IV advice?

[MSDeltaFlt]

Today was my first ER rotation. Things went well, I had a good time and felt comfortable interacting with patients, pushing drugs (although I most def need more experience) etc. What I wasn't comfortable with was IVs. I'm okay with missing them, I'm okay with retracting the catheter and seeking the vein, but I'm most concerned with my patient's level of discomfort. Nobody likes to have someone rummage a catheter up and down their arm looking for a vein.
After the second try I would discontinue my attempts and hand off to my Preceptor to establish the line.
At what point would you feel it was appropriate to stop trying?
I understand that this is a tough skill to learn, and I'm not discouraged, I'm more concerned with what other providers feels is an appropriate amount of attempts before handing off to a more experienced provider.

It depends. It depends on the severity of their condition and the amount of available veins and whether or not I have an IO. It also depends on whether I'm having an off day or not.

I was taught by a RN friend of mine who is considered. "big gun" when it comes to IV's, "if you can't feel it don't stick it".

I never stick to be punitive. Because some of these people are liable to have some weird form of Munchhausen Syndrome and actually enjoy that.

As far as causing too much pain sticking a needle in a pt's arm goes, it doesn't hurt me at all to stick them. There's a difference between being empathetic towards a pt's condition and being empathetic to the point of choosing to limit your care that the pt really needs.

Basically it boils down to realizing that the point of futility of accessing a vascular line is more fluid than one might think. And that, my friend, is what you also need to learn if not already doing so.

 

[Porta]

Basically it boils down to realizing that the point of futility of accessing a vascular line is more fluid than one might think. And that, my friend, is what you also need to learn if not already doing so.

I'm sorry but I'm not entirely sure what your trying to say. Are you saying I'm just over thinking it?

 

[MSDeltaFlt]

I'm sorry but I'm not entirely sure what your trying to say. Are you saying I'm just over thinking it?

I think you might be here. What I'm saying is try and try again UNTIL you realize (or even think) that there is no way you will be able to get the IV. Then let someone else try. Then go to the next pt and repeat the process.

Starting IV's is like any other skill. They're easy to learn, but hard to master. That takes experience. And you can't teach experience. So go get it.

 

[Porta]

I think you might be here. What I'm saying is try and try again UNTIL you realize (or even think) that there is no way you will be able to get the IV. Then let someone else try. Then go to the next pt and repeat the process.

Starting IV's is like any other skill. They're easy to learn, but hard to master. That takes experience. And you can't teach experience. So go get it.

Ah, okay. Roger, wilco.

 

[VFlutter]

I was taught by a RN friend of mine who is considered. "big gun" when it comes to IV's, "if you can't feel it don't stick it".

That really is some great advice. One of the RNs who trained me literally closed his eyes when looking for veins and would only go off touch. He rarely missed and could get lines in the worst patients. When I first started I was too visual, it took a while to get comfortable feeling veins out.

Another problem I had when I first started out was not having the tourniquet tight enough, that was the hardest part for me.

 

[Porta]

That really is some great advice. One of the RNs who trained me literally closed his eyes when looking for veins and would only go off touch. He rarely missed and could get lines in the worst patients. When I first started I was too visual, it took a while to get comfortable feeling veins out.

Another problem I had when I first started out was not having the tourniquet tight enough, that was the hardest part for me.

It is, I'm glad I posted this thread

 

[emsred23]

In the field you sometimes NEED an IV so you try 2,3,4 times. Depending on protocols then drill em! Once you get lots of practice itll just be smooth. If nothing pops up, know where the veins should be.... aim and guess. You cant get them all...

 

[Porta]

Hey guys,
Today was my last day of ER clinicals and I was fairly successful on my sticks. Thanks for the input!
- Porta

 

[Porta]

In the field you sometimes NEED an IV so you try 2,3,4 times. Depending on protocols then drill em! Once you get lots of practice itll just be smooth. If nothing pops up, know where the veins should be.... aim and guess. You cant get them all...

Oh, trust me...I had one pt who I stuck 3x...luckily 3rd time was a charm. The guy was a trooper though!

 

[blachatch]

Oh, trust me...I had one pt who I stuck 3x...luckily 3rd time was a charm. The guy was a trooper though!

I feel your pain had my first IV start today on a 93 y old. I was so nervous I was sweating, I messed up the first time.. but got it the second time after some playing around but the nurse had to take over since we weren't getting any blood flow for blood draws.:unsure:

 

[Porta]

I feel your pain had my first IV start today on a 93 y old. I was so nervous I was sweating, I messed up the first time.. but got it the second time after some playing around but the nurse had to take over since we weren't getting any blood flow for blood draws.:unsure:

I have decided I dislike sticking the elderly. They all seem to pray very loudly and scream about the devil...
I think it has more to do with the fact that they all had dementia and I live the the Deep South than my IV skills...

Hopefully.

 

[NomadicMedic]

Haha. You better get used to it. We stick far more old than young.

 

[Porta]

Haha. You better get used to it. We stick far more old than young.

"MA'AM I AM NOT THE DEVIL."

After awhile I just started agreeing with her.

My only issue was/is the texture of their skin threw me off. I spent the day sticking people who had nice thick skin and then....paper. Kinda threw my new found confidence

 

[Jambi]

"MA'AM I AM NOT THE DEVIL."

After awhile I just started agreeing with her.

My only issue was/is the texture of their skin threw me off. I spent the day sticking people who had nice thick skin and then....paper. Kinda threw my new found confidence

i've been known to toss a little lotion on their skin a few minutes before trying an iv. Traction is also your friend.

And don't be afraid of gnarly looking hands

And don't wear evil clown masks either, it's not nice.

 

[Porta]

i've been known to toss a little lotion on their skin a few minutes before trying an iv. Traction is also your friend.

And don't be afraid of gnarly looking hands

And don't wear evil clown masks either, it's not nice.

It's not a mask, it's how I do my makeup.

I'll remember that trick, thanks dude.

I was a little concerned with the hands bc they're so bony, does that matter?

 

[Jambi]

I was a little concerned with the hands bc they're so bony, does that matter?

i've never had a problem so long as there are viable veins.

 

[Handsome Robb]

I was a little concerned with the hands bc they're so bony, does that matter?

Don't start at a 45* angle and you're fine.

Hands take some practice but I'd honestly rather have a hand IV than one in my AC.

 

[blachatch]

The skin was giving me a hard time to on the older person.. The skin was so loose as i was trying to advance the Catheter I was pushing her loose flappy skin with it and was getting off track of advancing.. It was kind of frustrating even though it was my first time.

 

[Porta]

The skin was giving me a hard time to on the older person.. The skin was so loose as i was trying to advance the Catheter I was pushing her loose flappy skin with it and was getting off track of advancing.. It was kind of frustrating even though it was my first time.

thats exactly what happened to myself and my classmate last night.

 

[Akulahawk]

"MA'AM I AM NOT THE DEVIL."

After awhile I just started agreeing with her.

My only issue was/is the texture of their skin threw me off. I spent the day sticking people who had nice thick skin and then....paper. Kinda threw my new found confidence

Regardless of the skin thickness, visualize your target as the inside of a small piece of hollow pasta. You aim for the middle of that lumen and go from there. You start out with a shallow angle and after you have entered the skin, aim for that lumen and just go for it!