Vent: "I should warn you, I'm a tough stick..."

Specialties Emergency

Published

Seriously? If I had a dollar for every time I heard this and got it on the first stick, I'd be retired.:smokin:

Specializes in Emergency, Med/Surg, Vascular Access.
I just wish I could start an IV with confidence. Lately, I haven't been able to stick anything. I am a fairly new nurse and always try, but I am thinking I will never get it.

I am a new ER nurse, and a new nurse in general. I passed boards last month. I am horrible at IVs. :[ And my preceptor is not keen on letting me try more than once on a pt. I guess that's good for the pt., but it's not good for me. Out of like 7 or 8 attempts so far, I've gotten 2. I've honestly thought about quitting over it. If I can't start an freakin' IV, I feel like I don't have any business being an ER nurse. blah

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Specializes in Urgent Care NP, Emergency Nursing, Camp Nursing.

One the sources of this problem is the fixation many practitioners outside the ED have for starting IVs in the AC. When I did my internship in the ED before I graduated from nursing school, I very quickly learned to look all over the arm for veins - usually, if someone has crappy ACs, they'll have nice hands or forearms. The only time I insist on an AC is if I think the pt will be going for a PE study (or if the doc has added one on and I don't already have that kind of line). The only time outside of a PE study that I insist on 20g or better is for blood administration or high-volume fluid resuscitation. If I had a dollar for each time those two "rules" got me a line on a patient who was supposedly a hard stick, I wouldn't be retired yet - but my student loans would be much smaller :-D.

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Specializes in ER.
I just wish I could start an IV with confidence. Lately, I haven't been able to stick anything. I am a fairly new nurse and always try, but I am thinking I will never get it.

time and practice will lead to expert IV skills in time. Don't worry. I can remember that fear that I had when it was all new to me .... good to remember that.

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Specializes in ER.
I just recently had blood work done. The nurse asked if my veins were little or rolled. I told I did not know. But have been told that my veins are not agreeable to needles. Did not help that I was a weenie too.

She surmised that they were small and rolled. But I will never admit that. Whoever is sticking will figure it out. Besides, I am too busy making a face from getting stuck.

rolling veins are such an excuse. When patients say that, you remember it's a matter of firmly anchoring that stinker above and below where you plan to stick. The veins are usually large when they're also "rolly" - which is actually easier to get. My own experience it seems that these "rolly" vein people perhaps have less birfurcations than others... maybe that's an issue, but you can access any vein with the proper approach/prep/angle/anchor, etc. Many times I use the tourniquet above and below my insertion site to really pop it up. An old phlebotomist taught me that and for REALLY challenging patients, it is definitely a technique I use.

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Specializes in ER.
I would take it as a compliment. I always tell nurses that I'm a tough stick because I am. I also am much, much easier to get on my right arm... yet half of them will still do it on my left arm because the vein looks easier to get. Yet, they always end up on my right arm lol. I took a phlebotomy course and got stuck at least twice a week.... trust me, I'M A TOUGH STICK! lol

veins are usually more prominent and therefore easier to access on your dominant arm.

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Specializes in Emergency, Pediatrics.

I have to agree with the OP's VENT! I can't believe how many times I've already heard that, "I'm a tough stick." Recently, I had a lady who had some tough veins but we got her IV started on the 2nd attempt. She went on and on about her poor veins and how much she went through then asked the ER doctor if he'd order her a port so she wouldn't need any more sticks. I just had to turn around, walk away, and smile. She was there for an allergic reaction. No terminal or serious illnesses. Oh well.. they make our days interesting.

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I do not consider myself a hard stick if a 22g is used instead of a 20g. The last time I went for an MRI, I let the nurse know that the 2 previous MRIs were completed with a 22g instead of a 20g and the physician did not complain about the results of the test. When she looked for herself she recognized that I had small veins. She thanked me and got a 22g in after the first attempt. The last time I had surgery the anesthesiologist had to put an IV in my ankle. I also can not have art lines in either radial artery and the last two times they tried to put CVLs in my right jugular it took multiple attempts. Luckily I was in surgery and did not feel a thing.

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lol....

I try two times and hit them with an I/O before they get too fussy.

By the time they've seen the Black n Decker cordless drill it's in...

(3 words though: lidocaine, lidocaine, lidocaine) ;)

Oh lord stop it w/ the I/O. So many better ways to place intravenous access than DRILLING into someones bone! Have you ever had to remove one? Have you had to take care of a little girl after an amputation because of an I/O placed in the ED? Seriously think hard and long before breaking out the cordless drill! Invest in an ultrasound so you can visualize the vessel, you would be amazed at the amount of veins someone has that are just lame and lazy cause of dehydration! I saw that if their fingertips are pink then they got blood to them somehow...can't argue with that.

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Specializes in Emergency Dept. Trauma. Pediatrics.
If I had a dollar for every time I said that and a nurse rolled her eyes, and then had to stick me eight times before calling in a SWAT nurse to do it, I'd be retired.

Amen to that. Meanwhile I look like a shoot up with all the needle scars on my arms and nurses mad because their pride got hurt when they couldn't get the stick and they were one that can always get it. :rolleyes::rolleyes::rolleyes:

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Specializes in Emergency Dept. Trauma. Pediatrics.
I just wish I could start an IV with confidence. Lately, I haven't been able to stick anything. I am a fairly new nurse and always try, but I am thinking I will never get it.

It seems to me that it's always a crap shoot. I used to be really nervous and now I go in knowing I am either going to get it or I am not. But I am not going to beat myself up if I don't. It happens. Sometimes even though the vein looks beautiful and you do everything right you don't get it. Sometimes you do. Sometimes you don't feel anything and someone else feels it right away. My proudest moment was getting it in a 2 year olds foot. It was the only place left because she had severe burns on her upper extremities and it was her 3rd IV, she had one in her opposite foot the previous day she pulled out. She was a screamer and a fighter and kicker and man she was strong. Got it in right away first try. If I was capable of doing a cartwheel I would have done 3. lol

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Specializes in Emergency Dept. Trauma. Pediatrics.
One the sources of this problem is the fixation many practitioners outside the ED have for starting IVs in the AC. When I did my internship in the ED before I graduated from nursing school, I very quickly learned to look all over the arm for veins - usually, if someone has crappy ACs, they'll have nice hands or forearms. The only time I insist on an AC is if I think the pt will be going for a PE study (or if the doc has added one on and I don't already have that kind of line). The only time outside of a PE study that I insist on 20g or better is for blood administration or high-volume fluid resuscitation. If I had a dollar for each time those two "rules" got me a line on a patient who was supposedly a hard stick, I wouldn't be retired yet - but my student loans would be much smaller :-D.

Funny enough when we would get patients from the ED one of my pet peeves was the AC IV's when there were lots of other nice veins. (I really like the side of the arm). Always ended up having to redo those IV's because they were constantly getting messed with from the arm bending which caused the pumps to constantly go off, or we had to board the arms which my patients hated. That and having kids sent up with koban sp? on. Things I said I will try my darndest to avoid when I get in the ED. Now I will see if I can stick to not doing it.

Also on my unit we had to do a lot of sticks, one we did all labs on kids, not the phlebotomist, field sticks were only good for 24 hrs so we had to change those ones and we often had to put them in the kids because they couldn't get them in the ED. It wasn't uncommon for us to go down to the ED to do an IV or them to bring the kiddo up to us to do if we only had 2 nurses on if the kid wasn't going to be admitted.

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Specializes in Trauma, Teaching.
Funny enough when we would get patients from the ED one of my pet peeves was the AC IV's when there were lots of other nice veins. (I really like the side of the arm). Always ended up having to redo those IV's because they were constantly getting messed with from the arm bending which caused the pumps to constantly go off, or we had to board the arms which my patients hated. That and having kids sent up with koban sp? on. Things I said I will try my darndest to avoid when I get in the ED. Now I will see if I can stick to not doing it..

Lots of nice other veins don't always work for some of the tests we do. Having to stop and go back and restick someone because they ended up needing an AC line for the third time that night.... after awhile you learn to just go for the AC the first time. Also, we rehydrate a lot of people and send them home, and that AC runs really well, as well as getting labs drawn easily. Sometimes those other veins show up much better after I've dumped a liter or two into the AC, suddenly ALL those veins are very accessable, where they weren't before.

Yes, I know I can get blood off other sites, and run fast IVs in the forearm, but in the long run, that AC will remain my favorite. I've worked the floors, and the ED; we just have different priorities and needs.

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