Sadly, I have never mastered this skill. Here's an interesting article about an anesthesiology group that complained when the hospital decided to do away using IV teams at night.

Doctors demand return of hospital's overnight IV services

At my last job we relied on the IV nurses for difficult IV starts but it seems like there's always someone on the unit that can get the stick when you don't have the IV team available. I've also found that Filipino nurses are especially good at starting IVs.

As an ER nurse, it's very difficult for me to envision not having this basic nursing skill. I, personally, want to be able to do everything that my patient may need, within the scope of my practice. IV teams are fine, but in our hospital they're the ones who come and hang blood on the inpatients. That's insane! I say give the floor nurses the opportunity to practice the most basic invasive nursing skill and allow the IV team to deal with the Piccs.

I would consider talking to the manager or educator in the ER. As the educator for our ER I would certainly entertain the notion of IV clinicals in our secondary triage area. We place our novice nurses or those who have transferred from inpatient units who have anxiety or questionable IV skills in our triage area for at least 8 hours during the busiest times. This immerses them in a sea of IV starts. Depending on the size of your hospital (900 beds here) it may be kind of a down low thing. For a smaller institution, it could be more public. Good way to build relations between the ED and inpatient units.

I would love to have the chance to spend several hours just trying to start IV's. We learned the theory, then got to practice once on the fake plastic arm (which is NOT realistic in any way) and then we tried on patients when possible (which at times were few and far between). I have had a few good starts, but am often hit-and-miss. I would love tips on finding veins if anyone has any, and knowing which one to pick (other than one that is straight). And any other tips are good too! :)

Cannulation and venepuncture are quite difficult to master unless you have constant practice. I should say filipinos are very good in these procedures as they practice this in Philippines very often, mostly not relying on the doctors as they are more experienced than them. Actually....... better than them. I am working in a busy renal unit, with plenty of diabetics ( they are the most difficult to cannulate), with loads of IV administration. Only 2 of us are qualified to cannulate and there we practice our skills. Sometimes failed but mostly a success. Doctors even call us to do this. The downfall is, they will wait for you to come on the shift then you have to start the IV's.

Sadly in long term care IV's are not things we do on a daily basis so when they do come up its not always easy. The practice is not there. I am IV certified but starting one on A 90 Year old frail elderly patient is a hard challenging task.

Sounds like threading the needle (no pun intended). Are there any tricks of the trade? What helps get the IV in when you have a frail 90 year-old?

While I was learning about IV's I picked up on some tricks one is use a warm towel around the insertion site to raise the vein. Feel the vain for any possible rollers or valves, check your tornaquet not to loose not to tight, allow the extremity to dangle for a few moments while you prepare the equipment. Start at an angle to insert the needle,When you insert the needle you'll feel a pop when you are in you'll also see a flash return of blood at that point go level with the extremity and advance remove the tornaquet apply slight pressure above the hub remove the needle put the connection together. It is helpful to keep a 4x4 under the connection to catch any leakage. Turn your fluids on check the flow and look for any signs of infiltration. And above all else I would say a prayer "God guide my hand directly and gently into the vein" Starting IV's is not my favorite thing to do I don't like hurting people but when it is necessary and has to be done a steady hand helps.

I have to say that the best tips I have gotten for IV starting came from this blog post by ImpactED Nurse here: http://impactednurse.com/?p=30 The "ancient Australian Zen mantra" is gold. :)

When a patient is frail or has very thin skin, I often find it helpful to "float" the catheter in, just after I hit the vessel, and before I go "to far" as to blow it, I will retract the needle and slowly use the the flush to float the cather in.
Sometimes (not always) it will prevent the needle from puncturing the vessel wall at the valve. Often the valves are there but not felt, and this is my trick for getting around them. Another little trick I use is to pull the skin taunt by using a piece of paper tape aound the back side of the arm, it keeps you vessel visable and often stiller than it would be, especially on saggy skin. Also I find that at the end of a twelve hour shift, my eyes and body are tired, it's better to get the in coming nurse with fresh eyes to do the stick, it seems more sucessful and less traumatic for my patients.
And lastly be courtious NEVER STICK MORE THAN TWICE, HAVE MERCY AND DON'T DIG!

yelagyrl2002 said:

Thanks guys for the websites..I am a nursing student and this will help alot

Great readings. As a L&D nurse, we start IV's, but I have to say, they are too, hit and miss for me. It is surprising to see how many women are dehydrated, and how that does affect the stick. I read a great article in one of my recent nursing journals (American Journal Of Nursing, August, 2007, page 64 "Emergency: Infiltration and Extravasation". Then another good article was in Nursing 2007 , August, 2007 P. 18 "What you need to know about PICCs part I". I hope this will help some of you. It is awesome to have other nurses with experiences that can teach other nurses tricks of the trade. We are all in it together........

Depending on the age and situation, i.e. they're conscious, I will sometimes use buffered lidocaine when starting a line. The first things most kids do when they have pain is withdraw from it. If they don't feel the initial stick, it's easier on them and they don't pull away from the catheter.

we have iv nurses available 24/7; we don't even keep the necessary equipment on the unit. Our techs draw all labs except PICCS/centrals. We even have a hard stick tech team for lab work when floor techs are unable to get vein access. it is great.

I did an internship in L/D so I got pretty good at starting them. However, I have not had to do it in so long I don't know if I even could any longer.

As an LPN in the Hosp where I work, we are all certified, But the PICC and Central Lines are put in up in surgery. On the floor we only change the dressings. I find this acceptable. I also like the extra money on the paycheck for being certified.
Hit and Miss, is always there because of everyone being different in the veins. Some elders have such sunburnt and tough skin that you can't find a site any better than on one that has no fat left and the vein moves. Keep trying though and it will get better.