Venipuncture IV Skill nervousness

[genhen]

I'm a second semester student and just had my first lecture on IV's. After that, we went to skills lab where we attempted to venipuncture on a mannequin. According to the instructor, you should feel the resistance when you go through the vein wall into the vein. I tried a couple of times and couldn't "feel" that although I made it into the vein.

We have to do two sticks on fellow students this Friday and two more the following Friday. After that, on Saturday, we bring in four volunteers or "victims" to stick. Then, we move on to clinical in which we need to start 6 IV's. I'm ready to go back to skills lab on Monday after lecture on work on my venipuncture skill some more with the mannequin.

I'm kinda nervous about starting IV's and I was wondering if anybody else was trippin about it also. Some advice from people who have already done this would be cool also.

Peace

Genhen

2nd Semester Student

[Daytonite, BSN, RN]

Hi, Genhen! I was an IV therapist for a number of years. I was trying to think what might help you feel what this resistance feels like as a vein is punctured. I think I might have a solution for you. You will need either an IV device or just a plain old needle on a syringe and some rubber gloves or cheap-o balloons you can get at any supermarket toy aisle. If you put some air into a rubber glove and tie it shut (don't make it too bulging with air) and then insert the needle into one of the fingers or even the hand portion of the glove, I think you will get the idea of what that resistance kind of feels like. This might also work if you shove some cotton into the finger of a glove and then insert the needle through the rubber. At least you won't hear the popping sound and disturb others around you. Do it a couple of times with your eyes closed and really concentrate on paying attention to what you are feeling in the tips of your fingers, then in your fingers themselves that are holding the piercing device as you do this a number of times. Don't ram the needle in, but push it ever forward just so gently until that "pop" occurs. The resistance of the rubber will be pushing back at you at bit, just like with a real vein, but a bit stronger than a real vein. Remember that a real vein will be maintaining a blood pressure that will be the resistance pushing back at the tip of your needle. Now, in a human being, that "pop" as you pierce the vein is not something that you really hear, but the vibration of this traumatic event, or "pop", will be transmitted through the IV device and felt by your fingertips and fingers that hold it. People with thicker walled veins add an element of more resistance as well. Then, you will get little old people whose veins are like tissue paper and the IV needle will just slide right into their veins without you feeling hardly any resistance at all. I've actually started IV's on big burly men where I really had to push hard to get through those veins of theirs. Then, I've also had little old people where I really felt no "pop" at all and had to depend on my eyes to tell me I was "in". Let me assure you that the veins in those dummy arms are usually made out of some kind of plastic, so that the resistance and "pop" just aren't there. They are mainly designed to withstand hundreds of sticks by students.

[JenNJFLCA]

Just tell yourself that's it's no big deal & that you CAN do it. You don't want the pt to know you're inexperienced (and nervous) and talking yourself up can actually make you more successful. Confidence goes a long way!

[Future_Nurse_Natalie]

I was wiggin out about it before I did it for the first time. I had only done Virtual IV so I really had no idea! I just talked it thru in my head, took a deep breath, and amazingly got it on the first try!!! I love giving them and now volunteer to do them every time. It's actually fun so think about it that way. Good Luck!

[DutchgirlRN, ASN, RN]

I've been doing them for 30 years and still love starting IV's. They call me the "IV Guru" on the third floor. I have never felt any resistance when hitting the vein? The only thing I concentrate on is seeing the flash of blood so I can pull the touniquet off. The major problem I had in the beginning was going too much at a 30% angle instead of almost level with the skin. Quick initial stick, flash of blood (hopefully), pull the tourniquet, advance the catheter.

I learned without gloves and I have to feel the vein. I cut the finger off of my "feeling finger". As soon as I have it threaded and the hub taped down, I take off the glove with the cut off finger and quickly slide on a new glove before connecting the J-loop. It works great for me. Good Luck, you'll come to love starting IV's.

[Achoo!, LPN]

I have been doing venipuncture for years. I am nervous about getting the angle right for IV's since you have to be much lower. It's not so much finding a vein, but threading it without blowing it. Any suggestions?

[Daytonite, BSN, RN]

When you tell me that your veins are blowing when you try to thread the cannula only one thing really comes to my mind. That is, that you are not completely in the vein. Once you hit the vein, get blood return and lower the angle of your needle, you need to push the entire unit forward about an eighth or a fourth of an inch very carefully. That assures that both the tip of the stylet AND the cannnula are both in the vein. If only the stylet has gone into the vein, when you withdraw it, the vein blows because the cannula wasn't in at all. You have to visualize in your mind that you are putting a rigid piece of metal (the stylet) into a tube (the vein). It has to be a perfect fit. For this reason you need to be attentive to the angle of your insertion device and the actual location and run that the vein takes.

[Achoo!, LPN]

Thanks for the advice :)

[KatieBell]

I know what your instructor is talking about. Very few new IV starters feel that "pop" but after having done a lot, I feel it when I am in the vein. When I first started doing IV's I didn't feel it, but after doing a ton each day, I started to have that feeling of the difference between being in the vein and being under the skin...but it is hard to describe....

You'll get it. Remember that being able to start an IV is great, but again it is the thinking about where to put the IV, when to discontinue an IV etc that is what makes you a valuable nurse.

[SunshineBaby]

I got to start my first IV on a patient this week! At our school, we aren't even allowed to practice on each other or volunteers. So, I had only done it on the rubber arm. Then the nurse I was shadowing in clinic told me a patient needed an IV and to go get my instructor to supervise. I was sooo nervous. We are also required to wear gloves to feel the vein. The patient was so nice. I confided in him that I had never done one and he just smiled and said he trusted me. *LOL* I got my nerves under control and I got it the first time!

You'll do fine. Being nervous is completely normal. Just be confident in your skills, remember what you have been taught, and don't forget to breathe.

[smilin_gp]

Wow, I wish we had any IV experience at my school. We had the lecture, and nothing else! Guess I'll have to get these skills in practice.