Trying in vain to get in a vein

caliotter3 · Feb 7, 2010

I suspect that you will get this skill down after any length of time in your present position.

allnurses Guide · Feb 7, 2010

Sometimes the choice of vein is as important as getting the needle in. If you choose one that becomes torturous or branches above where you're aiming, it'll be hard to thread the catheter.

There are any number of venepuncture courses you could take to make you more comfortable - it's really a confidence thing, and once you get one, you generally go on a roll!

mustlovepoodles, RN · Feb 7, 2010

I remember that feeling. I started out in L&D, where everyone gets an 18ga. IV catheter. That thing's a whopper. At first i couldn't hit a thing. I'd get the flash and then blow the vein. I finally figured out that if I pushed just a little further in after the flash and turned on the drip that I could virtually float the catheter in. After that I became one of the best IV starters on the unit. That really paid off when I went to NICU~ :cool:

Give yourself a break. You're not a bad nurse, you just have a learning curve. This isn't a skill you have developed and it takes some time. I daresay after you have stuck enough people you will hit your stride.

JulieCVICURN, BSN, RN · Feb 7, 2010

One thing that really helped me when I was new at it was taking off the tourniquet as soon as I got the flash, and then threading the catheter the rest of the way in. My ratio of blown veins dropped dramatically after I started doing that.

Emergency RN · Feb 7, 2010

to the op; i used to teach iv classes and your difficulty as describe is probably the number one first time iv starters road block. here is the way around it:

first, take a brand new iv needle out and look very closely at the tip of it. notice where the tip of the needle is, where the lumen within the needle tip is, and most importantly, where the catheter tip is. if you've examined it carefully enough, you'll soon realize that the catheter tip itself actually sits behind the needle tip by a few millimeters. :idea:

hence, what everyone here is telling you is that when you first see the flashback of blood, only the needle tip has entered into the vein; the catheter tip is actually still sitting outside of the vein. at this point, when you try to advance it, the catheter tip will simply push against the outside of the vein, and the vein will then slip off of the needle tip; you've just blown another iv start attempt.

:eek:

so, the way around this is, when you first see blood return, resist the temptation to advance. instead, your next move should be to align the shaft of the stylet catheter assembly to almost zero degrees in relationship to the vein, and then continue to advance the entire assembly forward into the vein, such that both the needle tip and the catheter tip is pushed forward into the vein. after doing that, ensure that blood return continues to be evident, then holding the stylet in place, advance the catheter part only. :up:

congratulations... you've just started your first iv. :yeah:

DogWmn · Feb 7, 2010

This otta be a sticky somewhere! Good info for anyone starting out or trying to improve this skill.

tewdles, RN · Feb 7, 2010

avoid starting just distal to any obvious valves...

MAISY, RN-ER, BSN, RN · Feb 7, 2010

Don't beat yourself up...it's a skill that requires practice and a "feel" for the vein-everyone has bad days-I have gone through veins I should have been able to access in the pitch dark due to their size!

ER generally uses large veins if possible-forget hands and wrists-go for the AC! Unless your facility requires larger than a 20g-I will use what is appropriate for the patient....so a22 or 20 is sufficient to get started....access is important-a second line or central line can always be inserted later if need be.

As for valves, you can't see them in the AC, but a big vein will usually float a catheter so it's a non-issue as it is in smaller veins.

Truly, best practices consist of placing the smallest gauge required to do the job along with starting distally...important for the floor....not even a consideration in the ER unless you know the pateint is coming for an IV infusion of antibiotics and not a life threatening emergency.

Don't worry....you'll be doing it in no time.

M

taz628, BSN, RN · Feb 7, 2010

I had the same issue as the OP when I transferred to the ER. I was trained to start IVs on my old unit, but working nights I rarely had a reason to start them. I'm not waking a pt in the middle of the night to rotate an IV (dayshift usually did it before I got in, anyway). So I was crud at them when I came to the ER. During my orientation they sent me for half a day with the IV team for a refresher course, is that an option for you, OP? It helped a lot, and one of the flex ER nurses works full time in PACU so she gave me some awesome tips. It took me a good 2 1/2 MONTHS to finally hit my stride with IV starts, and I've now been known to hit some crazy hard veins with success. :) Everyone around you had their own tips of the trade, find out what they are and make them your own!! Soon enough you'll lose that feeling of insecurity and do a happy dance every time you start an awesome line - I know I do. :)

Medic/Nurse, BSN, RN · Feb 7, 2010

this is a numbers game.

this is a technical skill and although necessary - it is a miniscule part of being a great er nurse. i have never known any er nurse that "washed out" of the er solely because they could not get the iv placement skill down. do them and it will come. with the right attitude and dedication - you will get this down!

after you get your system down - no defeating "self-talk" and go in there and get the patient "lined up"! great "technique" tips on here - not too much i could add.

everyone starts the same way. i know that each and every one of your co-workers were in the same spot at one time or another - so, they will all understand and i'll bet that help is yours for the asking.

get with the best iv folks in your er. ask for their help. i say get with a few supportive co-workers and ask if they will let you start iv's on their "routine" patients that are "easy" sticks. i know that time issues come up - but, be creative.

also, maybe you can "volunteer" to work op surgery and get all the lines in - these folks are usually healthy and hydrated, so they are often easy to get. likewise, i find that even venipuncture (not catheter placement) also helps hone the skill. do the am blood draws for lab if possible.

this is a numbers game.

do more - get better. after a few hundred, you will be a pro.

good luck.

Otessa, BSN, RN · Feb 7, 2010

Ok, so I've been a nurse for 4 years and just started working in the ER. I'm off orientation and I am doing fine except for one thing. Starting Iv's. Where I worked before, we had an IV team, so I never started IV's. Now, for the first time, i'm learning how to start IV's . Last night I was 0 for 4. I would find the vein, get as far as getting the flash, but then when I tried to thread the catheter I would meet resistance and would blow the vein. I tried twice on each of the 4 patients and I ended up having to have someone else come in and start the line. I was so frustrated by the end of the night, I was questioning my abilities as an ER nurse. I love working in the ER and I really want to learn this skill. Any tips or suggestions out there to help this struggling ER nurse would be helpful.

Are they leaving alone to start these IVs??? If they are they are not seeing what you may or may not be doing to get into that vein. It could be a technique issue that could be easily remedied with some mentoring.

otessa