Tips for IV starts

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Any tips for getting better at IV starts? I have been on my own for 3 months and have hit 2 IVs. I know it's a basic technical skill, but I am not doing well at them. I don't like causing my patients extra sticks. I'll take technique tips, "old nurse tips" or any tip to help me start hitting them. Thanks!

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Here are some old threads to get you started. There's been a lot of information written in these threads.

https://allnurses.com/forums/f18/iv-tips-tricks-3793.html

I particularly like Post #50 by teeituptom on this thread. It is "Vision the Vein, Be the needle" After 30 years of starting IV's I gotta say that this is so very, very true.

https://allnurses.com/forums/f224/bad-sticker-needs-help-122091.html

https://allnurses.com/forums/f8/iv-help-specific-questions-about-insertion-site-advancing-118999.html

https://allnurses.com/forums/f224/starting-ivs-116506.html

Outside of that it takes practice, practice, practice. Good luck.

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I read through some of the "old threads"....they are great! Most facilities now use IV catheters with retractable needles. Insight Autoguard, "IAG" is a fairly popular product in the field. BEWARE! You MUST go in SLOWLY with this type of catheter and come in at a lesser angle to avoid puncturing the back of the vein wall. Once you see the "flash", go almost parallel to the vein and advance VERY slowly. It was a very difficult transition to IAG's for myself and other coworkers who had learned with "jelcos". As for size: I work Urgent Care and routinely use a 20 gauge for rehydration. When the patients condition does not appear very stable, I use a 16 or 18.

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I read through some of the "old threads"....they are great! Most facilities now use IV catheters with retractable needles. Insight Autoguard, "IAG" is a fairly popular product in the field. BEWARE! You MUST go in SLOWLY with this type of catheter and come in at a lesser angle to avoid puncturing the back of the vein wall. Once you see the "flash", go almost parallel to the vein and advance VERY slowly. It was a very difficult transition to IAG's for myself and other coworkers who had learned with "jelcos". As for size: I work Urgent Care and routinely use a 20 gauge for rehydration. When the patients condition does not appear very stable, I use a 16 or 18. :rolleyes:
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Specializes in Neonatal ICU (Cardiothoracic).

The problem I had to overcome when starting IV's [i start mainly on 24-34week preemies] is that I would get all excited when I saw a flashback and instantly advance the catheter. You have to drop the angle of the needle and insert it a smidge further. Also make sure your catheter hasn't slipped over the end of the needle before you insert it, or it'll snag. I tend to go by sight, but then I always stick babies who have tiny veins to begin with. Stretching the skin helps, and keeping it wet with alcohol helps too. I am now convinced that a 24 gauge IV can fit into any vein no matter how small! I've stuck a baby's thumb vein with a 24g before! Also remember that we all have our lucky and unlucky streaks. I can get 5 in a row, and then miss 5. IV's are weird like that!

Good LUck!!

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Specializes in NICU.

Going to endo, to start iv's, for the next two days. I hope I get at least a few sticks. I will let you guys know. Yes, I think the older threads were very helpful. I will do my first one on a real person tomorrow.(hopefully) I am crossing my fingers.

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The problem I had to overcome when starting IV's [i start mainly on 24-34week preemies] is that I would get all excited when I saw a flashback and instantly advance the catheter. You have to drop the angle of the needle and insert it a smidge further. Also make sure your catheter hasn't slipped over the end of the needle before you insert it, or it'll snag. I tend to go by sight, but then I always stick babies who have tiny veins to begin with. Stretching the skin helps, and keeping it wet with alcohol helps too. I am now convinced that a 24 gauge IV can fit into any vein no matter how small! I've stuck a baby's thumb vein with a 24g before! Also remember that we all have our lucky and unlucky streaks. I can get 5 in a row, and then miss 5. IV's are weird like that!

Good LUck!!

:bowingpur

Steve, you rock! I don't think I could hit those little premie veins. Anyway, you give good advice, that is why most new folks can't start their IV's. Must drop the angle! Also, I use a couple of techniques that I think help you score. (Like the carpenter's rule), it pays to look twice - stick once. In other words, don't feel bad about spending a little extra time finding the best vein their is to offer. Then the other thing I do was taught to me by a CRNA; first, get that arm dependent, milk it a few times and then slap on the tourniquet. Alcohol is great to help show you those veins too. good luck! SG

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Specializes in Med Surg, Hospice, Home Health.

biggest thing is take your TIME! If the patient is right handed, try to place in left arm...if patient is possibly going to need a CT with contrast, the bigger the better...

a straight vein is easier to hit than a crooked vein

linda

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Specializes in med/surg, telemetry, IV therapy, mgmt.

An IV should never be placed in a crooked vein. It will go phlebitis on you very rapidly. The vein cannot assume it's normal position with the straight cannula within it. The cannula then irritates the internal wall of the vein with the patient's arm movements and a phlebitis develops. What you can do is place just the very tip of the cannula in a straight area of a crooked vein and tape it very well so it doesn't shift and check it frequently for infiltration. If a cannula is within a vein, there is no law that says you have to shove the entire length of the cannula into the vein. Warning, however, is that other nurses coming after you may take the site apart, thinking the cannula is sliding out and, god-forbid, slide it up into the vein and re-dress it. Best to clearly mark the clear dressing noting what you have done, or cover the site with enough gauze to cover the exposed cannula to discourage others from trying to "fix" what they might think is a problem.

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Specializes in Trauma/ED.

Hope I'm not repeating someone but I've always found on a difficult stick using a blood pressure cuff as a tourniquet inflated enough to prevent venous return but not to inhibit arterial blood flow, also using a heat pack helps a lot by relaxing the vein causing it to dilate...I have found with these tricks, taught to me by a 30yr IV therapy nurse, I haved been able to hit veins that have been missed by numerous nurses.

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Specializes in ER/ICU/STICU.

I would also add to start with the bigger veins in the AC to practice. These veins are usually popping out and are easier to hit. As you get better and you get your technique down, then start moving down the arm to smaller veins.

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Practice Practice Practice! Search out all IV starts and try. Rely on feel, not look. With hard sticks some of their best veins are not visable to the eye, yet are like pipelines. The best veins are bouncy, if visible you dont want to stick in a y. You will probably hit a valve. Confidece is also key. If you think you can do it you will more often. After prepping site find the right angle that works for you for insertion, stabalize the vein. Once needle is in and you see flash advance just a little more before retracting needle. Apply pressure to site just above insertion site(this should prevent blood flow all over until you can attach flush) Hope this helped a little- let me know. Good luck

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