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Discussion

Venipuncture competency

I got my ADN in 2011. I have very little clinical experience. I landed a wonderful job in an ambulatory care center and am responsible for starting IVs on our patients in preop. I have been in this capacity for 18 months. My IV skills don't seem to be reaching the point where I feel certain I can stick everyone. Our clinic only has about 9-12 patients A MONTH that need IVs for general surgery. In my 18 months, that amounts to about 216 venipunctures, 90% of those performed by me. I don't have records for successful sticks, but believe I was successful 85% of that 90% or 165 sticks. I still have trouble palpating a vein, and prefer to choose one that is obvious VERY OBVIOUS. Should I focus on continuing to practice and increase the number of sticks, or is there a competent feeling that you get after so many years, months, sticks? I feel very frustrated and INCOMPETENT. Have talked to the supervisor, she thinks I should have more certainty by now.

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    Eh, it is difficult to get IV's in dehydrated people to begin with, even if you do it daily. Especially when it needs to be a larger gauge, and only in the right hand.

    It is not reflective of the practice of IV's as a whole.

    Is there someone there who has had more experience? Ask for pointers. Is there an IV team in the partner hospital? Ask if you can shadow them one Saturday.

    Is there an ambulance company or fire department with Medics nearby? Ask for some tutoring.

    Always, always learn to feel. It should feel like a rubber band--in mildly dehydrated people, not so much a taut rubber band, but you can feel it.

    When someone has been NPO for 8+ hours, it can be challenging, but feel for the vein. Make sure you position well. Curl those fingers around your own. Hands are valve heaven. Start looking at forearms, if your policy permits--wrists and A/C's are usually a no-no, but see what you can do if there's just no access. Hang that hand down, agitate with the swab, and wear a size smaller gloves as to really be able to feel well.

    You got this, and best wishes!

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    Take home a tourniquet, and start getting handsy with people you know. Get used to feeling for veins. It does take practice, and it does click with time. Remember not to go for what you can SEE, but rather, for what you can FEEL. Are you able to practice on coworkers? Sometimes that can be very helpful.

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