IV Skills Help

[naturegirl]

I need some quick ideas. I seem to have hit a slump in my IV skills. I have an uncanny knack for finding every valve or anomaly lately. Where would you recommend I go to get back on track? I'm an Intermediate working very part time and also in a volunteer service. I don't have the luxury of someone standing over me helping me through every stick. Any ideas? Go to phlebotomy school? volunteer at the plasma center? I'm working on an A & P course but I need practical help. I am sure someone has had this problem before me. HELP!

[tskstorm]

Practice doesn't make perfect, perfect practice makes perfect.

Just keep at it ... in acute cases look in the AC, more often then not you can hit a vein there by pure dumb luck, in patients who are most likely going to be in the hospital try to avoid the AC, as the hospital will probably pull it and start a new one.

As far as anatomy of the veins itself, look and feel for it before doing anything.

Not sure what else there is to say. Try a hospital rotation in the ER? do some bloods?

Sorry if it doesn't help

[DwayneEMTP]

You know, I don't think anyone in the world could have sucked at IV's worse than I did.

I think in my first ten attempts during hospital clinicals I hit one! They even sent me home on one shift because they wouldn't let me try any more. :shock:

I asked for help, begged for criticism. But the feeling seemed to be “you can either do it or you can't.”

The only advice I got really was, “Quite being so timid, just stick it!” But I couldn't see how being more 'brute force' and less precise was going to resolve my problems. (It turned out I was mistaken)

On my first shift on the ambulance I was nervous as a one legged man in an ass kicking contest. The whole time my preceptor was yelling at me, and I couldn't hit anything! Finally I just got fed up, she was telling me what an idiot I was for taking so long (in different words, but that's an accurate paraphrase) so I just got a general feel for the vein and rammed the cath. And got flash! Taped it down and was good to go.

I thanked the God of fools and small children for a miracle, yet tried the same approach on my next IV. Get a general feel for the vein, and go for it without thinking very much, flash! I think in my next forty IVs I missed one and had to re-stick two or three. And several of the successes were on very heavy people where the anatomy was deep and the very mobile (to say the least).

Anyway, my point is that for some reason I seemed to just keep getting in my own way. Some part of my little pea brain seems to know how to do this if I just don't over think it. I'm now confident with every start. Maybe this will work for you, maybe not...I just thought I'd throw it out there.

Also, I spent a shift in endoscopy. My pharmacology instructor suggested it as the patients all do a cleansing the night before so tend to be a bit dehydrated. The theory being they are a little harder to stick, but you're surrounded by nurses that successfully stick them day in and day out. It was a great experience and very helpful.

I'll bet you'll find it will “just come together” all of a sudden. That seems to be a common thread to the 'learning' stories.

Good luck!

Dwayne

[Scaramedic]

The only advice I got really was, “Quite being so timid, just stick it!” But I couldn't see how being more 'brute force' and less precise was going to resolve my problems. (It turned out I was mistaken)

You know this one is just too easy.

[DwayneEMTP]

You know this one is just too easy.

Oh hell. :oops:

[fiznat]

IVs can be really tough when you are first starting. Don't sweat it if you are missing a bunch, because we all do when we are new to the procedure.

It may sound silly, but I honestly feel like self confidence is one of the most important components of getting an IV. Personally, when I don't think I am going to get a line- I often don't, regardless of anatomy. When I feel good about my IV sticks, when I know I'm going to get this line - surprise surprise - I do. Try to keep your head up. Be positive. Don't get upset if you miss a line, because we all do.

As far as practical advice, try a few different techniques on your next few sticks:

1) Try not going for the vein right away as you stick. Get your catheter under the skin first, and then go at the vein from the side. This helps with those "rolling" veins quite a bit, and to be honest I use this technique in the ambulance a lot because the needle is easier to control once it is under the skin. Start your stick a half inch or so distal to where you see the vein, then go right up towards it.

2) Try the other way: "stabbing the vein" directly with the needle as you enter the skin. This works especially well for deeper veins where you can't feel too well but can see the color of it. Try to be as exact as you can, and move slowly, because these deeper veins are harder to judge as far as depth, so your "X axis," as I like to put it, needs to be dead on.

3) Remember to keep moving the needle forward a little bit even after you see the flash. Keep in mind that the needle tip is longer than the end of the catheter, and you get flash before the catheter is actually in the vein. If you try to advance at this point, it will feel like you've hit a valve even though you haven't. Don't be afraid to keep going with the needle within the vein until you are able to feed the catheter to the hub.

4) If you need to use a tiny needle - #22 or #24 - remember to move really slowly. The bore of the needle at this size is really really tiny, and it will take longer than normal for flash to show up in the chamber once you have entered the vein. Make very small motions and have patience.

5) Don't worry too much about the patient's pain. I know this sounds like bad "patient-care" advice, but it is better that you just get the line (even after fishing a little) than have to stick them again. Apologize to your patients and thank them for being patient, but don't let your worry about their pain hinder your ability to get the line. Just get it.

Anyways, hope that helps. The key to all of this really is just to practice practice practice. I don't think I was really proficient at IVs until after my first 100 or 150 sticks. I know that is a lot, but it really did take that long before I felt confident about getting the line on just about every patient. ..And these days, when I do miss, it doesn't bother me that much because I know that the patient was a tough stick. No big deal. Keep at it man.

[naturegirl]

This is so helpful. I think that the self confidence is a big part of it. I got called on the carpet by my B supervisor over it and I'm glad now she took the I class because I can't wait to return the favor. I know they're tracking my stats and I think it's shooting my confidence down. I've down them successfully and I know I can do it. Medic school is a long way off to get those practical experiences. I think I'm going to go to the local medical assistant/phlebotomy school and ask the instructor for a little practical education.

My last one I thought was good until I ran fluids and nothing went. when I pulled the cath out I was obviously right where I should have been. I don't know why the fluid wouldn't go. I had the vein on the side of the wrist, no positional issues.

I will keep trying. Thanks for the ideas

[Dustdevil]

Good stuff! A lot of it is indeed head work. Both the psychological "attitude" part, like Dwayne addressed, as well as the process of deciding what your plan of attack is. As Fiz points out, there is no one approach that fits all sticks. There are several different techniques, each of which is appropriate for different situations.

I would say that it would be a lot easier to specifically address your problems if we knew what you were already doing. Without that, all we can do is give you a shotgun answer, which covers a little bit of everything, and you can see what fits with what you are already doing and what doesn't. As much as I would love to say for you to search for previous topics on this matter -- as there have been many, with much great information -- it probably wouldn't be easy to pick them out of the pack, as there is no real keyword to search that would single them out. We should probably take all the info from this thread and combine it into a Knowledge Base article for future reference.

Anyhow, are you having problems with all sticks, or just IVs? I mean, is it a problem hitting the target, or is it a problem establishing a patent IV? A problem hitting the vein is easier addressed than trying to figure out why they aren't taking. But you make it sound like you're hitting okay, but the complications are after getting the flash.

[naturegirl]

Honestly, both lately. I don't want to make excuses but I've had lots of people lately with medical issues, not young healthy people with veins you can just throw the needle at. The last one was a lady with diabetes and hypertension. Her veins looked good, got flash but then blew not one but two. Third time I was gold, but then the IV wouldn't run. No matter what I did, I couldn't get it to go, but I didn't see any infiltration. I noticed the cath wouldn't advance completely but I didn't know why. All this was during a rough drive. It wasn't a positional issue like AC with the arm being bent. This last vein was on top of the wrist below the thumb. I finally gave up and pulled it and got such a shot of blood I knew I was in a vein. I don't know. I didn't know that people with diabetes and hypertension shouldn't necessarily have a tourniquet, I haven't had all that training. As an I-85 they really just taught us the mechanics of how to do it, not all the problems that cause veins to not cooperate. All my good sticks have been on healthy young trauma patients. It seems like all my patients lately have been unstable diabetics with shunts and crappy veins. Or they tell me that the nurses can't even find a vein and I think I just don't even want to try. That's why I thought I should get more education to address this. I'm so open to help.

[mediccjh]

Everyone gets the IV funks in their careers.

Part of the problem can be the catheter brand itself. The ones we have in Newark suck---the needles are dull, and the catheter itself tends to kink. The ones I use in PA, the needles are sharper, and the catheters are made of Teflon, so they don't kink.