Starting IV's

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We're starting IV's on each other this week and i'd like to ask you guys for some tips. We practiced once on the dummies but I know it will be way different when we start it on each other. We need 3 successful tries before the second semester in January. Thanks a lot!:)

Specializes in ER, PACU.

To the students who are worried that they are not learning how to put IV's in during clinicals...

In my school we were not allowed to stick each other in lab or anything like that, so we couldnt learn there, and we were given "student nurse guideline" packets by the hospitals we did clinicals in that specifically stated that students were not allowed to draw blood or start IV's and if you were caught doing it you would be dismissed. I was very dissapointed that I was not going to learn this in school and thought that it would be a great disadvantage when I was going to look for a job.

Turns out it really doesnt matter, I was still hired in ER as a new grad, and they knew that I had no experience starting IV's.

The truth is, a skill like this is just what it is..A skill. Anyone can be trained to do it and with practice you will get good at it. What is important is your nursing knowledge that you are gaining as an RN. The skills will come with time.

Specializes in LPN.

As an LPN, we never learned IV starting in school. However, on the job, we have an IV inservice every year. We all have to start on IV on each other each year. If you are really really the need for torture, you can repeat the class as it's offered semi-annually.

Specializes in Trauma ICU, MICU/SICU.
My school doesn't teach us how to start IVs. :imbar

I hate to hijack a thread, but is it just my school or what? Anyone else have to learn this skill OJT??

We also will not learn how to start IV's in school. It is illegal in PA for anyone but an RN (I think, maybe LPN's can as well) to start an IV in hospital. We won't even learn venipuncture. I'll learn that in my new job as a tech in December though.

Specializes in Emergency & Trauma/Adult ICU.
We also will not learn how to start IV's in school. It is illegal in PA for anyone but an RN (I think, maybe LPN's can as well) to start an IV in hospital. We won't even learn venipuncture. I'll learn that in my new job as a tech in December though.

Suemom2kay,

I'm also in PA ... we learn venipuncture & IV starts in critical care. I've already done venipuncture in my job as a tech ... I was really "behind" other techs who are students at another nursing school in my area - they learn venipuncture much earlier in their program. If you have a source of info about the illegality of students or others starting IVs in PA, could you send me a PM? Thanks much.

Specializes in Trauma ICU, MICU/SICU.

I don't have any concrete information re: IV starts. Its just what I've been told. Perhaps I've misunderstood and its a school/hospital policy. All I know is that its out of my control so I'm not sweating it.

Specializes in CICu, ICU, med-surg.

We learned how to do blood draws and IV starts during our first semester. Talking with other students, my understanding is that this is pretty unusual. The nurses during clinicals are always surprised when we say that we are allowed to do these sorts of things.

To add to the first post about applying good tourniquet.....Also, "milk" the arm first and then quickly apply tourniquet. This helps even more to distend the veins. If you still see nothing, apply a very warm towel or IV bag (after removing tourniquet of course!) and come back after 10mins or so, then try again. Don' forget, there is another arm! Check them both. Don't feel rushed to choose a site because it is better to spend a few extra minutes ensuring your success then to stick and stick someone. Oh, and close your eyes and feel every persons arm (family, friends etc) that you can so that you learn to "feel" for the veins, not look. SG

I actually wouldn't mind letting one of my classmates stick me - but we're not allowed to do invasive procedures on each other. We checked off on IVs with a simulated arm - had its own veins and red printer ink "blood." I had a nervous breakdown in my IV checkoffs, but that's beside the point. Did my first venipuncture in clinic today, and it went quite well - I was SO nervous, but it wasn't quite as frightening sticking someone as I thought. I'll be giving my first shots tomorrow at the flu shot clinic we're doing. :)

I have a ton of tips, but I'm on the way out the door to pick up my kids. I'll try to post again later, but here's one that comes to mind..

To avoid blowing elderly/fragile veins, use a BP cuff (inflated to about 100 mmHg) instead of the tourniquet. Also seems a little more comfortable on the patient since those rubber tourniquets can pull arm hair/snap! Youch!

cool! thanks manna! i can't wait for more tips. we're doing it tommorrow afternoon so wish me luck!

Specializes in Emergency, Trauma.

The ONLY way to get good at IVs is to do it over and over, no matter how many good tips you get- there is just a feel to doing it that comes with practice.......but as far as finding veins, BP cuff as a tourniquet works wonders, as does gravity (letting the extremity dangle over the edge of the bed), warm compresses help.

The elderly pts that have these huge prominent veins- they sometimes look great, but when you palpate, they just don't have that nice bounce and just feel flabby, those are the ones where it's best not to use a tourniquet- they just end up blowing, especially if they're on coumadin.

Obese pts (especially women for some reason) usually have reasonably sized veins in the upper arms, even as high as near the shoulder.

Although a VERY tender area, inner aspect of the wrist usually yields something.

I know lots of nurses hate to see IVs in the AC, but when you'rs just learning, it's alot of times a "can't miss" spot that lets you get the feel of putting in IVs, builds your confidence to working up the the more difficult sticks. When I first started, an older nurse told me to just put a 20 in the AC in everyone- It worked, I was able to do this on most, so I became comfortable with my technique and then branched out to other veins.

For IVs in the hand or wrist, don't put your tourniquet way up high, put it in the middle of the forearm.

If the pt says they're a hard stick, ask them if there's a spot where other nurses have had luck with. If they're truly a hard stick, they always remember where someone found a vein in the past. I can't tell you how many times a pt has been able to show me where their one hiding vein is.

LAST resort (if pt not diabetic or with PVD) look at the foot and ankle (depending on hospital policy)

Biggest rule of all, do not go by sight..go by FEEL.

Specializes in NICU.

Great advice, everyone!!

Good luck tomorrow! Let us know how it goes.

Have done so many IV's, could not count in my 20 years... but am rather good at it... the anesthesiologist in my OR come to me for their difficult patients.. I learned many years ago that tournaquet placement is very important...about 6 inches above your target site...... ( exception are the elderly with fragile veins)... the second step is the most important one..... PATIENCE..... so many are in a hurry and don't wait long enough for the veins to distend.... I don't mean 10 minutes of obstructing blood flow..... but wait and watch until you can feel your vein... use your fingers and get familiar with the anatomy of the arm... alcohol swabs used as a friction can help them distend....I like to have my patient hang their arm over the side of the bed for about a minute.. then I tournaquet it while in that position... it works very well. When you find your target..( I strongly believe in using a local... it's just the nice thing to do.... if your unit does not allow it, ask your director if she would support your training to use it....) appproach the vein slowly and wait for your flash back.... make sure it's a good one... and then thread carefully... many a vein is blown by not taking care when threading..if you are unsure or it does not thread due to a valve.. use your IV fluid to guide it in... anyway... it's worked for me for a long time now.. I use warm moist wash rags sometimes before I put the tournaquet on... especially if I know it's going to be difficult... and one more thing... if you think your catheter is the problem.. which many times it is... some are just plain easier to use than others... ask your director if your hospital has others available... One area in your hospital that you can become proficient in IV insertion is the Same Day Surgery Unit.. our hospital trains our newly hired nurses in that settng... one stick right after the other...my final word of advice... don't try to put an 18 in a 20 vein.... you'll be sitting there all day....... and don't waste an 18 vein using a 22 ..... GOOD LUCK

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