a knowledge base that you can then add to. You will see that the administration of IV therapies,the establishment of IV access and the maintenance of VADs is more complex than at first blush. You need this valuable information so that you can practice it and provide the standard of care because once you are practicing that is the standard that you will be legally need to uphold.

Next, read all of the policies and procedures at your facility. You can compare those to the current standard and then get an idea if they are fairly up to date and consistent with good practice.

Next, seek out individuals that can train you in the practical application and clinical skills you will need to be a success. It will take longer and be a more frustrating process if you are trained by someone with so so skills.

By the way, you always want to use the smallest shortest cannula that will meet your patient's needs so bigger in this case is not always better. A 24 gauge may have been fine as long as the patient did not need something larger for surgery,a viscous medication or a CT scan power injection as examples.

This is a skill set, a set of materiel and body of knowledge that you will acquire little by little so take is step by step and DO make you business to seek out the education because it will serve you very well in your career.

Do-over, ASN, RN · Jun 19, 2014

Practice, and don't rush.

Get comfortable and take your time. Every vein is different, so is every patient, obviously.

classicdame, MSN, EdD · Jun 20, 2014

arrange with your supervisor and a nurse on another unit to let you hang with them, paid or unpaid, in a department where there are plenty of IV's started. In my hospital that is ER, Same Day Surgery, GI lab and Cath Lab. I have arranged for nurses to go there for practice and, after a few hours, they feel much better about skills. Good luck! If you do not work in a hospital you need to make sure co-workers call on you till you get this skill down to a science.