Tips for starting an IV?

Ortho_RN · Apr 1, 2004

I dont have any tips.. I just wanted to say.. If you miss several don't feel bad... I have good days where I get everyone and I have days where I can't get any.... Just try your best..

Good Luck :)

ljr3000 · Apr 1, 2004

First of all you are going to be alone without and instructor looking over your shoulder. That is wonderful.

Make sure you raise the bed so you are at a comfortable level. Get all of your stuff together; tubing with saline connected for flush, tape, lot of alcohol pads. Put torniquette ?sp on and look for a good vein. Some people feel them but I am one that prefers to see them. Go at an angle right under the skin, if you don't hit it the first time you can pull back without coming all the way out and move it around a little. If you do see a flash of blood slowly thread the catheter in. Before you take it apart to connect the tubing be sure to take off the turniquette this can build up blood and spew it. I always pull the cath out right to the end and have my tubing ready to quickly attach. Then flush a little with saline to make sure you are in the vein and it doesn't blow. The skin will puff up if you are not in. If it flushes well then put your dressing on and congratulations.

The first time I did one by myself I forgot to take the torniquette off so when I pulled out the cath to put the tubing on a lot of blood came out. LOL

OH and the alcohol pads are very useful in case a little blood does get out as you are connecting your tubing. Alcohol soaks up the blood wonderfully.

Good LUck!! Let me know how it goes.

Long Term Care Columnist / Guide · Apr 1, 2004

First of all, take it slooooooooow........this is a skill that requires time, patience, and LOTS of practice to master. And even later down the road when you are more proficient, there will be days when you can't hit the broad side of a barn, let alone a spindly, dehydrated vein with a 24 gauge needle! :chuckle

I subscribe to what I call Zen IV starts: first I collect my thoughts, then go in to visit the patient and tell him what I'm going to do. Only then do I begin prospecting for an appropriate vein; once I find some possibilities, I gather my equipment, turn up the lights, and wash my hands. I usually consider IV starts a sit-down performance, although I've been known to do them practically standing on my head if need be in order to get a line in quickly. :) I also bring a Chux to put under the patient's arm to protect the bed linens (pts. on anticoagulants tend to bleed no matter how well you occlude the vein).

If the pt. is a "hard start", or dehydrated, or very large, I'll use a warm moist pack on the prospective site for 10 minutes or so to encourage the veins to come out of hiding. A good vein will be both visible and palpable; it will be plump and elastic to the touch, not rubbery....you'll pick up the "feel" of it as you practice on a variety of subjects. Of course, you'll sometimes have to go by feel alone, and sometimes you'll be deceived by what looks like a great vein but has valves that you'll bump up against and be unable to advance the catheter, or worse, runs away and hides!

Once all is ready---vein and catheter selected, area prepped, tape and transparent dressing opened, IV bag hung and tubing primed etc.---I stick the needle in, bevel up, at a slight angle, depending on the vein (the antecubitals, as well as veins in an obese patient, tend to lie deeper below the skin's surface than, say, those in the hand or wrist), then lower it to where it's almost parallel with the skin surface and advance the needle smoothly until I get good blood return. Once I'm in, I slide the catheter itself further in while at the same time removing the needle.....otherwise, it's too easy to go all the way through the vessel wall and blow the vein. Then I occlude the vein with my non-dominant hand while I attach the tubing and flush solution, take off the tourniquet or BP cuff, and flush to make sure the line is patent. Next comes a strip of tape to keep everything in place, the transparent dressing, and more tape to secure the site and the line. Finally, I start the drip itself and watch the patient for a minute or two to see if he tolerates it well and to catch any trouble before it gets out of hand (yes, you can have what looks like a perfect start, and the next minute you've got infiltration).

Now, it takes longer to tell it than it does to actually DO it.......it usually takes me less than 5 minutes from stepping into the patient's room to documenting the start on the IV flow sheet. But in the beginning, you'll want to take your time, and in the meantime the Intravenous Nurses Society has all the info and helpful hints you could possibly need.......they are THE experts in IV therapy, and they are continually developing new and better standards of care.

I wish you luck. You'll do fine, I'm sure.......just don't get discouraged! It took me six YEARS to finally get comfortable with IV starts---I used to be scared to death, avoided them like the plague, and would always ask another nurse to do them for me if my patient's veins didn't stick up like ropes. But in the PRN position I'm in a lot of times, I could no longer avoid IVs.....and as I did more and more of them, I got to be pretty darn good, and now I'm one of the go-to people for the entire hospital when a hard start comes up. I'm proud of that. And you will be too, once you get past the fear and master this task that is as much an art form as a skill. :)

belladelicious · Apr 4, 2004

Update...I got it first try baby! It was a lot easier than I thought. And I wasn't nervous at all, and that morning I thought to myself...I'm going to get the first one. And luckily I did.