Unsuccessful IV stick.

Published

I tried my first IV stick this week and I didn't get it in. I actually went under and to the side. :( I didn't even feel comfortable with the site but the instructor insisted that I pick between the antecubital and the cephalic vein above the wrist. I wanted to choose the metacarpal vein that I had picked out but the instructor thought it might be too small. The thing is, I could see it and feel it, so I felt better about it. I couldn't feel the cephalic vein, and I couldn't see the antecubital, so how was I to pick? I chose the cephalic vein because at least I could see it. I got really nervous and just wasn't sure I could make it in but I tried anyways, and I didn't make it. It has knocked my confidence level down quite a bit. I had 2 other opportunities to get an IV in during the day but once I saw the veins, I didn't think I could do it. I am really discouraged right now. I just need a bit of encouragement, I guess. Everyone else who tried had a successful stick and I'm feeling a bit like a loser right now. My instructor says I get first dibs at IV's next week. I am working myself into a fret over it. I certainly don't want to keep putting holes into people that go nowhere and serve no purpose!

Specializes in LTC/Behavioral/ Hospice.

Thank you all so much for your encouraging words and advice. :) You have really made me feel more confident about going at this again on Wednesday. Now all I need is someone with hoses for veins and the willingness to let a student nurse practice on her/him! :chuckle

Up Vote Up Vote ×
I'm one of those annyoing people who just has a knack for starting IVs; I'm not sure what it is or why it happens, it just does.

One thing I have noticed is that new nurses or nurses who have trouble starting IVs don't take their time...they tend to go for the first thing they see. I'll often put on the tourniquet and then take some time to just look, tap around on a few areas, etc. Also, if I don't get an immediate flash, I don't pull the cathlon out right away; sometimes just taking a minute and repositioning is all it takes.

But I would say the one thing that has really helped is to just take your time. It doesn't take any longer to look around for a bit than it does to just stick the first thing you see and then have to stick the pt. again...and at least in my case, I often save my pts another IV start.

This is good advice. I also sometimes will wrap a pts arm with a warm blanket as I get my stuff ready.

It seems like I never miss in the ER or when I have to go to start IV's on CT scan pts. But the OB's . .. maybe because by the time they need an IV it is when they are in pain and we are going to do an epidural. I miss more in OB than anywhere else. Our OB patients don't get an IV unless it is a pit induction or epidural. Normal deliveries - no IV.

Good light is another thing.

steph

Up Vote Up Vote ×

One other thing I forgot...ask the pt. if he's had IVs before, and if so, if one arm was better for "sticking" than the other. And if the pt says, "My left arm is better than the right," BELIEVE him!

I can't tell you how many times I've seen nurses ignore this, go ahead and stick someone several times on the "bad' arm, then have to ask someone else to try, and that person gets it on the first stick...on the arm the pt said was best. I don't care if you see pipelines...if the pt says it's a bad arm, better to believe him than stick several times and repent later.

I just had this exp. a few weeks ago; I told the nurse my R was better than the L, and that usually L arm IVs blow right away, if she even get one in at all. Of course, she was just sure she saw something on the L, stuck me, and you guessed it...nada. So she wound up looking for another spot on the L arm, and I finally said, "Look, I don't want you to try again on that arm. Use my R arm." Will wonders never cease...that IV was fine.

Make sure you select the appropriate gauge IV; don't try to put an 18/20 in a vein that won't support an IV that big. If you need a larger bore IV, then make sure the vein is big enough...don't try to put it in the smaller hand veins.

Try having the pt take some slow, deep breaths while you're starting the IV; guided imagery works well for some, too.

Up Vote Up Vote ×
Specializes in LTC/Behavioral/ Hospice.

Thank you fab4fan. :) This may sound dumb but if I need to get an IV into an antecubital fossa, how do I guide a 1 1/2" catheter into a vein that I can't see? That vein actually was bigger but I didn't know where to direct the catheter! I was afraid that I would infiltrate. ???

One other thing I forgot...ask the pt. if he's had IVs before, and if so, if one arm was better for "sticking" than the other. And if the pt says, "My left arm is better than the right," BELIEVE him!

I can't tell you how many times I've seen nurses ignore this, go ahead and stick someone several times on the "bad' arm, then have to ask someone else to try, and that person gets it on the first stick...on the arm the pt said was best. I don't care if you see pipelines...if the pt says it's a bad arm, better to believe him than stick several times and repent later.

I just had this exp. a few weeks ago; I told the nurse my R was better than the L, and that usually L arm IVs blow right away, if she even get one in at all. Of course, she was just sure she saw something on the L, stuck me, and you guessed it...nada. So she wound up looking for another spot on the L arm, and I finally said, "Look, I don't want you to try again on that arm. Use my R arm." Will wonders never cease...that IV was fine.

Make sure you select the appropriate gauge IV; don't try to put an 18/20 in a vein that won't support an IV that big. If you need a larger bore IV, then make sure the vein is big enough...don't try to put it in the smaller hand veins.

Try having the pt take some slow, deep breaths while you're starting the IV; guided imagery works well for some, too.

Up Vote Up Vote ×
Specializes in long term care.

Don't get discourgared. I have been an RN for 3 1/2 years and somedays I can't hit the broad side of a barn. This was only your first attempt. Keep practicing and it gets better. Just don't give up. Keep thinking to yourself "I CAN do it".

Good Luck!! :saint:

Up Vote Up Vote ×

Some of it is just getting familiar with the venous structures, good old A&P. I also palpate the vein as far as I can feel it. Sometimes I will stick just a little below where I first feel the vein, advance a little, and then when I get a flash, then thread it.

But I would suggest that you first get comfortable with starting IVs on veins you can see and palpate; then start trying to tackle the ones where you have to go by feel only.

If you have an IV team, ask if you can spend the day with an IV nurse. Or see if you can spend the day in day-surgery; they start lots of IVs there. If you can't do that, then ask your NM to have you do any IVs that need to be started, and ask your co-workers to do the same. It's hard to get comfortable with starting them if you only get to do one here and there.

It takes practice, practice, practice. And patience, patience, patience.

Up Vote Up Vote ×

Oh yeah, and if you can, find a patient who's some big macho guy to try on - a lot of the time they like to feel they're being helpful AND show you they can stand the pain all at the same time. You miss, they'll go "That's okay, honey, go ahead and try again," or else they applaud like fools when you get it, and either way you leave feeling pretty happy.

Up Vote Up Vote ×
+ Join the Discussion