Trouble with starting IV's

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I am in fourth semester and have had six attempts to start an IV, but I have yet to successfully start one. My first attempt was the only time I have come close, I got flashback so I was in the vein, but the catheter wouldn't advance, my instructor even tried to push the catheter in the vein and it wouldn't go. It was my first try so I didn't think much of it and I was really excited about it and couldn't wait for another attempt. But each attempt I get I find myself getting more and more disappointed in myself. This semester I had two attempts with one instructor and then I got two attempts with another. When I got a second attempt with each of those instructors and when I was unsuccessful I couldn't help but feel like I was letting them down, like you let me try a second time and I still can't get it. The last time the instructor even suggested practicing on the practice arms like we did learning the skill. I just don't feel that would help because they are nothing like a human arm. I don't need remediation because I know the skill, but I just can't get the needle in the vein. Each time, I get the needle next to the vein but when I try to stick the vein it moves away from the needle. I am probably the only student in my class that has had this many opportunities, but I still can't get it. I am so frustrated with myself.

Specializes in Med/Surg, Academics.
Hospitals are no longer getting paid after a medicare patient in their facility gets a CRBSI.

It wouldn't be too far off to say that a lot of CRBSI's come from nurses not following the basics that we did learn in nursing school or duing orientation: scrubbing the hub, not touching the insertion point once you've scrubbed the area with CHG, ignoring routine site changes per policy, ignoring tubing changes per policy, improper PICC line dressing changes, etc. It's not that the most nurses aren't experts in IV therapy; it's that they are too lazy to follow basic infection control techniques with regard to IVs and PICC lines!

During our annual competencies, the IV certified nurses were harping on the basics because that's where the problem lies, not in the higher-level knowledge that they gained during certification.

Many students agonize over their lack of IV insertion skills. I did too, because I live in a state where it is against regulation for nursing students to do venipuncture. I have worked at my facility for one year and placed a lot of IVs the proper way. We have not had a single CRBSI on my unit, and none of us are IV certified.

If you gain a lot of practice during orientation and stick with the basics of IV insertion and assessment, a new nurse will do fine.

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Specializes in Clinical Research, Outpt Women's Health.

The point of this thread is to try to help the student who is asking for help.

I think it would be nice to not derail it like is being done and maybe IVSRUS could use her expertise to help this student.

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Specializes in ICU.
Wow... Ya think I am overinflating the importance of IV therapy because of my expertise in it??? Do you have the same view of your Infection control practitioners or your wound specialists? Your dismissal of its importance tells me that you might want to come sit in on a class or two!

No offense, but while I don't doubt I could learn a lot, I'd rather stab myself in the eye....

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Ok I will give you the advice that changed my whole iv experience. I got this during my er rotation from an er nurse of 20years. My school was all about "you have to see the vein and go at a 45 degree angle." I missed everytime. The er nurse told me to feel for the vein, hold one finger above the site you want to use one below to hold the vein still (not too hard tho), and position the needle like you are landing a plane with very little angle. (i wish I could show you!) Never missed an iv on first try since. Had prob on only one blood draw but it was a very dehydrated elderly lady and I still got half a tube when no one else could. I hope it makes sense to you

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Ok I will give you the advice that changed my whole iv experience. I got this during my er rotation from an er nurse of 20years. My school was all about "you have to see the vein and go at a 45 degree angle." I missed everytime. The er nurse told me to feel for the vein, hold one finger above the site you want to use one below to hold the vein still (not too hard tho), and position the needle like you are landing a plane with very little angle. (i wish I could show you!) Never missed an iv on first try since. Had prob on only one blood draw but it was a very dehydrated elderly lady and I still got half a tube when no one else could. I hope it makes sense to you

I never thought or was told to hold the vein in place that I wanted to stick. They want us to feel the vein and not just go by what we see. I know this is going to sound harsh but I think another problem I have is I am too gentle when going to insert the needle. One instructor told me that you have to kind of be force full when attempting to stick the vein because if you don't the vein will move to the other side. I know I have to learn this skill but I just have a hard time being that force full or moving the needle that quick in someone's skin because I know it hurts them. Thanks for the tip and thanks everyone else for the help.

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IV starts can be an art form. Keep in mind not all angiocaths are the same. You've only had a few attempts at IV starts... We all have been there and it takes time. I still miss veins sometimes, all nurses do. It's more about confidence. You have to tell yourself "I've got this. That vein is not going to get me". It's the lack of confidence that. Makes you miss. We all have off days! It's ok... Just practice. I like teaching people to practice ivs on me so I can critique and give suggestions. When you're in clinical, ask one if your preceptors to watch you and allow them to give you suggestions. Usually when you go next tons vein, it wasn't anchored properly. Sometimes you can't advance and need to pull back a little and float in in with a flush. Also, maybe ask if you can spend several hours in ER where a ton of iv starts happen so you can practice. One last note, you need to make sure you have the right size iv for the size if the vein . Sometimes the iv is just too big. Hope this helps and remember every nurse has been there. If they say they are perfect, they're lying. Lol. Good luck and just be confident!

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I am in my last semester of school....the only three opportunities I have had to start an IV were on A) an IV drug User B) A morbidly obese woman with about an inch on adipose tissue on her arms and C) and extremely dehydrated 10 yo. Talk about being set up for failure. :no:

I will continue to seek opportunities to start IV's and make sure I watch my base skills for aseptic technique. However it really depends on what area of nursing you go into as to how important having that skill is to you. If you are interested in Psych nursing IV's aren't as important as they are to an Oncology or ER nurse.

I am taking the try try again attitude for IV's right now and hopefully I will have a chance to improve those skills in practicum

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What frustrates me the most is it seems so easy but in fact it's totally opposite. When my instructor takes over to get it in there they make it look easy and I realize they have done hundreds of IV's so it isn't much of a problem to them. Since most of the time students have few opportunities during clinical to start an IV, I feel that since I have had so many opportunities that I should have it by now, but no. I get right next to the vein, but still can't get it in there.:( The next time I get an opportunity I'll try to forget all the past failures and just focus on feeling confident and say to myself "I can do this".

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Do you try a certain spot more than others? I find the hand and the ac have the best veins but are inconvenient to the patient. Most of my iv starts were in the er so I was able to utilize these spots more often. You say you are not forceful. Is it because you dont want to hurt your patient or is it because you are not confident? I was told by a seasoned step down unit nurse that the faster you go with the needle the less pain your patient feels. Do your instructors make you nervous? I feel I learned more from the floor nurses during clinical than my instructors. At my school they were more like drill sergeants who used intimidation to their advantage. They would belittle you in front of classmates and patients but boy do you never forget that lesson! Maybe you can ask to try an iv start with your floor nurse? I dont know what your state regulations are on that or if it would be an option. Maybe if your hospital has iv nurses ask to follow one for a day and pick their brain. I think it is a skill that can be done a bunch of ways but you need to find the way that works for you. In my experience in interviewing after school they do ask if you are okay with iv starts but I dont think its a dealbreaker. Hospitals around me no longer have iv teams but many still do so it may not be a big deal after you graduate.

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Do you try a certain spot more than others? I find the hand and the ac have the best veins but are inconvenient to the patient. Most of my iv starts were in the er so I was able to utilize these spots more often. You say you are not forceful. Is it because you dont want to hurt your patient or is it because you are not confident? I was told by a seasoned step down unit nurse that the faster you go with the needle the less pain your patient feels. Do your instructors make you nervous? I feel I learned more from the floor nurses during clinical than my instructors. At my school they were more like drill sergeants who used intimidation to their advantage. They would belittle you in front of classmates and patients but boy do you never forget that lesson! Maybe you can ask to try an iv start with your floor nurse? I dont know what your state regulations are on that or if it would be an option. Maybe if your hospital has iv nurses ask to follow one for a day and pick their brain. I think it is a skill that can be done a bunch of ways but you need to find the way that works for you. In my experience in interviewing after school they do ask if you are okay with iv starts but I dont think its a dealbreaker. Hospitals around me no longer have iv teams but many still do so it may not be a big deal after you graduate.

My instructors are not mean or intimidating for the most part, except for one last semester. But I did find that when I had a chance to do a half a day clinical in the ER with a nurse there I was more confident and felt more free because I didn't feel like the nurse was judging me or grading me. With my clinical instructors I feel different because they are grading you based on your performance, well anyway I'm sure you know what I mean. At the college I attend we are not allowed to practice real IV sticks, we use those fake arms. The spot I use is chosen by the instructor. I don't want to be forceful with the needle because I don't want to hurt the patient and that's the biggest reason, and because I'm less confident in myself because of all the failures I've had. I don't mean to keep whinning about my problems, it just helps to vent my frustrations and to get ideas and tips from people who have been in my shoes and truly understand.

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Specializes in Trauma Surgical ICU.

You will hurt your pt with an IV, making them walk after surgery, cleaning wounds etc.. Simply put, get over it.. I say this with a smile and from a loving place :) All of those things may be hurtful to some, bothersome for some or just uncomfortable etc but they are all "good" things for the pt. Have you ever pulled a bandage off really slow; hurts much worse than if you go fast right...Same with the IV. The tourniquet is the most painful part of inserting the IV once you get good at it.

Keep at it, don't let your fear get in the way. Find the vein and don't go too slow, the vein will move away from you.. Anchor it with your other hand and go in at about the same angle as the arm, once you get flashback, advance the needle a little further then advance the cath. If you go to fast you could go right through the vein, so keep that in mind.. When at clinicals, ask to watch your nurse do a few, then attempt as many as you can. You will get this :)

Also try youtube, might find some great videos to help

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Stabilizing the vein really helps imo (one finger above and one below the insertion site). Just be aware that some instructors will criticize you for a finger above the site as it is easier to accidentally stick yourself that way. You might want to ask if you instructor about it first. You can always stabilize with a finger below the insertion site. Apply slight pressure down and away from the point of insertion. You'll get it! 6 tries isn't a lot.

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