Trying in vain to get in a vein

[robinbird]

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.

[Super_RN, BSN, RN]

Find a willing and easily stickable co worker and practice on them! Not only will you not be nervous about not getting the "patient", they'll be able to give you some pointers while you try.

9 times out of 10 I float my lines in vs. advancing all the way before flushing.

[sage2320]

There are some great tips in this thread! For those nurses who float their catheter in, how do you do that while holding onto the catheter with your dominant hand? Is your IV line already attached to the catheter directly? How wide do you open your line to float the catheter in?

[robinbird]

Thanks to all who replied. I can't wait to try your suggestions. I'll let you

know how it goes.

Robin

[iluvivt, BSN, RN]

The most common mistakes I see are

1. failing to further advance the catheter/needle once a flashback is observed...so as ER RN so beautifully described....once you see that flashback drop your angle so your device is flush with the skin then advance ever so slightly..about 1/8th an inch then pull the needle back hopefully blood will still be coming through the device...what product are you using.????.there are some special features to some I can tell you about

2. DO NOT start at a sharp angle most veins can be easily hit with a no higher than about a 15-20 degree angle and those are the deep ones. I see a lot of RNs do a through and through puncture

3 Site selection and vein selection is critical...avoid areas of flexion..the numberONE area for lawsuits is the wrist especially the volar surface AVOID IT...stay away from the wrist at the area of flexion along near the radial nerve side...IF you have to go for it......FEEL IT and go A FEW CMS BELOW it in the hand or above the area of flexion...be very careful with vesicants like Dopamine and Levophed and 3 and 5 percent NS and Calcium preperations (CaCl the worst)...if you start an IV at an area of flexion for these or the hand the extravastion is worse..ask for a Central line once the emergency is over...YES there is the technical skill to it....but it is much more than that you have to know what you are going to ADMINISTER AND THE BEST Way to do that to avoid patient injury...and I have seen some horrible things that should have bben avoided had the nurse used better judgement. I may get blasted for this as a lot of nurses do not realize this...but try to avoid the ACF..these are really blood drawing veins.....if you must use them re-site to a suitable location as soon as able..that is the AVA and INS recommendation

4. Apply warm packs and use gravity to your advantage,a BP cuff pumped up to slightly below pts diastolic also is a great trick

5 Please have someone really GOOD at it teach you before you start poking pts....I sit down with nurses and we do dry runs on an our anatomical arms.

[Super_RN, BSN, RN]

There are some great tips in this thread! For those nurses who float their catheter in, how do you do that while holding onto the catheter with your dominant hand? Is your IV line already attached to the catheter directly? How wide do you open your line to float the catheter in?

I have a saline flush attached to my pigtail, so when I get my catheter in, get flashback, I advance just a tad more then pull the needle out with my dominant hand--then I attach the pigtail with my dominant hand and flush and it floats right in.

[melsman1904]

I had the same types of problems you are describing early on. I rectified it by asking my fellow nurses to allow me to try every IV on the floor until I was more comfortable. I understand that time may be an issue in ER, but volunteer to do as many as you can. I'm still not an ace yet, but my hit/miss ratio is improving steadily. Good luck!