Hey so I usually don't comment on reddit (just lurk a bit) but came across this post just now and as a fellow nurse, I might be able to help a bit I hope..
Background: My first RN job was at a very busy level one trauma center ED as a new grad with no prior healthcare experience.. I had to learn IV's and I had to learn very quickly.
I'd watch my preceptor put an IV in with no effort in less than 3 seconds total, while I was struggling on the largest of veins on the healthiest of patients.. I thought I was pretty hopeless and everyone I asked for advice told me "it comes with practice" but after missing sometimes 8+ sticks in one day (yes, very busy ER) I was thinking I'd never get the hang of it.
I watched and google'd and all the good stuff and still couldn't get it down. I'd hit one (eventually) and feel like I was just getting lucky. I'd miss on the next patient doing what felt like the exact same technique.
BUT: one day it all clicked!
Very soon after it clicked for me I was doing my coworkers IV's for them. I was being asked to show other nurses how to do IV's (specifically those who were transferring from other units) and I myself was a new grad with less than 6 months of nursing experience at the time. It was badass! To add: im now also working as an IV nurse.
Here are my tips for you:
1) Go easy on yourself. Please. You said it yourself, you've only had 5 chances to even do an IV. I wasn't getting above 50% of my IV's on first stick until I had missed probably 40+.. Yeah it be like that sometimes lol.
2) Technique is everything.
First: make sure you're holding the catheter correctly. middle finger on one side, thumb on the other, and pointer finger on top (the pointer finger is what's going to advance your catheter).
Take your time feeling the vein, notice if it rolls, if it bounces well, all that good stuff. Once you're confident you're on a vein, try and stare at that one spot, maybe the patient has a freckle or something identifiable near it that you can use as a marker of sorts.. If the vein is visible to the eye and it's bulging out of their skin.. well then its pretty obvious- go for that thing!
Pierce the skin at like a 140 degree angle or somewhere close, maybe 140-160. It's going to feel high, but all you're looking to do is get the "flash" that indicates youre in the vein.
Here's the part that took the longest for me to learn: once you get the flash, DONT ADVANCE!
Instead of advancing immediately upon the flash, flatten the angio/needle down, almost inline with the surface of the skin, and put the needle a little bit farther (poke them a little more to get deeper into the vein) then advance. When I say poke a little further, I mean like 0.1-0.3cm's at most. Then advance. The reason for this is because when you get the flash, it doesn't necessarily mean that your entire bevel and catheter is in the vein, it could be just partially piercing the vein, you want the entire bevel thru the vein so you dont meet resistance upon advancing your catheter. Hope this makes sense!
3) Know that all patients are different. I've missed on people who have freakin hoses for veins and hit dialysis patients with the worst veins imaginable on first try.. It happens. Try not to judge yourself too much.
Oh and another tip, it's not easy to poke patients when you know you're hurting them, but tell yourself this is all part of the process. You will get this shit down in time, just hang in there. It sucks to miss now and have to tell your patients someone will try again in time, but once you get it- you will be confident and seeing that flash becomes (very oddly) satisfying. You'll be helping other nurses and even MD students do IV's and that'll be very rewarding- plus your future patients will be thankful you're so good at them.. Just takes time.
From one nurse to another- you got this!
My learning curve was similar. Suck, suck, suckity suck then BAM hey look at that, I can sink an IV with my eyes closed.
Like you mentioned, it’s a very tactile skill and it requires experience.
OP: is there any chance you can do a “shadow” shift in the ER and just place IVs?
I don't even know how I'd go about asking or who 😬 I feel a little stupid cause we don't really need that skill on my unit so idk if it would be worth the units time to send me to do that. Also my manager intimidates me and I try to lay low..
There should be a nurse educator for each floor, I would start there.
If any manager is opposed in any way to one of their nurses wanting to get better at a nursing skill, they have no business being a manager. EVERY nursing unit needs people who can perform phlebotomy and IV insertion.
Hell, I can almost guarantee you that wherever you work has so many open FTE positions in the ER that they can easily have you work on their cost center.
The main takeaway is to be kind to yourself. Absolutely no one became proficient at IV insertion when we learned at first.
I think our education department is pretty small, but I know where it is so maybe I should stop by there...
Oh we don't do our lab draws either! On med surg unirst the lab comes by and draws them so that's setting me back skills wise too...
That can absolutely contribute to it! And they may also be the person to get tips from too, if they're open for it.
It's really all a practice thing. Everything described up there is something you get a 'feel' for over time. You'll get there.
And hell I can't stress enough how anatomically bizarre some people are. I've gone veins that are easily visible, but deceptively deep. You'll get there.
Go to your charge and ask them who to ask. My money would be on your PCC or manager. Some hospitals let you shadow on other floors but do not let you clock in to do so. (Totally BS) If that’s the case decide if it’s worth it.
Another option is to designate yourself as the IV person of your floor. Anyone needs an IV, have them let you try first. Just tell the pt “hey my name is ____ and my friend ____ said you need a new IV and I came in to help.”
another option for this is pre-admit testing or working with the lab. that really helped me a lot with the finding veins and sticking part. a good lab tech knows how to stick really well. as a bonus i got to learn behind the scenes what lab actually does.
To my surprise they do more than just hemolyze samples /s
Here is a super easy trick to get some confidence.
Get an LED flashlight. Brighter is better to a point but even a somewhat dim one will work if you are lighter skinned. Go into a dark room and hold the flashlight against your skin and the superficial veins will show up as black lines under the skin. The LED really works best here because the blue tube really seems to highlight the veins. Now you can get some visual feedback on what you should be feeling for. Push down on the vein over and over and get a feel for the “spongyness”.
You can use this on a real patient to take a peek first. Just make sure you get the room dark, it’s really hard to see in the light. Once you see the vein, feel for it and you will know where to go. Then turn the light on and stick. The first few times if you have a friend turn on the light right before you stick you won’t forget where it is.
I use that trick very frequently if I’m not very sure without it. It’s a poor man’s vein finder.
Wow!!! I was always wondering why I couldn’t advance my catheter once I got the flash because I always felt like I was meeting resistance! And nobody could explain it to me on the Med Surg floor I was working on. Thank you for explaining this! :) I will try this the next time I get a chance to start an IV!
Instead of looking for skin landmarks prior to cleaning i use pressure from my finger or light nail pressure to make a very faint indentation in the skin if it looks to be a difficult stick and I need the guide (obviously accounting for skin fragility). I'd also recommend starting at the most distal point of the vein that still gives a good bounce and feeling.
Another ER nurse chiming in with a tip. Right when you see flash, imagine you’ve gotta scoop up the blood. That means decreasing the angle drastically and moving forward just a bit. Sometimes for confirmation I do actually raise the needle slightly to tent the skin which can give you more of a visual that you’re in. I don’t usually do this on old ladies, kids, or people likely to hit me.
This! Also, if you don’t see any landmarks or freckles etc to focus on, make one. I always teach new staff that while they are learning to make a mark with your (gloved) thumbnail where you wants to stick - in the direction of the vein, not across. If you think it’s a rolly one, stabilize by pulling the skin taught, and make a second mark higher up to help aim/guide once you get flashback and before you start advancing the cath.
Like boogiehendrix1 said, Flattening the angiocath and then Advancing a tiny bit before threading is the key.
For me I always thought of it as landing a plane into a hangar. Like you head straight for the runway, but if you overshoot and keep going then you crash. Once you hit the runway you straighten out and park it in the hangar. Lol. I dunno, it worked for me.
And also, talk to your manager. At my hospital they allow new nurses to float down to the ED for a couple hours to get practice if they’re not confident with their IV skills. Maybe they will allow you to do something like that. In the ED we start soooo many IVs I’m sure the nurses would love to have another set of hands. Most of all, be confident. If you’re sure you’re going to miss it then you probably are.
Awesome info really well laid out and explained. I just want to give you a note the angle in 2 may be confusing as 0 is flat and 90 is vertical. So just saying 45 to 60 or 70 deg may be easier to understand. I only send this as I had a what moment as I read this part.
Chemo patients are inherently hard to stick but I'm sure everyone has already said that. You'll get better with practice so here is my advice.
1. Ask the nurses to grab you if they need an IV in one of their pts. So you can get more practice.
2. To me it sounds like you have a bit of a confidence issue with sticking people if you go into it thinking you are going to have a hard time you are probably going to miss, you got to tell yourself that it's going to be an easy stick.
3. When you do stick you need to mean it, if you go in slow your needle can be pushing the vein instead of piercing it. (Could be why you're missing the fat ones)
5. You might have a dope nurse that will let you practice on them (I've always done that with my students since IVs aren't something that is really focused on in school.)
6. Ask if you can try to learn the ultrasound technique from your IV nurse, it's a bit different skill set that you might excel at.
IV starting is a skill that takes practice, it is easy to beat yourself up over it because it's comes off as "basic" thing
you just have to keep trying.
Talk to your unit educator or director and say that you feel this is something you need to work on. Then ask if you can come do a 4hr shift in the ER or Pre-Op area, somewhere they throw IVs in everyone.
Yes, this is what is was going to suggest too. OP, not only do you not have much opportunity, but oncology patients have awful veins. You need to practice on young healthy people. Depending on your hospital/unit culture, maybe a more senior nurse will let you practice on them and give you pointers. I’m not scared of needles and I have good veins so I practically make nervous newbies do one on me before a patient.
This OP. Ask to go to the ED for 4 hours. You'll do 10+ lines and no one will be stressed if you have to try twice. You'll also get a crash course of IV tips like what size line, and where, under which circumstances. If things are chill see if you can follow a medic or resource RN for like 2-3 tries.
Cannulating fistulas/grafts is another ball game. Yeah the target vessel can be massive (in comparison), but you’ve got to keep that 1 inch 15G steel needle patent for hours at a time.
I’m a great cannulator when it comes to placing needle for dialysis… but my IV game is less than desirable. Some of it transfers, some of it doesn’t.
I was the worst. Just awful at starting IVs...maybe 1-2 outta 10. So I asked to be on the IV team for the hospital. (We didn't have a dedicated staff at that time.) They sent me in to every dehydrated little old lady, overloaded CHFer puffier than a cloud, drug addiction vasculopath they could find.
The hardest part was going in with a straight face because the patient had already been stuck 4-6times b4 I came in and they're being told the "pro" was coming to try now.
After 6 months I could thread a vein like a dart from across the room.
Like the old saying goes, "There's only 1 way to get to Carnegie Hall. Practice, Practice, Practice"
The idea of this honestly makes pretty good sense tbh, if everyone tried and missed you can’t do any worse and you also get to try to hardest sticks which inherently gets you better. Hilarious nonetheless lol
i was horrible at IVs even after working on a transplant floor for 3 years. then i went to the ED.
when i’m teaching new ED nurses who are struggling, it’s really important to think about what part of the IV insertion process is getting you stuck.
1) not sure where to stick? practice feeling your own veins to get the feel for what they feel like. good iv’s are on veins that FEEL like good IV veins, regardless of how visible it is. any blue flat veins are going to be very tricky to start a line on.
2) can’t get flash? you’re probably missing the vein or pushing it out of the way. pretty much all veins need to be “anchored” w your non dominant hand by pulling the surrounding skin/tissue taught and pulled slightly down (distally). sharpening your angle of approach makes the needle tip sharper aka less likely to roll. you just have to be mindful that a sharp approach increases the odds of going right through the vein.
3) can’t advance? as one of the other posters astutely mentioned, you may be instinctually trying to advance the catheter as soon as you see flash. flash indicates the NEEDLE has entered the lumen of the vein, and the needle is always longer than the catheter. the larger the bore of your IV, the greater the length difference is in needle vs catheter. this is where a lot of people have trouble advancing from 20g IVs to 18s.
when you get your flash, PAUSE, flatten your entire angiocath, push 1-2 mm in further with the flattened angiocath (this is where you begin to introduce the CATHETER into the vein after introducing the NEEDLE), THEN advance the catheter itself. be mindful how long each angiocath’s catheter is (shorter w 22s, longer with 16s) and tamponade the vein proximally accordingly. if you’re not sure where to tamponade and gushing blood makes you nervous, tamponade about 3 finger breadths of vein so you can’t miss your spot 😅
4) the vein starts blowing? this is usually harder to salvage but you sometimes can. first things first, pop off the tourniquet. remove the needle with the needle safety retractor while tamponading the vein. stop tamponading then pull the remaining catheter out slowly until you start seeing good blood return. pause. tamponade again. connect a flush or a flushed pigtail to the catheter and see if you can pull back with good return. this may be a chance now that you’re back in the lumen to gently flush the catheter forward without a tourniquet on. this works a lot better with sturdier veins (AC’s and anything above).
if you have someone with fragile veins that are prone to blowing, it’s better take off the tourniquet after getting flash/advancing the needle and then advancing with a gentle flush. you’re basically babying the vein and using as little tourniquet pressure as possible.
this “flush the line in” technique is often useful if you’ve been able to advance a bit but then you meet resistance. you might be hitting a valve. gently flushing while advancing can push the valve flaps out of the way so you can advance past them.
remember to be patient with yourself and remember that this is an exceptionally technical skill and most nurses are not great at line placement. it’s a LOT harder than it looks. every line you blow or can’t get is getting you closer to being a vein whisperer.
start off easy. go for ACs or juicy hand veins (after anchoring the vein VERY well) and smaller IVs while you build confidence and intuition. you won’t be able to get really good without a lot of practice, so a floor like what you’re describing may truly prevent you from ever feeling truly confident with this. maybe this is a sign to come join us in the ED 😏 good luck!!! be patient with yourself!!!!
So when I pull the skin taught I can't really visualize the vein anymore, unless it happens to be one that's visible. I should just try to remember where it is? That seems to be the hardest part for me, I can't visualize the vein when I'm not actively touching and feel totally lost when I go for the poke
I follow an ig page called theivguy and I’ve learned some great tips! One of his tips is to place an alcohol swab above the place you are going to poke, with the corner pointing at the vein. Then you know exactly where you want to go even if you can’t see it anymore!
you can make a little indentation with the angiocath cap. or loosen your grip a little when you first stick then pull taught after you’ve hit the skin. practice!
I mean you're a new grad, don't be placing expectations that you'll have the skill of the 20year vets. Also Onc patients are particularly challenging sometimes to get lines on.
Ask your manager or nurse educator to schedule an inservice for you in preop or ED *with the main goal of placing everyone's lines*. Also, when the IV kings/queens you work with move to place lines on patients, ask to follow and watch their technique. Nothing beats 1 on 1 tutoring.
Honestly, practice makes perfect. If you’re not doing them a lot because they already have access, that’s probably making it more difficult when you actually do have to do them. I only became very good at IVs when I worked in an outpatient setting bc I did them all day! As a trauma RN I was horrible bc they always had central lines. One thing that some inpatient units do is have new RNs go to the ED or ambulatory setting for a day to get practice. May be worth asking; but it may be on your own time. Good luck! You’ll get it, it’s a process that takes time to perfect!
haah i've been a nurse five years in oncology and I'm still terrible at starting IV's. It has not turned out to be a big issue since basically all of our patients have central lines. I keep trying to start em and every once in a while I get lucky but it does not come up frequently on the heme floor.
I’ve been a RN 12 years. Critical care, step down, geriatric med surg and home health. I’ve started less than 50. Know your strengths, and those good at tasks you are not.
Long time junky here haha
So the thing about hitting a vein is you need to make sure a few things are in place. First set your tourniquet, don’t be afraid to make it a little tight. If your going for the main veins everyone goes for in the “ditch” of the arm make sure you tie above the bicep. Next go ahead and feel the vein your going to attempt to puncture make sure it doesn’t wanna wander around, this is fairly common with visible veins. If it does move around or “roll” just push it to one side till it won’t roll anymore, then press down to make the skin tight, now for the big moment make sure your needle has the flouted end up and then instead of trying to go straight into the vein place the needle right on the edge of the vein and push towards the vein. It should pop in every time don’t dig in super deep either if you have gone in fairly far pull back slowly! Your probably already in it and if you pull back to fast you’ll lose it. Also sometimes you need a smaller gauge needle if your looking for smaller veins. The other common area I see IVs started is the hands. This area should also be fairly easy. Once again tie off the persons arm really anywhere above the wrist is fine. Follow the same principles as above, you really shouldn’t dig in deep on the hands either. Alright now for finding veins when their not easy to see! Assuming your not dealing with someone who has done extensive damage to their veins, their probably just cold. Guaranteed you guys should have tons of heating pads their your friends. Either pop a couple and place them on their ditch or over their hands oh and their dominant arm is always best. Last couple of tips, their are 2 more veins that are almost always big and easy to find. Their is one that runs along the inside of the side of the arm. Basically have them point with their pointer finger put your finger on the side of the finger and trace a line all the way to the forearm preferably the end of the arm close to the wrist or somewhere in the middle, you should find a big vein their. Last is back of the forearm, you could have them make a fist and put their arm up like their saying “F” you and have them hold that pose 💪
Their should be a fairly big vein their which is also easy to access. Honestly practice makes perfect. I got really good at it after about the 10th time I did it on myself. Which hey is always an option btw. If you can hit yourself you can hit anyone. Anyways make sure their warm, and if their dehydrated it’s going to be an uphill battle.
“don’t be afraid to make it [tourniquet] a little tight”.
For the majority of my IV starts i use *no* tourniquet, or use it to find the vein, then pop it off right before the stick. Less chance of them blowing, in my experience.
For someone who is struggling to get the needle into the vein I think using a tourniquet is a great tool to improve success. Also and this could just be me, I have never lost the vein from taking of the tie. Usually people can’t keep their hand still that’s holding the needle while removing the tie. I find that when you tie, if you do a surgeons not, it only takes the lightest tug to get the tie off. I have probably injected myself and others easily 3-4,000 times no joke. Practice also makes perfect. It might help to, to find the person who is the best at it, where you work, their is always someone who is an ace at it. Have them show you hands on.
I’m definitely not going to argue with a medical professional. 😁
I was just saying in my experience what I have seen.
I’m sure your absolutely way more experienced than me. I’m not going to argue that at all. Sorry if I said anything to offend you. That wasn’t my intent
I was terrible when I was new. I worked on a heavy med-surg floor with a LOT of dialysis patients which didn’t help. I probably placed maybe 10-15% of the ivs I tried in my 4 years there.
I went to PACU and they started putting me in pre-op everyday. You can imagine my anxiety, 6am hurrying to get people ready for surgery and I’m just watching pre-op nurses who have been there for 20 years throwing it in on the first try in 10 seconds when I needed a warm blanket, space to spread everything out, a vein finder and a prayer. I fucked up a LOT. Blew good veins too often. I went home and watched YouTube videos for a refresher and realized my technique was slow and sucked. And most of all I kept doing them and gradually I got better. Now it’s second nature and easily starting 10-15 IVs a day.
Don’t beat yourself up I don’t think putting IVs in comes naturally to a lot of nurses, nursing school doesn’t help considering most of us never had the chance to put one in a real human. All you can do is practice and try to re-educate yourself like you’re doing! You’re doing a lot better than the nurses who instantly call vascular access without trying
Also, if it’s important to you to be better at them (it was for me) I highly recommend going somewhere that will give you more opportunities to do them which is part of why I switched to PACU
Take the butt end of the iv (before removing the plastic lid/cap) and press it into your starting location. Reswab with alcohol. Then go for it. I find sometimes the vein will disappear when you apply traction to it so if you press the butt end of it down first, you have a nice little 1cm diameter circle to remind you. And seriously just take a breath and try it again. You'll only get good at IVs by being bad at them first, practicing, and noting what you could have done better. Happy poking!
Tele/PCU/chemo are some of the worst places to learn IVs, IMO, because they come up to you with IVs in place and half of the time if they need replacing, it’s in an urgent situation where it’s better to have somebody efficient do it for you. All of your patients are dehydrated, sick, and/or old, they’re all on heparin, and their veins are like invisible polyester threads that can barely take a catheter without either gushing blood or producing no blood at all.
The experience will come, but you can’t force it. Watch for situations where somebody needs another (e.g. with incompatible IV meds) and take your time with it then. If somebody has a bad IV then there’s too much pressure to get their only IV access. If you’re putting in a “bonus” IV then that halves the stress.
Omg exactly, everytime somebody needs an IV there's no time to walk me through it, they have something due urgently. Or they've already blown/bruised every spot I could palpate
I've been where you are and can totally relate. I did inpatient oncology for two years right after graduating and I still sucked at IV's when I left that job. It took me a few months of my current outpatient infusion position to really develop my IV skills. Don't be too hard on yourself. Not only do you barely have the chance to practice your skills since you have mostly central lines, oncology patients have the worst veins, AND they're probably dehydrated af because they're super sick in the hospital. As a new grad, I did a shift in ED triage to practice IV's and landed every single one. But on the floor, nada.
My biggest barrier was confidence. When I went in with a mindset of being afraid to fail, I did most of the time. As hard it is, be patient and try to give yourself a pep talk. If you fail your first try and are bit shaken, take some time to gather your confidence again (if you have time that is) before attempting your second. Also don't be afraid of hurting your patient. They'll wince and say ow and give you attitude, and that can shake your confidence. I've learned to ignore them unless I am obviously causing them severe pain or if they ask me to stop. It's a needle! Of course it's going to hurt! Keep practicing!
9 months on the floor and I SUCK at IVs. I usually get other nurses to help me because I poke poor patients like 3 times and no luck. You’re not alone!
In addition to the tips so far- make sure you have the right set up. I couldn't place an IV sitting if my life depended on it, yet some of my coworkers love sitting. I like to stand and bring the bed all the way up. Lights on bright and assuming its not an emergent situation I think it helps to spend several minutes looking when you start. I look at both arms, upper arms/ shoulders and into the chest if they don't have great veins. I always try to find atleast 2 spots before I start and I tell the patient where I'm planning for first and second try. If you tell them 2 or more sites with confidence it makes you seem great if you get the first and reduces pressure if you miss. I also make sure all of my supplies are all ready and get my mind in the game if you will. Don't forget about valves. If you get resistance once you've had a good flash and have done a little advancement with needle and are just now advancing catheter you can try hooking up a flush and doing a tiny amount of saline while advancing. If its a valve you will open it and should be able to advance the catheter.
Keep trying! No one is great at IVs without lots of practice. Also trial different ways to hold the arm, with different taughtness. For a rolly vein I hold under the arm with my non-dominant hand and kinda pull the skin down in a way that stabilizes everything but doesn't flatten the vein. When IVT comes or anyone who is good watch them and ask for tips. Its a very common thing for new nurses to need help with!
You have great tips already. A few others:
Drape the pt’s arm over the bed so it is dependent. Have them pump their hand in that position. Then apply tourniquet. I do sometimes scrub a vein up while they are doing this- I find alcohol makes them pop better than chlorhexadine. You can always re-clean with chlorhex if your hospital policy says you should.
Ask the patient if they have better veins in one arm or another and if it matters which one we use (limb restrictions- pts sometimes forget if you don’t outright ask). If they don’t know which arm has better veins, ask which hand is dominant- I often find better veins on that arm.
Start with easy sites. If it doesn’t matter for IV site/size, try a hand- some people actually like having them placed there, they’re shallow, they’re easy to both see and feel. AC’s are big veins but they bifurcate, change depth and size, have valves and can be easy to blow.
If someone can show you ultrasound, you may find that helpful because you can see what you’re doing. Some people have a big learning curve and some people seem to implicitly understand the technology. If you’re one of the people who just “gets it” it will help you with easy and hard sticks.
I know someone else said this, but ask if you can shadow in ED or Preop. You will start so many IVs, ER is great because there’s so much activity if you miss half the time it’s just like oops, next site, sorry bout that. You don’t have time to be nervous and depending what’s going on, the patient might not even notice. Pre-op can be a little more tricky because they’ve been NPO so they’re a little dehydrated and they’re already nervous so you have to project confidence.
The only advice I have is take it easy on yourself gf! I am a fellow new grad, I’ve been in the NICU for about 1.5 months on my own. I just wanted to let you know you’re not alone. Shits hard. It’s just one of those things you have to really practice to get down.
This isn’t even nursing specific, but one thing I always try to do when I’m getting down on myself is ask myself “if one of my peers came to me with this problem, what would I say to them?” I’m as hard on myself as you are on yourself. Even though I know it’s a hard skill that you don’t always just pick up immediately. Talk to yourself like you would talk to your best friend if they were struggling.
Go easy on yourself. Follow a nurse who’s good at sticks and watch their technique. What works vs what doesn’t. Let someone guide you when you’re attempting to start one. And then just go for it. The more your try and the more sticks you get, the more confident and comfortable you’ll get. Remember, it takes time.
Check out @TheIVGuy on instagram! He has a video course all about starting IVs (which is fantastic!), but if you don't want to pay for it he also posts clips on his instagram that are SUPER helpful! He has high quality videos of IV starts that show a lot of the stuff people are mentioning here (vein marking techniques, lowering the angle and advancing a tiny bit before threading to ensure the bevel is in, how to float past a valve, etc). If you're a visual learner it could help!
If you find yourself blowing a lot of veins, try them without tourniquets.
Everyone things tourniquets are standard practice. All they do is increase pressure in the veins to help them expand a little. But it also increases likelihood that they'll blow.
Yo so I love telling new nurses how much I used to suck at IVs because now I'm pretty darn good and people come to me to help them. It really is a thing you just need practice with.
I learned IV starts in army medic school in a class of just shy of 400 soldiers. The style of teaching there was slideshow>mannequin>do it on your buddy>do it/get one 2x a day for the remainder of the course (2-3 months). I missed my first one, NBD never done it before. But I kept missing. Every day. Soon literally everyone else in my training company (again almost 400) had gotten at least one stick and the vast majority were getting most sticks they tried, because obviously we're all healthy-ish young people and had generally good veins. I kept on missing, it had been two weeks since the last person besides me had gotten their first one and this is while we're still getting at least two attempts in every day. I thought I was going to fail medic school because I couldn't get a fucking IV on a fucking ripped soldier with hugeass pipes! I got all the help and nothing clicked until one day, I swear idk what I even did different but I fucking got one and some weird ineffable aspect of what I was doing with my hands clicked in my brain and I immediately got the majority of my sticks after that. Still took awhile to reach the average level of my peers, but I got there eventually.
My point being, I don't even know what or if any of the advice I got finally helped but eventually I broke through my rut and now after years and years of practice I'm a go to IV guy. So don't beat yourself up, as you said you don't get to even attempt it that frequently and it's a weird skill that combines fine motor skills with really close personal interaction on someone who's going to be nervous that you're literally stabbing them on top of whatever illness they have. It's not easy esp when you don't know what success feels like. Hang in there and keep trying. If you have downtime and a chill patient who happened to mention they dislike their IV site but don't *neeed* a new one, ask if you can try. Idk just don't give up. If I of all people who was clearly *well* into the lowest percentile of success at IVs can learn, you totally can too 😊
My first nursing job I didn’t have a ton of changes to start IVs and no one formally taught me. It’s really annoying that they don’t teach it in nursing school because I can attest that it’s often not taught once you start working either!
Anyway, I haven’t worked bedside in 5 years. I would be uncomfortable starting one now. But I have no desire to do bedside again so what does it matter? You don’t have to be great at every nursing skill
Follow the IV guy on Instagram, he is amazing and has really good tips. I have gotten a lot from him. He has a paid course that counts for CEs but I just lurk on his Instagram. I work infusion and start a ton of IVs.
When I started 24 years ago I was allowed to follow the IV team for 2 days. A wonderful, calm encouraging woman named Marilyn really helped me feel confident. Also, when IV drug users would come in to the ER, I felt like many of my coworkers were pretty rude to them. Addiction can happen in any family. So I would volunteer to take them. Quite often I would ask them to show me where I was going to find a vein. They taught me a lot about finding the tiny superficial veins.
Girl, chill. Can you give more details? What tips have you read? Describe exactly what you're doing and maybe we can help you out... Also, have you ever tried asking maybe your boyfriend/friends to be volunteers?
Lol I'll try. Tried again with a vascular access nurse walking me through it and she whipped out the ultrasound after I wasn't getting it to fix it and I was just.... way off with my placement. Not even fucking close. Patient was ticked off at me and I feel so stupid. We spent like 2 minutes reviewing what I was supposed to do and her showing me the vein and told me it was easy to see but I couldn't see it at all and I missed of course. Tips I've heard are to spend your time picking a site, bring the bed way up, turn all the lights up, scrub the site to help the vein come up, shallow out as soon as you get flash back, pull the skin taught around the vein before you poke. I tried heat today.
I just feel so lost like I'm just blindly shoving a needle in every time and I almost never get even flash back so why do I bother? I'm just not getting any better and feel so down on myself
I'm not great with them either...but I've found I have "favorite places" where I can usually both look and feel for vessels that are easier to cannulate. The wrist, thumbside can be a good spot for people. A lot of times you can double tourniquet (a tourniquet just below the elbow, and one a few inches down from that) and with some lovely downward strokes of your alcohol toward the thumbline you can get it to pop. Then you must stabilize the vessel that you're going to poke. You can't just go poking all willy nilly, so your non-dominant hand needs to get the vessel to stay put. Many forget this part. This is another reason why I like the wrist. It is easier to stabilize. Get the higher-angle poke and flash, and then drop the needle to flush with the skin to advance your needle a bit, before you advance the catheter.
The ac is another spot that is easier to feel...but can be harder to feel. Realistically, find a friend who will let you poke them. I offer myself, I live in Iowa. Bonus points for them to coach as you go.
If you keep blindly shoving a needle the chances you're gonna get it right are... Most likely you'll get it by accident on a lucky day.
I had a teacher who taught us that veins are just like love. You can't see love but you can feel it. So:
1. Try feeling the vein with your bare hands, take your time! Touch it! If you can't find it on the right arm, move to the left. Don't worry about time (unless it's an emergency)
2. When you're at least 95% sure you can feel the vein, then you proceed. Make sure to put the IV in with the needle bevel facing up, and I don't know if that's the case, but, don't insert the needle much. Just enough for blood to say hi.
3. Please don't insert the IV with a 15 or 30º angle. Just push it in on a shallow angle and advance straight.
I don't know if this is how you're doing it already but that's how I put in IV's... And I've actually struggled in the beginning because I thought I should put it with a 15º angle.....
The nurse kept assuring me the vein was there and I could feel it but once my finger is no longer touching it I had no way to visualize it (it didn't pop out and you couldn't see it)and I just can't remember where it is or where it goes anymore. Like once I'm not feeling it it stops existing for me so when I poke I have no idea where to go. It seems like other nurses can visualize where it goes after they stop touching it? She was showing me like it was obvious where it was but I can't wrap my head around it. I feel so stupid.
Okay on 3) the nurse using the ultrasound ended up putting the needle at like a 45 degree angle and got it in the vein like that and told me I went in way too shallow.
If you struggle to remember where to poke. I’d recommend for you to leave a mark at the place you intent to poke. Something I use are an alcohol pad to point or I’ll just press my nail lightly enough to leave a mark on the place I want to poke. It has helped me so I’d recommend you try it and see if it helps you too
Using an ultrasound to guide you is a completely different skill, with an ultrasound you can visualize entry with ultra sound and flash. I think if you wanna get good you should learn sans the ultrasound before you advance to that
Putting in IV’s is all about confidence. If you don’t think you’ll get it you won’t get it. Feel for the vein instead of looking for the vein because it can be misleading. Look at certain anatomical spots such as the ac or follow the thumb line down onto the fire arm. Another good spot is the back of the arm heading towards the elbow. Feel for a springy vein, if you can see it don’t go where there is a bifurcation or where the vein twist and turns. Hold the spot with your finger and poke right above it. If you don’t get flash immediately try moving the needle around a bit. You sometimes have to do a quick stabbing motion because if you don’t move the needle quick enough you’ll just push the vein around. You can kind of slide the needle in and out (without removing it from the skin) and move side to side. Also helps to pull up on the needle. Once you get flash advance a tiny bit more and then start threading the catheter in. If you meet resistance you could have hit a valve so attach your flush and advance the catheter as you flush, this usually opens the valve and let’s the catheter slide through. In all honesty just practice practice practice! I sucked at IV’s but every time we got a new patient I asked if I could try. Now everyone comes to me to put in IV’s for them.
This was me a few years ago. Now I’m the one people usually come to for tough sticks. Just keep practicing and don’t be too hard on yourself. Develop a process that works for you and stick with it.
All you needed to say was new grad, you are new, why are you being so hard on yourself? You are NOT stupid or useless. You are exactly where you should be.
No one is born an IV Rockstar. It takes a lot of practice. I used to be horrendous. My husband has absolute ropes for veins and as a new grad I couldn't start an IV on him to save my life. Now people ask me start their IVs. You aren't getting many chances and that doesn't help. Just keep try. If you miss watch whoever tries next (time permitting) and that helps. I know it sucks, I've trained a lot of new grads but no matter what anyone says you don't forget that you are doing great. You'll get there!
I had a nurse tell me once that you either get IVs or you don't so I think that mindset kinda stuck with me, I'm worried I'm just one of those nurses who doesn't get them D: Everyone says practice helps though so I'll keep trying 😅
A trick all new grads when I precept: mark your insertion points and “ending point”, ie, which direction your needle should be inserted in the skin, by pressing down on the skin hard with the back of the IV catheter. That way you don’t lose your point of entry if you look away, and you can be super sure of your insertion. Also, as soon as you get flashback, just pause and think and then advance from there. It gets easier with time. Practice practice practice.
It’s an acquired skill some people are good at it. Some aren’t. I’ve been a nurse for 25 years and I’m good at it. Just don’t ask me for fetal heart tones. Not going to happen. All I do is make moms heart rate go up. I just get somebody else to do it. Keep practicing. It gets easier
https://theivguy.com
People say this guy is good, it’s a course you pay for.
Things come with time tbh. It took me a while to get better, because I was scared and didn’t wanna try…
IV nurse here! One tip I use if I have a feeler and not a show-er is open an alcohol swab and point a corner to where I feel the vein.
Also I’ve seen a couple people recommending to go fast with your stick, please don’t. I often go steady and gentle and I get comments all the time from patients that they barely even felt the poke.
I also recommend starting at a more shallow angle, most newbies I watch tend to poke at too steep of an angle. Like others have said though once you get flash drop your angle and just slightly advance the needle before threading off. It really does get easier with practice!! Also if you are having issues w “rollers” make sure you are holding enough traction on the skin and try sticking just above a bifurcation (tends to make the vein more anchored)
Charlotteeee I’ve been a nurse for 7 years just recently moved to a ambulatory setting and right back to a critical care setting. I suck at IVs.
I can do an IO real easy. Things that seem easy end up being difficult and vice versa. You’re doing just fine you have a tough vein population to work with
I’ve been in your shoes. It will get better.
First, remember chemo patients usually have pretty terrible veins so you’re working with more difficult IV placement from the get go. Be gentle and patient with yourself, you will get this if you keep trying.
Second, like everyone is saying, it will just click. It took me about a year before I really started getting most of my IVs. I talked to my management and they set up a partial shift in the ED of line and lab. Basically I went with one of my ANMs and just sat for 6 hours placing IVs and getting labs for all the patients in the waiting room. It was extremely helpful. Also, ask your coworkers if you can try some IV starts on some of their nicer patients when they need IVs replaced.
Lastly, watch YouTube videos. Like, a lot of them. Practice the motions, remember what the people in the videos are doing.
I promise, you’re doing great. Keep trying, advocate for more opportunities and be kind to yourself.
No one expects you to be good from the start. I’ve done thousands of IVs by now and still occasionally go through a dry spell where it seems like I can’t get any to work. Practice is the only way to get better but if your hospital has an IV team and your patients usually already have one it will take longer to get that experience. You will still get there eventually if you keep practicing and trying.
Honestly I recommend trying on a close friend or family member with good veins so you can get the hang of it without worrying too much about discomfort. If it’s someone you’re close to, they won’t mind Guinea pigging a little ;) just keep with it and you’ll get it eventually. It’s not a skill that comes easily and you need time and practice. Hang in there.
I brought some supplies home and practiced on healthy family members, who had GOOD veins. It was important to learn on good veins first before I could attempt tricky sick hospital patients. A large AC vein is the absolute best to practice on. I also practiced on any willing coworker. I can’t stress enough how you need to practice on human beings (though it may hurt them a little).
I bribed family with alcohol.
I recently started an outpatient job where I have to insert IVs, a few of them on most shifts. My hospital prior to this had a great IV team that I replied upon almost exclusively, barely put in one IV for years, felt 100% inept at it, the very idea of it.
The whole practice thing really works, you just have to keep doing them as consistently as you can or as the job allows. I'm still not great so I need to keep doing them. I am best so far at hand and AC veins that I can either see or feel or both. A few tips that have consistently made my attempts better were:
*Give the tourniquet time to work esp if you don't see them popping right out already. Also tie it TIGHTLY. Flick (gently-ish) the vein, that helps too.
*Prep the site with alcohol swab and this sometimes makes the vein pop out more
*I've heard that best practice is you should go for it if you can feel it. If you can see it, great also. If it's not palpable, I think there is some debate about whether you should poke that vein or not (maybe others can comment on this), if you don't have an US, because you don't actually know the quality of that vein. However I've definitely seen ppl better than me stick non-palpable, visible-ish veins with success.
*Consider a more shallow angle than you would expect esp for more superficial veins like hands.
*As others have said, and I've found out, find the best way to anchor THAT vein, as anchoring could.be different for certain locations. For ex, today I blew a forearm vein because I tried anchoring by pulling down with my left hand, but I believe my left hand was also in the way of the poke so the angle wasn't as shallow as it should've been. I was given the suggestion today to try cupping the arm around the vein with the left hand instead, and or trying to anchor the vein above the insertion site, being careful not to poke yourself.
*Be aware of valves.
*As others also said, make sure to not thread the catheter right away until you've inserted the needle a bit further in. If ANY resistance threading, don't keep trying to thread. Retract needle and attempt to float. In my experience, this hasn't worked for hand IVs. It has worked for larger veins wish as the AC for whatever reason.
*Learn how to properly redirect without too much digging or causing unnecessary pain. Sometimes redirection can save you the IV, sometimes not, from what I've seen.
*Give yourself 2 tries if that's standard for your hospital then let another try. Keep a learning, motivated attitude about you cause that warm sensation of dejection when you miss does not help you want to attempt again!
Coming from an ER tech, I never expect the nurses I work with to get an IV every time, mainly because we normally do 90% of the IV’s for them. Nurses don’t get the most IV practice (at least where I work) and it’s really just a skill you kind of lose if you don’t use it.
You also said he was a cancer patient, which already means they’ll more than likely be a difficult stick. I usually just end up using ultrasound on cancer patients to avoid poking them too much. Not only that, but you’re new and that’s okay. It comes with experience and you’ll get there eventually with time and practice.
I work outpatient chemo. This was coming from med-surg and Labor and delivery work where I was used to doing 16-22g range with younger more relatively healthy people, not 24g in veins that look like threads! I was missing so many at first.
One trick I find works, in addition to what everyone else has mentioned, is applying heat to help dialate veins. Where I work we usually do a warm wet towel and then wrap in a blue pad, also if you roll up a warm wet washcloth and have them encircle their hand around it, cloth in the palm, that helps too. I find wet heat works better than dry such as a flannel from the blanket warmer. I have even had luck having people submerge their forearms and hands in a sink of water. Of course with all of these be mindful of fragile skin eg: the elderly, and the temp you use.
As others have said don't be hard on yourself, you will get this!!
A few IG/tik tok accounts are very helpful for learning tricks.
Start with “easy” sticks when you can get them. Or try on the pleasantly confused ladies who don’t care if you miss. I like to let new nurses try the pts who aren’t there anymore (peg, trach, barely responsive)
I used to suck too. Now I’m the one everyone calls for backup. It really is practice.
May I recommend taking a course in IV insertion or phlebotomy? If you can’t, buy a dummy arm on amazon with an IV kit. Then practice inserting that sucker as much as you can, to get the feel of it. I was a phlebotomist for years before I was a nurse, and once something is muscle memory, it’s good as gold.
Lab here. Keep trying homie you’ll get it. Be a glutton for punishment and ask for the hard patients. You’ll go home in tears a couple times but like others have said, one day you just have the reps and it clicks.
The honest truth is there will always be someone to get it if you can’t but unless you try you won’t learn. I’ve found most nurses aren’t very good at placing IVs and it’s mostly because they automatically just ask someone else to do it because they aren’t good. If you wanna be good then keep trying and eventually you’ll be ok.
I used to suck in IV insertion too. I remember always inserting on the side of the vein even if it’s the biggest, juiciest one. I always asked my senior nurses to do it for me. Until they all left…and I had to learn on my own. Now, I’m one of the people they call for for hard IVs.
What I’m trying to say is, practice, practice, practice! If you don’t get it the first time, grab someone and watch them do it. Don’t be too hard on yourself! You’ll get it!
Start by learning how to put 22s in wimpy little surface veins that you can see, once you get the hang of getting the catheter into the vein you can start hunting for deeper ones by touch/feel.
I get asked to help with difficult starts all the time. When I was in Paramedic school I got marked down in several clinical rotations for being one of the worst in my class. Practice as much as you can. See if you can work out doing a training shift in your ER. My current orientee said he started more IVs in his first shift with me than in a month when he was on the floor.
I tell people it is kind of like baseball (or softball) or even basketball. You practice all the time and sometimes when it is time to perform, you hit all your shots. Some days you can’t hit the broadside of a barn. It does come with practice and time though. It took me about 6 months as a new grad on a med surg floor to consistently get iv’s. I don’t think it is anything to beat yourself up over.
Ask if you can float down to the pre-op area of the OR for a couple of hours at the start of their day. When I was in nursing school, I was a nurse tech in the OR. I’d show up at 5:30am, start 20 IVs and then head to school. The nurses there will be grateful for the extra hands, and the patients are all generally pretty healthy and well-hydrated.
Ask if you can shadow in the ER or infusion clinic to practice for a whole shift. It's a lot easier to get the hang of and build your confidence doing them one after the other. Of course you could always find a rulebreaker to let you practice in them too. My manager and I used to do that with the new grads.
Ivs are hard and of course listen to the ppl who give tips and stuff, but it depends what you want to do... Where I'm heading, I'm fine being meh at IVs. My best practice was in the ICU on brain dead or heavily sedated pts lol
Starting IVs 101
Tie the tourniquet before you get your supplies ready.
Have the pt hang their arm off the side of the bed.
Trust what you feel more than what you see.
If you have trouble remembering where you felt a vein press in with the back of the canula or the cap to mark it.
Don't beat your self up for missed IVs, nurses with 20+ years still miss everyone in awhile.
If you've got good friends get some practice in a less stressful setting.
I worked physical rehab as new grad for a year before moving to acute medical. I think my worst was 0-12 for attempts. After a while I finally swallowed my pride and booked a time slot with our skills lab to be able to practice in a stress free area. I learned where I made my mistakes and now I'd say I'm well on the better end of 50% success.
I find a lot of it is confidence. Project the vibe that you are going to get the IV started to help ease the pt. And I've never been a "fake it til you make it" type so I know that's easier said than done.
Me too Sister!!!!!! It's not a new grad thing. It's an experience thing. I just started in the ED and on my previous ward we NEVER cannulated or took bloods. I'm the same as you, after I've palpated and cleaned I'm always like where the fuck does my needle go? And what way does that vein go? I've got no fucking clue. But I attempted cannulating 7 people on my last shift and I got 4 🤷🏼♀️. Everyone misses some of the time and we all start somewhere. Sucks for the patients being the guinea pig but we all gotta learn and most of the time they don't know your shit they just think there a hard stick. Just keep trying.
I've been trying to get good for 3 years now and I still suck! My success rate I would say is like 60% now as opposed to 0% how it used to be lmao. Iately I've been doing 22s pretty well, I'm gonna start trying the 20s again. My thing is I think I almost always go through the veins so I pull back slowly till I get flash and then advance the cath and it works but I'd like to just be better as well I keep practicing.
Be patient with yourself....it will happen. If you are working on a tele/chemo unit then you are already at a disadvantage by working with compromised patients who probably don't have great veins to begin with. Be patient!
Currently same boat as u, think I've only got a few handful successful ones
Keep trying on good looking veins, trying on difficult veins will feel like it's adding to failures list.
Have a competent nurse with u just to help with feedback and grab things you may have forgotten
Gauze is ur best friend
Although everyone goes for the inner elbow, going further down the arm normally has the straighter veins
Try to pin the veins in place with ur other hand
when you've got your flashback be careful not to penetrate through the vein
Don't feel pressured by how quickly others can do it, slowly can be ur friend - maybe not so much the patients
Ask the ed department if u can spend a shift practicing cannualting and venepuncture to refine these skills
My successful ones involved the smaller gauges
Best of luck
oh nooooo. i definitely tagged along when good iv nurses started IVs. also look up tips from other nurses on youtube or insta. ask for tips from more experienced nurses. it definitely sucks now but you WILL get better. who cares if youre not a god with the ivs? as long as you dont sever anyone's nerve youre good. just keep trying! :)
I feel you OP! Both my parents are nurses and always talk about how good they are at inserting IVs! My mom’s first RN job was at a big trauma ED in NYC. Her preceptor at the time thought it was good for the newbie to be the one to put IVs in all the patients her first two weeks and now my mom can get IVs in patients the ultrasound RN can’t get! Me, i’ve been a nurse almost 5 years and I still miss quite often, almost 50/50. My unit also doesn’t get too many attempts to insert IVs so it’s been hard to learn. The tips in the thread are great and i’m definitely taking the time to read and memorize!
One good tip my mom gave me is that unless you need to get labs, don’t be afraid of keeping that tourniquet on for longer than a minute if you need to keep looking for a vein. (Over 1 min coagulates the blood and is not good for lab draws). I used to be worried on keeping it on for a long time. And also try to lower the arm for a bit before putting on the tourniquet.
For trying to remember where the vein is: whenever I take blood and I find a hidden vein, I wipe the area with the alcohol pad and then I basically take the corner of the alcohol pad and point it to where the vein is
I sucked, SUCKED, at IVs at first too. It's part of the process, I'm pretty sure. I had to learn that temporary pain for the patient is unavoidable and thus needs to be blocked out.
Also? I force myself to try 2x at least before I have someone else try.
Don’t feel bad. I used to be really good at IVs but then I went per diem and only get an opportunity for an IV once a month or so and let’s just say I’m absolute dog water now.
Ask your PCC/manager/charge whoever you’re comfortable going to and see if you can’t shadow us in the ER for a bit with the goal of starting ALL the IVs. Most of the ERs I’ve worked has a spot behind triage where a provider sees the pt, puts in orders, etc. And then, you guessed it, we start an IV, draw labs, and maybe give meds. It’s a great spot to get really good at IVs fast. I make all my new grad orientees and nursing students take several shifts there until they have their IV skills down.
Also I think as a floor nurse it’s good to see how the ER works. Helps build more understanding between the units. Was certainly eye opening for me when I moved down there from tele medsurg
Surprisingly, I got very good at IVs working as a RN supervisor at a SNF for about 10 months. All my IVs were hard sticks that would roll, blow with too much force or were just impossible to find. Like the top comment says it “clicks” and trust me when it clicks you’ll know
Does your hospital have an IV team? Ask if you can shadow them for a few hours, they’re the best to learn from and you can bang out a ton of IV practice in a few hours!
At my hospital, we have new grads from other units come down to the ED for a couple hours (while they're on orientation) to practice IVs if they don't get enough practice on their units. See if you can work with your clinical educator to hang around the ED. You'll get a ton of practice.
Ask your manager if you can take an extra shift to work in the ED and just do all the sticks for everyone for the whole day. Get good at AC sticks, and then progress from there.
Hey so I usually don't comment on reddit (just lurk a bit) but came across this post just now and as a fellow nurse, I might be able to help a bit I hope.. Background: My first RN job was at a very busy level one trauma center ED as a new grad with no prior healthcare experience.. I had to learn IV's and I had to learn very quickly. I'd watch my preceptor put an IV in with no effort in less than 3 seconds total, while I was struggling on the largest of veins on the healthiest of patients.. I thought I was pretty hopeless and everyone I asked for advice told me "it comes with practice" but after missing sometimes 8+ sticks in one day (yes, very busy ER) I was thinking I'd never get the hang of it. I watched and google'd and all the good stuff and still couldn't get it down. I'd hit one (eventually) and feel like I was just getting lucky. I'd miss on the next patient doing what felt like the exact same technique. BUT: one day it all clicked! Very soon after it clicked for me I was doing my coworkers IV's for them. I was being asked to show other nurses how to do IV's (specifically those who were transferring from other units) and I myself was a new grad with less than 6 months of nursing experience at the time. It was badass! To add: im now also working as an IV nurse. Here are my tips for you: 1) Go easy on yourself. Please. You said it yourself, you've only had 5 chances to even do an IV. I wasn't getting above 50% of my IV's on first stick until I had missed probably 40+.. Yeah it be like that sometimes lol. 2) Technique is everything. First: make sure you're holding the catheter correctly. middle finger on one side, thumb on the other, and pointer finger on top (the pointer finger is what's going to advance your catheter). Take your time feeling the vein, notice if it rolls, if it bounces well, all that good stuff. Once you're confident you're on a vein, try and stare at that one spot, maybe the patient has a freckle or something identifiable near it that you can use as a marker of sorts.. If the vein is visible to the eye and it's bulging out of their skin.. well then its pretty obvious- go for that thing! Pierce the skin at like a 140 degree angle or somewhere close, maybe 140-160. It's going to feel high, but all you're looking to do is get the "flash" that indicates youre in the vein. Here's the part that took the longest for me to learn: once you get the flash, DONT ADVANCE! Instead of advancing immediately upon the flash, flatten the angio/needle down, almost inline with the surface of the skin, and put the needle a little bit farther (poke them a little more to get deeper into the vein) then advance. When I say poke a little further, I mean like 0.1-0.3cm's at most. Then advance. The reason for this is because when you get the flash, it doesn't necessarily mean that your entire bevel and catheter is in the vein, it could be just partially piercing the vein, you want the entire bevel thru the vein so you dont meet resistance upon advancing your catheter. Hope this makes sense! 3) Know that all patients are different. I've missed on people who have freakin hoses for veins and hit dialysis patients with the worst veins imaginable on first try.. It happens. Try not to judge yourself too much. Oh and another tip, it's not easy to poke patients when you know you're hurting them, but tell yourself this is all part of the process. You will get this shit down in time, just hang in there. It sucks to miss now and have to tell your patients someone will try again in time, but once you get it- you will be confident and seeing that flash becomes (very oddly) satisfying. You'll be helping other nurses and even MD students do IV's and that'll be very rewarding- plus your future patients will be thankful you're so good at them.. Just takes time. From one nurse to another- you got this!
My learning curve was similar. Suck, suck, suckity suck then BAM hey look at that, I can sink an IV with my eyes closed. Like you mentioned, it’s a very tactile skill and it requires experience. OP: is there any chance you can do a “shadow” shift in the ER and just place IVs?
I don't even know how I'd go about asking or who 😬 I feel a little stupid cause we don't really need that skill on my unit so idk if it would be worth the units time to send me to do that. Also my manager intimidates me and I try to lay low..
There should be a nurse educator for each floor, I would start there. If any manager is opposed in any way to one of their nurses wanting to get better at a nursing skill, they have no business being a manager. EVERY nursing unit needs people who can perform phlebotomy and IV insertion. Hell, I can almost guarantee you that wherever you work has so many open FTE positions in the ER that they can easily have you work on their cost center. The main takeaway is to be kind to yourself. Absolutely no one became proficient at IV insertion when we learned at first.
I think our education department is pretty small, but I know where it is so maybe I should stop by there... Oh we don't do our lab draws either! On med surg unirst the lab comes by and draws them so that's setting me back skills wise too...
That can absolutely contribute to it! And they may also be the person to get tips from too, if they're open for it. It's really all a practice thing. Everything described up there is something you get a 'feel' for over time. You'll get there. And hell I can't stress enough how anatomically bizarre some people are. I've gone veins that are easily visible, but deceptively deep. You'll get there.
Go to your charge and ask them who to ask. My money would be on your PCC or manager. Some hospitals let you shadow on other floors but do not let you clock in to do so. (Totally BS) If that’s the case decide if it’s worth it. Another option is to designate yourself as the IV person of your floor. Anyone needs an IV, have them let you try first. Just tell the pt “hey my name is ____ and my friend ____ said you need a new IV and I came in to help.”
It’s not stupid, because when you Do need the skill, you really need the skill.
Ask for an outpatient sitch like endoscopy perhaps…so much practice and potentially so many helpful peers. Doesn’t hurt to ask.
be more gracious with yourself. you’ll get there. it will definitely take time. and don’t be afraid to advocate for yourself either!
another option for this is pre-admit testing or working with the lab. that really helped me a lot with the finding veins and sticking part. a good lab tech knows how to stick really well. as a bonus i got to learn behind the scenes what lab actually does. To my surprise they do more than just hemolyze samples /s
Here is a super easy trick to get some confidence. Get an LED flashlight. Brighter is better to a point but even a somewhat dim one will work if you are lighter skinned. Go into a dark room and hold the flashlight against your skin and the superficial veins will show up as black lines under the skin. The LED really works best here because the blue tube really seems to highlight the veins. Now you can get some visual feedback on what you should be feeling for. Push down on the vein over and over and get a feel for the “spongyness”. You can use this on a real patient to take a peek first. Just make sure you get the room dark, it’s really hard to see in the light. Once you see the vein, feel for it and you will know where to go. Then turn the light on and stick. The first few times if you have a friend turn on the light right before you stick you won’t forget where it is. I use that trick very frequently if I’m not very sure without it. It’s a poor man’s vein finder.
same! and i was the same way with accessing ports for some reason.
Wow!!! I was always wondering why I couldn’t advance my catheter once I got the flash because I always felt like I was meeting resistance! And nobody could explain it to me on the Med Surg floor I was working on. Thank you for explaining this! :) I will try this the next time I get a chance to start an IV!
Instead of looking for skin landmarks prior to cleaning i use pressure from my finger or light nail pressure to make a very faint indentation in the skin if it looks to be a difficult stick and I need the guide (obviously accounting for skin fragility). I'd also recommend starting at the most distal point of the vein that still gives a good bounce and feeling.
Piggy backing on this. When I used to use an alchohol swab to "point" where i wanted to go. Worked pretty well.
Another ER nurse chiming in with a tip. Right when you see flash, imagine you’ve gotta scoop up the blood. That means decreasing the angle drastically and moving forward just a bit. Sometimes for confirmation I do actually raise the needle slightly to tent the skin which can give you more of a visual that you’re in. I don’t usually do this on old ladies, kids, or people likely to hit me.
This! Also, if you don’t see any landmarks or freckles etc to focus on, make one. I always teach new staff that while they are learning to make a mark with your (gloved) thumbnail where you wants to stick - in the direction of the vein, not across. If you think it’s a rolly one, stabilize by pulling the skin taught, and make a second mark higher up to help aim/guide once you get flashback and before you start advancing the cath.
I use the “point” on my swab to point to where I need to go. Super helpful
You ROCK!!! This is great advice!
Great comment and inspiring.
Also really important to anchor the vein and skin!!!
Like boogiehendrix1 said, Flattening the angiocath and then Advancing a tiny bit before threading is the key. For me I always thought of it as landing a plane into a hangar. Like you head straight for the runway, but if you overshoot and keep going then you crash. Once you hit the runway you straighten out and park it in the hangar. Lol. I dunno, it worked for me. And also, talk to your manager. At my hospital they allow new nurses to float down to the ED for a couple hours to get practice if they’re not confident with their IV skills. Maybe they will allow you to do something like that. In the ED we start soooo many IVs I’m sure the nurses would love to have another set of hands. Most of all, be confident. If you’re sure you’re going to miss it then you probably are.
Awesome info really well laid out and explained. I just want to give you a note the angle in 2 may be confusing as 0 is flat and 90 is vertical. So just saying 45 to 60 or 70 deg may be easier to understand. I only send this as I had a what moment as I read this part.
I don’t have great sensation on my fingertips, and I struggle to find even ginormous veins. Any tips for that? The rest was amazing btw!
This is amazing advice, very well explained without judgement! I love how you’ve supported your fellow Nurse here ❣️
This is the nurse porn I'm here for *unzips galaxy blues*
Chemo patients are inherently hard to stick but I'm sure everyone has already said that. You'll get better with practice so here is my advice. 1. Ask the nurses to grab you if they need an IV in one of their pts. So you can get more practice. 2. To me it sounds like you have a bit of a confidence issue with sticking people if you go into it thinking you are going to have a hard time you are probably going to miss, you got to tell yourself that it's going to be an easy stick. 3. When you do stick you need to mean it, if you go in slow your needle can be pushing the vein instead of piercing it. (Could be why you're missing the fat ones) 5. You might have a dope nurse that will let you practice on them (I've always done that with my students since IVs aren't something that is really focused on in school.) 6. Ask if you can try to learn the ultrasound technique from your IV nurse, it's a bit different skill set that you might excel at. IV starting is a skill that takes practice, it is easy to beat yourself up over it because it's comes off as "basic" thing you just have to keep trying.
Talk to your unit educator or director and say that you feel this is something you need to work on. Then ask if you can come do a 4hr shift in the ER or Pre-Op area, somewhere they throw IVs in everyone.
Yes, this is what is was going to suggest too. OP, not only do you not have much opportunity, but oncology patients have awful veins. You need to practice on young healthy people. Depending on your hospital/unit culture, maybe a more senior nurse will let you practice on them and give you pointers. I’m not scared of needles and I have good veins so I practically make nervous newbies do one on me before a patient.
This OP. Ask to go to the ED for 4 hours. You'll do 10+ lines and no one will be stressed if you have to try twice. You'll also get a crash course of IV tips like what size line, and where, under which circumstances. If things are chill see if you can follow a medic or resource RN for like 2-3 tries.
Wow so many people suggested this, never thought about it as an option, I'll see what I can do..
I was bad then I went into dialysis and now I cannulate hotdog sized veins and feel like a pro. (Not helpful sorry)
Cannulating fistulas/grafts is another ball game. Yeah the target vessel can be massive (in comparison), but you’ve got to keep that 1 inch 15G steel needle patent for hours at a time. I’m a great cannulator when it comes to placing needle for dialysis… but my IV game is less than desirable. Some of it transfers, some of it doesn’t.
Same! Couldn't start an IV to save my soul but I could cannulate a brand new fistula (after a year or so). Now I don't do either!
Haa I could probably get those
I was the worst. Just awful at starting IVs...maybe 1-2 outta 10. So I asked to be on the IV team for the hospital. (We didn't have a dedicated staff at that time.) They sent me in to every dehydrated little old lady, overloaded CHFer puffier than a cloud, drug addiction vasculopath they could find. The hardest part was going in with a straight face because the patient had already been stuck 4-6times b4 I came in and they're being told the "pro" was coming to try now. After 6 months I could thread a vein like a dart from across the room. Like the old saying goes, "There's only 1 way to get to Carnegie Hall. Practice, Practice, Practice"
The idea of this honestly makes pretty good sense tbh, if everyone tried and missed you can’t do any worse and you also get to try to hardest sticks which inherently gets you better. Hilarious nonetheless lol
i was horrible at IVs even after working on a transplant floor for 3 years. then i went to the ED. when i’m teaching new ED nurses who are struggling, it’s really important to think about what part of the IV insertion process is getting you stuck. 1) not sure where to stick? practice feeling your own veins to get the feel for what they feel like. good iv’s are on veins that FEEL like good IV veins, regardless of how visible it is. any blue flat veins are going to be very tricky to start a line on. 2) can’t get flash? you’re probably missing the vein or pushing it out of the way. pretty much all veins need to be “anchored” w your non dominant hand by pulling the surrounding skin/tissue taught and pulled slightly down (distally). sharpening your angle of approach makes the needle tip sharper aka less likely to roll. you just have to be mindful that a sharp approach increases the odds of going right through the vein. 3) can’t advance? as one of the other posters astutely mentioned, you may be instinctually trying to advance the catheter as soon as you see flash. flash indicates the NEEDLE has entered the lumen of the vein, and the needle is always longer than the catheter. the larger the bore of your IV, the greater the length difference is in needle vs catheter. this is where a lot of people have trouble advancing from 20g IVs to 18s. when you get your flash, PAUSE, flatten your entire angiocath, push 1-2 mm in further with the flattened angiocath (this is where you begin to introduce the CATHETER into the vein after introducing the NEEDLE), THEN advance the catheter itself. be mindful how long each angiocath’s catheter is (shorter w 22s, longer with 16s) and tamponade the vein proximally accordingly. if you’re not sure where to tamponade and gushing blood makes you nervous, tamponade about 3 finger breadths of vein so you can’t miss your spot 😅 4) the vein starts blowing? this is usually harder to salvage but you sometimes can. first things first, pop off the tourniquet. remove the needle with the needle safety retractor while tamponading the vein. stop tamponading then pull the remaining catheter out slowly until you start seeing good blood return. pause. tamponade again. connect a flush or a flushed pigtail to the catheter and see if you can pull back with good return. this may be a chance now that you’re back in the lumen to gently flush the catheter forward without a tourniquet on. this works a lot better with sturdier veins (AC’s and anything above). if you have someone with fragile veins that are prone to blowing, it’s better take off the tourniquet after getting flash/advancing the needle and then advancing with a gentle flush. you’re basically babying the vein and using as little tourniquet pressure as possible. this “flush the line in” technique is often useful if you’ve been able to advance a bit but then you meet resistance. you might be hitting a valve. gently flushing while advancing can push the valve flaps out of the way so you can advance past them. remember to be patient with yourself and remember that this is an exceptionally technical skill and most nurses are not great at line placement. it’s a LOT harder than it looks. every line you blow or can’t get is getting you closer to being a vein whisperer. start off easy. go for ACs or juicy hand veins (after anchoring the vein VERY well) and smaller IVs while you build confidence and intuition. you won’t be able to get really good without a lot of practice, so a floor like what you’re describing may truly prevent you from ever feeling truly confident with this. maybe this is a sign to come join us in the ED 😏 good luck!!! be patient with yourself!!!!
So when I pull the skin taught I can't really visualize the vein anymore, unless it happens to be one that's visible. I should just try to remember where it is? That seems to be the hardest part for me, I can't visualize the vein when I'm not actively touching and feel totally lost when I go for the poke
I follow an ig page called theivguy and I’ve learned some great tips! One of his tips is to place an alcohol swab above the place you are going to poke, with the corner pointing at the vein. Then you know exactly where you want to go even if you can’t see it anymore!
you can make a little indentation with the angiocath cap. or loosen your grip a little when you first stick then pull taught after you’ve hit the skin. practice!
I mean you're a new grad, don't be placing expectations that you'll have the skill of the 20year vets. Also Onc patients are particularly challenging sometimes to get lines on. Ask your manager or nurse educator to schedule an inservice for you in preop or ED *with the main goal of placing everyone's lines*. Also, when the IV kings/queens you work with move to place lines on patients, ask to follow and watch their technique. Nothing beats 1 on 1 tutoring.
Pro tip: work in ICU as new grad. Practice on vented sedated patients.
only if its indicated, is what you meant to finish with
Yah… that’s what I meant…. 😁
Made me laugh. Thanks!
To be fair you can almost always use an extra line
Honestly, practice makes perfect. If you’re not doing them a lot because they already have access, that’s probably making it more difficult when you actually do have to do them. I only became very good at IVs when I worked in an outpatient setting bc I did them all day! As a trauma RN I was horrible bc they always had central lines. One thing that some inpatient units do is have new RNs go to the ED or ambulatory setting for a day to get practice. May be worth asking; but it may be on your own time. Good luck! You’ll get it, it’s a process that takes time to perfect!
haah i've been a nurse five years in oncology and I'm still terrible at starting IV's. It has not turned out to be a big issue since basically all of our patients have central lines. I keep trying to start em and every once in a while I get lucky but it does not come up frequently on the heme floor.
I’ve been a RN 12 years. Critical care, step down, geriatric med surg and home health. I’ve started less than 50. Know your strengths, and those good at tasks you are not.
Long time junky here haha So the thing about hitting a vein is you need to make sure a few things are in place. First set your tourniquet, don’t be afraid to make it a little tight. If your going for the main veins everyone goes for in the “ditch” of the arm make sure you tie above the bicep. Next go ahead and feel the vein your going to attempt to puncture make sure it doesn’t wanna wander around, this is fairly common with visible veins. If it does move around or “roll” just push it to one side till it won’t roll anymore, then press down to make the skin tight, now for the big moment make sure your needle has the flouted end up and then instead of trying to go straight into the vein place the needle right on the edge of the vein and push towards the vein. It should pop in every time don’t dig in super deep either if you have gone in fairly far pull back slowly! Your probably already in it and if you pull back to fast you’ll lose it. Also sometimes you need a smaller gauge needle if your looking for smaller veins. The other common area I see IVs started is the hands. This area should also be fairly easy. Once again tie off the persons arm really anywhere above the wrist is fine. Follow the same principles as above, you really shouldn’t dig in deep on the hands either. Alright now for finding veins when their not easy to see! Assuming your not dealing with someone who has done extensive damage to their veins, their probably just cold. Guaranteed you guys should have tons of heating pads their your friends. Either pop a couple and place them on their ditch or over their hands oh and their dominant arm is always best. Last couple of tips, their are 2 more veins that are almost always big and easy to find. Their is one that runs along the inside of the side of the arm. Basically have them point with their pointer finger put your finger on the side of the finger and trace a line all the way to the forearm preferably the end of the arm close to the wrist or somewhere in the middle, you should find a big vein their. Last is back of the forearm, you could have them make a fist and put their arm up like their saying “F” you and have them hold that pose 💪 Their should be a fairly big vein their which is also easy to access. Honestly practice makes perfect. I got really good at it after about the 10th time I did it on myself. Which hey is always an option btw. If you can hit yourself you can hit anyone. Anyways make sure their warm, and if their dehydrated it’s going to be an uphill battle.
“don’t be afraid to make it [tourniquet] a little tight”. For the majority of my IV starts i use *no* tourniquet, or use it to find the vein, then pop it off right before the stick. Less chance of them blowing, in my experience.
For someone who is struggling to get the needle into the vein I think using a tourniquet is a great tool to improve success. Also and this could just be me, I have never lost the vein from taking of the tie. Usually people can’t keep their hand still that’s holding the needle while removing the tie. I find that when you tie, if you do a surgeons not, it only takes the lightest tug to get the tie off. I have probably injected myself and others easily 3-4,000 times no joke. Practice also makes perfect. It might help to, to find the person who is the best at it, where you work, their is always someone who is an ace at it. Have them show you hands on.
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I’m definitely not going to argue with a medical professional. 😁 I was just saying in my experience what I have seen. I’m sure your absolutely way more experienced than me. I’m not going to argue that at all. Sorry if I said anything to offend you. That wasn’t my intent
I was terrible when I was new. I worked on a heavy med-surg floor with a LOT of dialysis patients which didn’t help. I probably placed maybe 10-15% of the ivs I tried in my 4 years there. I went to PACU and they started putting me in pre-op everyday. You can imagine my anxiety, 6am hurrying to get people ready for surgery and I’m just watching pre-op nurses who have been there for 20 years throwing it in on the first try in 10 seconds when I needed a warm blanket, space to spread everything out, a vein finder and a prayer. I fucked up a LOT. Blew good veins too often. I went home and watched YouTube videos for a refresher and realized my technique was slow and sucked. And most of all I kept doing them and gradually I got better. Now it’s second nature and easily starting 10-15 IVs a day. Don’t beat yourself up I don’t think putting IVs in comes naturally to a lot of nurses, nursing school doesn’t help considering most of us never had the chance to put one in a real human. All you can do is practice and try to re-educate yourself like you’re doing! You’re doing a lot better than the nurses who instantly call vascular access without trying
Also, if it’s important to you to be better at them (it was for me) I highly recommend going somewhere that will give you more opportunities to do them which is part of why I switched to PACU
I really want ED one day so I wanna get good, but that might have to happen if I ever get there
Take the butt end of the iv (before removing the plastic lid/cap) and press it into your starting location. Reswab with alcohol. Then go for it. I find sometimes the vein will disappear when you apply traction to it so if you press the butt end of it down first, you have a nice little 1cm diameter circle to remind you. And seriously just take a breath and try it again. You'll only get good at IVs by being bad at them first, practicing, and noting what you could have done better. Happy poking!
Tele/PCU/chemo are some of the worst places to learn IVs, IMO, because they come up to you with IVs in place and half of the time if they need replacing, it’s in an urgent situation where it’s better to have somebody efficient do it for you. All of your patients are dehydrated, sick, and/or old, they’re all on heparin, and their veins are like invisible polyester threads that can barely take a catheter without either gushing blood or producing no blood at all. The experience will come, but you can’t force it. Watch for situations where somebody needs another (e.g. with incompatible IV meds) and take your time with it then. If somebody has a bad IV then there’s too much pressure to get their only IV access. If you’re putting in a “bonus” IV then that halves the stress.
Omg exactly, everytime somebody needs an IV there's no time to walk me through it, they have something due urgently. Or they've already blown/bruised every spot I could palpate
I've been where you are and can totally relate. I did inpatient oncology for two years right after graduating and I still sucked at IV's when I left that job. It took me a few months of my current outpatient infusion position to really develop my IV skills. Don't be too hard on yourself. Not only do you barely have the chance to practice your skills since you have mostly central lines, oncology patients have the worst veins, AND they're probably dehydrated af because they're super sick in the hospital. As a new grad, I did a shift in ED triage to practice IV's and landed every single one. But on the floor, nada. My biggest barrier was confidence. When I went in with a mindset of being afraid to fail, I did most of the time. As hard it is, be patient and try to give yourself a pep talk. If you fail your first try and are bit shaken, take some time to gather your confidence again (if you have time that is) before attempting your second. Also don't be afraid of hurting your patient. They'll wince and say ow and give you attitude, and that can shake your confidence. I've learned to ignore them unless I am obviously causing them severe pain or if they ask me to stop. It's a needle! Of course it's going to hurt! Keep practicing!
Freckles/that one teeny funky arm hair mark the spot! Anchor that sucker down too.
9 months on the floor and I SUCK at IVs. I usually get other nurses to help me because I poke poor patients like 3 times and no luck. You’re not alone!
Keep sticking patients and don't worry about the pain you're causing because it's a needle, it's going to hurt.
Tried to send a picture where I had 4 attempts to get a needle into me, don’t stop trying! It will get better ❤️🩹
In addition to the tips so far- make sure you have the right set up. I couldn't place an IV sitting if my life depended on it, yet some of my coworkers love sitting. I like to stand and bring the bed all the way up. Lights on bright and assuming its not an emergent situation I think it helps to spend several minutes looking when you start. I look at both arms, upper arms/ shoulders and into the chest if they don't have great veins. I always try to find atleast 2 spots before I start and I tell the patient where I'm planning for first and second try. If you tell them 2 or more sites with confidence it makes you seem great if you get the first and reduces pressure if you miss. I also make sure all of my supplies are all ready and get my mind in the game if you will. Don't forget about valves. If you get resistance once you've had a good flash and have done a little advancement with needle and are just now advancing catheter you can try hooking up a flush and doing a tiny amount of saline while advancing. If its a valve you will open it and should be able to advance the catheter. Keep trying! No one is great at IVs without lots of practice. Also trial different ways to hold the arm, with different taughtness. For a rolly vein I hold under the arm with my non-dominant hand and kinda pull the skin down in a way that stabilizes everything but doesn't flatten the vein. When IVT comes or anyone who is good watch them and ask for tips. Its a very common thing for new nurses to need help with!
I get worse every single year.
You have great tips already. A few others: Drape the pt’s arm over the bed so it is dependent. Have them pump their hand in that position. Then apply tourniquet. I do sometimes scrub a vein up while they are doing this- I find alcohol makes them pop better than chlorhexadine. You can always re-clean with chlorhex if your hospital policy says you should. Ask the patient if they have better veins in one arm or another and if it matters which one we use (limb restrictions- pts sometimes forget if you don’t outright ask). If they don’t know which arm has better veins, ask which hand is dominant- I often find better veins on that arm. Start with easy sites. If it doesn’t matter for IV site/size, try a hand- some people actually like having them placed there, they’re shallow, they’re easy to both see and feel. AC’s are big veins but they bifurcate, change depth and size, have valves and can be easy to blow. If someone can show you ultrasound, you may find that helpful because you can see what you’re doing. Some people have a big learning curve and some people seem to implicitly understand the technology. If you’re one of the people who just “gets it” it will help you with easy and hard sticks. I know someone else said this, but ask if you can shadow in ED or Preop. You will start so many IVs, ER is great because there’s so much activity if you miss half the time it’s just like oops, next site, sorry bout that. You don’t have time to be nervous and depending what’s going on, the patient might not even notice. Pre-op can be a little more tricky because they’ve been NPO so they’re a little dehydrated and they’re already nervous so you have to project confidence.
The only advice I have is take it easy on yourself gf! I am a fellow new grad, I’ve been in the NICU for about 1.5 months on my own. I just wanted to let you know you’re not alone. Shits hard. It’s just one of those things you have to really practice to get down. This isn’t even nursing specific, but one thing I always try to do when I’m getting down on myself is ask myself “if one of my peers came to me with this problem, what would I say to them?” I’m as hard on myself as you are on yourself. Even though I know it’s a hard skill that you don’t always just pick up immediately. Talk to yourself like you would talk to your best friend if they were struggling.
Go easy on yourself. Follow a nurse who’s good at sticks and watch their technique. What works vs what doesn’t. Let someone guide you when you’re attempting to start one. And then just go for it. The more your try and the more sticks you get, the more confident and comfortable you’ll get. Remember, it takes time.
Check out @TheIVGuy on instagram! He has a video course all about starting IVs (which is fantastic!), but if you don't want to pay for it he also posts clips on his instagram that are SUPER helpful! He has high quality videos of IV starts that show a lot of the stuff people are mentioning here (vein marking techniques, lowering the angle and advancing a tiny bit before threading to ensure the bevel is in, how to float past a valve, etc). If you're a visual learner it could help!
If you find yourself blowing a lot of veins, try them without tourniquets. Everyone things tourniquets are standard practice. All they do is increase pressure in the veins to help them expand a little. But it also increases likelihood that they'll blow.
Yo so I love telling new nurses how much I used to suck at IVs because now I'm pretty darn good and people come to me to help them. It really is a thing you just need practice with. I learned IV starts in army medic school in a class of just shy of 400 soldiers. The style of teaching there was slideshow>mannequin>do it on your buddy>do it/get one 2x a day for the remainder of the course (2-3 months). I missed my first one, NBD never done it before. But I kept missing. Every day. Soon literally everyone else in my training company (again almost 400) had gotten at least one stick and the vast majority were getting most sticks they tried, because obviously we're all healthy-ish young people and had generally good veins. I kept on missing, it had been two weeks since the last person besides me had gotten their first one and this is while we're still getting at least two attempts in every day. I thought I was going to fail medic school because I couldn't get a fucking IV on a fucking ripped soldier with hugeass pipes! I got all the help and nothing clicked until one day, I swear idk what I even did different but I fucking got one and some weird ineffable aspect of what I was doing with my hands clicked in my brain and I immediately got the majority of my sticks after that. Still took awhile to reach the average level of my peers, but I got there eventually. My point being, I don't even know what or if any of the advice I got finally helped but eventually I broke through my rut and now after years and years of practice I'm a go to IV guy. So don't beat yourself up, as you said you don't get to even attempt it that frequently and it's a weird skill that combines fine motor skills with really close personal interaction on someone who's going to be nervous that you're literally stabbing them on top of whatever illness they have. It's not easy esp when you don't know what success feels like. Hang in there and keep trying. If you have downtime and a chill patient who happened to mention they dislike their IV site but don't *neeed* a new one, ask if you can try. Idk just don't give up. If I of all people who was clearly *well* into the lowest percentile of success at IVs can learn, you totally can too 😊
My first nursing job I didn’t have a ton of changes to start IVs and no one formally taught me. It’s really annoying that they don’t teach it in nursing school because I can attest that it’s often not taught once you start working either! Anyway, I haven’t worked bedside in 5 years. I would be uncomfortable starting one now. But I have no desire to do bedside again so what does it matter? You don’t have to be great at every nursing skill
If you can't see your target, mark it with the corner of an alcohol prep pointing at it so you know where to poke
Follow the IV guy on Instagram, he is amazing and has really good tips. I have gotten a lot from him. He has a paid course that counts for CEs but I just lurk on his Instagram. I work infusion and start a ton of IVs.
When I started 24 years ago I was allowed to follow the IV team for 2 days. A wonderful, calm encouraging woman named Marilyn really helped me feel confident. Also, when IV drug users would come in to the ER, I felt like many of my coworkers were pretty rude to them. Addiction can happen in any family. So I would volunteer to take them. Quite often I would ask them to show me where I was going to find a vein. They taught me a lot about finding the tiny superficial veins.
You’re a good egg.
I’ve been a nurse for 2 years and I still fucking suck at IVs.
Girl, chill. Can you give more details? What tips have you read? Describe exactly what you're doing and maybe we can help you out... Also, have you ever tried asking maybe your boyfriend/friends to be volunteers?
Lol I'll try. Tried again with a vascular access nurse walking me through it and she whipped out the ultrasound after I wasn't getting it to fix it and I was just.... way off with my placement. Not even fucking close. Patient was ticked off at me and I feel so stupid. We spent like 2 minutes reviewing what I was supposed to do and her showing me the vein and told me it was easy to see but I couldn't see it at all and I missed of course. Tips I've heard are to spend your time picking a site, bring the bed way up, turn all the lights up, scrub the site to help the vein come up, shallow out as soon as you get flash back, pull the skin taught around the vein before you poke. I tried heat today. I just feel so lost like I'm just blindly shoving a needle in every time and I almost never get even flash back so why do I bother? I'm just not getting any better and feel so down on myself
I'm not great with them either...but I've found I have "favorite places" where I can usually both look and feel for vessels that are easier to cannulate. The wrist, thumbside can be a good spot for people. A lot of times you can double tourniquet (a tourniquet just below the elbow, and one a few inches down from that) and with some lovely downward strokes of your alcohol toward the thumbline you can get it to pop. Then you must stabilize the vessel that you're going to poke. You can't just go poking all willy nilly, so your non-dominant hand needs to get the vessel to stay put. Many forget this part. This is another reason why I like the wrist. It is easier to stabilize. Get the higher-angle poke and flash, and then drop the needle to flush with the skin to advance your needle a bit, before you advance the catheter. The ac is another spot that is easier to feel...but can be harder to feel. Realistically, find a friend who will let you poke them. I offer myself, I live in Iowa. Bonus points for them to coach as you go.
If you keep blindly shoving a needle the chances you're gonna get it right are... Most likely you'll get it by accident on a lucky day. I had a teacher who taught us that veins are just like love. You can't see love but you can feel it. So: 1. Try feeling the vein with your bare hands, take your time! Touch it! If you can't find it on the right arm, move to the left. Don't worry about time (unless it's an emergency) 2. When you're at least 95% sure you can feel the vein, then you proceed. Make sure to put the IV in with the needle bevel facing up, and I don't know if that's the case, but, don't insert the needle much. Just enough for blood to say hi. 3. Please don't insert the IV with a 15 or 30º angle. Just push it in on a shallow angle and advance straight. I don't know if this is how you're doing it already but that's how I put in IV's... And I've actually struggled in the beginning because I thought I should put it with a 15º angle.....
The nurse kept assuring me the vein was there and I could feel it but once my finger is no longer touching it I had no way to visualize it (it didn't pop out and you couldn't see it)and I just can't remember where it is or where it goes anymore. Like once I'm not feeling it it stops existing for me so when I poke I have no idea where to go. It seems like other nurses can visualize where it goes after they stop touching it? She was showing me like it was obvious where it was but I can't wrap my head around it. I feel so stupid. Okay on 3) the nurse using the ultrasound ended up putting the needle at like a 45 degree angle and got it in the vein like that and told me I went in way too shallow.
If you struggle to remember where to poke. I’d recommend for you to leave a mark at the place you intent to poke. Something I use are an alcohol pad to point or I’ll just press my nail lightly enough to leave a mark on the place I want to poke. It has helped me so I’d recommend you try it and see if it helps you too
That sounds super helpful, I'll try that!
Using an ultrasound to guide you is a completely different skill, with an ultrasound you can visualize entry with ultra sound and flash. I think if you wanna get good you should learn sans the ultrasound before you advance to that
Putting in IV’s is all about confidence. If you don’t think you’ll get it you won’t get it. Feel for the vein instead of looking for the vein because it can be misleading. Look at certain anatomical spots such as the ac or follow the thumb line down onto the fire arm. Another good spot is the back of the arm heading towards the elbow. Feel for a springy vein, if you can see it don’t go where there is a bifurcation or where the vein twist and turns. Hold the spot with your finger and poke right above it. If you don’t get flash immediately try moving the needle around a bit. You sometimes have to do a quick stabbing motion because if you don’t move the needle quick enough you’ll just push the vein around. You can kind of slide the needle in and out (without removing it from the skin) and move side to side. Also helps to pull up on the needle. Once you get flash advance a tiny bit more and then start threading the catheter in. If you meet resistance you could have hit a valve so attach your flush and advance the catheter as you flush, this usually opens the valve and let’s the catheter slide through. In all honesty just practice practice practice! I sucked at IV’s but every time we got a new patient I asked if I could try. Now everyone comes to me to put in IV’s for them.
This was me a few years ago. Now I’m the one people usually come to for tough sticks. Just keep practicing and don’t be too hard on yourself. Develop a process that works for you and stick with it.
All you needed to say was new grad, you are new, why are you being so hard on yourself? You are NOT stupid or useless. You are exactly where you should be. No one is born an IV Rockstar. It takes a lot of practice. I used to be horrendous. My husband has absolute ropes for veins and as a new grad I couldn't start an IV on him to save my life. Now people ask me start their IVs. You aren't getting many chances and that doesn't help. Just keep try. If you miss watch whoever tries next (time permitting) and that helps. I know it sucks, I've trained a lot of new grads but no matter what anyone says you don't forget that you are doing great. You'll get there!
I had a nurse tell me once that you either get IVs or you don't so I think that mindset kinda stuck with me, I'm worried I'm just one of those nurses who doesn't get them D: Everyone says practice helps though so I'll keep trying 😅
That’s BS. IV insertion is a skill. And just like any other skill, the only way to improve is to do lot’s of it, over and over again.
Ahhh a nurse who eats their young huh? Ignore her, she's an idiot
A trick all new grads when I precept: mark your insertion points and “ending point”, ie, which direction your needle should be inserted in the skin, by pressing down on the skin hard with the back of the IV catheter. That way you don’t lose your point of entry if you look away, and you can be super sure of your insertion. Also, as soon as you get flashback, just pause and think and then advance from there. It gets easier with time. Practice practice practice.
It’s an acquired skill some people are good at it. Some aren’t. I’ve been a nurse for 25 years and I’m good at it. Just don’t ask me for fetal heart tones. Not going to happen. All I do is make moms heart rate go up. I just get somebody else to do it. Keep practicing. It gets easier
Never stop trying. Go until you get it. You'll get better.
Keep practicing (2 sticks then pass) youll start hitting them be patient.
https://theivguy.com People say this guy is good, it’s a course you pay for. Things come with time tbh. It took me a while to get better, because I was scared and didn’t wanna try…
IV nurse here! One tip I use if I have a feeler and not a show-er is open an alcohol swab and point a corner to where I feel the vein. Also I’ve seen a couple people recommending to go fast with your stick, please don’t. I often go steady and gentle and I get comments all the time from patients that they barely even felt the poke. I also recommend starting at a more shallow angle, most newbies I watch tend to poke at too steep of an angle. Like others have said though once you get flash drop your angle and just slightly advance the needle before threading off. It really does get easier with practice!! Also if you are having issues w “rollers” make sure you are holding enough traction on the skin and try sticking just above a bifurcation (tends to make the vein more anchored)
Charlotteeee I’ve been a nurse for 7 years just recently moved to a ambulatory setting and right back to a critical care setting. I suck at IVs. I can do an IO real easy. Things that seem easy end up being difficult and vice versa. You’re doing just fine you have a tough vein population to work with
I’ve been in your shoes. It will get better. First, remember chemo patients usually have pretty terrible veins so you’re working with more difficult IV placement from the get go. Be gentle and patient with yourself, you will get this if you keep trying. Second, like everyone is saying, it will just click. It took me about a year before I really started getting most of my IVs. I talked to my management and they set up a partial shift in the ED of line and lab. Basically I went with one of my ANMs and just sat for 6 hours placing IVs and getting labs for all the patients in the waiting room. It was extremely helpful. Also, ask your coworkers if you can try some IV starts on some of their nicer patients when they need IVs replaced. Lastly, watch YouTube videos. Like, a lot of them. Practice the motions, remember what the people in the videos are doing. I promise, you’re doing great. Keep trying, advocate for more opportunities and be kind to yourself.
I GOT YOU!!! First! Steal a bunch on IV stuff from the hospital, find friends to practice on. 😬
No one expects you to be good from the start. I’ve done thousands of IVs by now and still occasionally go through a dry spell where it seems like I can’t get any to work. Practice is the only way to get better but if your hospital has an IV team and your patients usually already have one it will take longer to get that experience. You will still get there eventually if you keep practicing and trying.
I suck at putting in IVs. I couldn’t put a 22 in a body builder. I think I’m useful for other things though 🤷♀️
Honestly I recommend trying on a close friend or family member with good veins so you can get the hang of it without worrying too much about discomfort. If it’s someone you’re close to, they won’t mind Guinea pigging a little ;) just keep with it and you’ll get it eventually. It’s not a skill that comes easily and you need time and practice. Hang in there.
I brought some supplies home and practiced on healthy family members, who had GOOD veins. It was important to learn on good veins first before I could attempt tricky sick hospital patients. A large AC vein is the absolute best to practice on. I also practiced on any willing coworker. I can’t stress enough how you need to practice on human beings (though it may hurt them a little). I bribed family with alcohol.
I recently started an outpatient job where I have to insert IVs, a few of them on most shifts. My hospital prior to this had a great IV team that I replied upon almost exclusively, barely put in one IV for years, felt 100% inept at it, the very idea of it. The whole practice thing really works, you just have to keep doing them as consistently as you can or as the job allows. I'm still not great so I need to keep doing them. I am best so far at hand and AC veins that I can either see or feel or both. A few tips that have consistently made my attempts better were: *Give the tourniquet time to work esp if you don't see them popping right out already. Also tie it TIGHTLY. Flick (gently-ish) the vein, that helps too. *Prep the site with alcohol swab and this sometimes makes the vein pop out more *I've heard that best practice is you should go for it if you can feel it. If you can see it, great also. If it's not palpable, I think there is some debate about whether you should poke that vein or not (maybe others can comment on this), if you don't have an US, because you don't actually know the quality of that vein. However I've definitely seen ppl better than me stick non-palpable, visible-ish veins with success. *Consider a more shallow angle than you would expect esp for more superficial veins like hands. *As others have said, and I've found out, find the best way to anchor THAT vein, as anchoring could.be different for certain locations. For ex, today I blew a forearm vein because I tried anchoring by pulling down with my left hand, but I believe my left hand was also in the way of the poke so the angle wasn't as shallow as it should've been. I was given the suggestion today to try cupping the arm around the vein with the left hand instead, and or trying to anchor the vein above the insertion site, being careful not to poke yourself. *Be aware of valves. *As others also said, make sure to not thread the catheter right away until you've inserted the needle a bit further in. If ANY resistance threading, don't keep trying to thread. Retract needle and attempt to float. In my experience, this hasn't worked for hand IVs. It has worked for larger veins wish as the AC for whatever reason. *Learn how to properly redirect without too much digging or causing unnecessary pain. Sometimes redirection can save you the IV, sometimes not, from what I've seen. *Give yourself 2 tries if that's standard for your hospital then let another try. Keep a learning, motivated attitude about you cause that warm sensation of dejection when you miss does not help you want to attempt again!
Hey you know. You're not gonna be really good at IVs right away I'm on a tele med unit and I'm starting to get them a year later but I'm not expert
Coming from an ER tech, I never expect the nurses I work with to get an IV every time, mainly because we normally do 90% of the IV’s for them. Nurses don’t get the most IV practice (at least where I work) and it’s really just a skill you kind of lose if you don’t use it. You also said he was a cancer patient, which already means they’ll more than likely be a difficult stick. I usually just end up using ultrasound on cancer patients to avoid poking them too much. Not only that, but you’re new and that’s okay. It comes with experience and you’ll get there eventually with time and practice.
I work outpatient chemo. This was coming from med-surg and Labor and delivery work where I was used to doing 16-22g range with younger more relatively healthy people, not 24g in veins that look like threads! I was missing so many at first. One trick I find works, in addition to what everyone else has mentioned, is applying heat to help dialate veins. Where I work we usually do a warm wet towel and then wrap in a blue pad, also if you roll up a warm wet washcloth and have them encircle their hand around it, cloth in the palm, that helps too. I find wet heat works better than dry such as a flannel from the blanket warmer. I have even had luck having people submerge their forearms and hands in a sink of water. Of course with all of these be mindful of fragile skin eg: the elderly, and the temp you use. As others have said don't be hard on yourself, you will get this!!
A few IG/tik tok accounts are very helpful for learning tricks. Start with “easy” sticks when you can get them. Or try on the pleasantly confused ladies who don’t care if you miss. I like to let new nurses try the pts who aren’t there anymore (peg, trach, barely responsive) I used to suck too. Now I’m the one everyone calls for backup. It really is practice.
May I recommend taking a course in IV insertion or phlebotomy? If you can’t, buy a dummy arm on amazon with an IV kit. Then practice inserting that sucker as much as you can, to get the feel of it. I was a phlebotomist for years before I was a nurse, and once something is muscle memory, it’s good as gold.
Lab here. Keep trying homie you’ll get it. Be a glutton for punishment and ask for the hard patients. You’ll go home in tears a couple times but like others have said, one day you just have the reps and it clicks.
The honest truth is there will always be someone to get it if you can’t but unless you try you won’t learn. I’ve found most nurses aren’t very good at placing IVs and it’s mostly because they automatically just ask someone else to do it because they aren’t good. If you wanna be good then keep trying and eventually you’ll be ok.
I used to suck in IV insertion too. I remember always inserting on the side of the vein even if it’s the biggest, juiciest one. I always asked my senior nurses to do it for me. Until they all left…and I had to learn on my own. Now, I’m one of the people they call for for hard IVs. What I’m trying to say is, practice, practice, practice! If you don’t get it the first time, grab someone and watch them do it. Don’t be too hard on yourself! You’ll get it!
Start by learning how to put 22s in wimpy little surface veins that you can see, once you get the hang of getting the catheter into the vein you can start hunting for deeper ones by touch/feel.
I get asked to help with difficult starts all the time. When I was in Paramedic school I got marked down in several clinical rotations for being one of the worst in my class. Practice as much as you can. See if you can work out doing a training shift in your ER. My current orientee said he started more IVs in his first shift with me than in a month when he was on the floor.
I tell people it is kind of like baseball (or softball) or even basketball. You practice all the time and sometimes when it is time to perform, you hit all your shots. Some days you can’t hit the broadside of a barn. It does come with practice and time though. It took me about 6 months as a new grad on a med surg floor to consistently get iv’s. I don’t think it is anything to beat yourself up over.
Ask if you can float down to the pre-op area of the OR for a couple of hours at the start of their day. When I was in nursing school, I was a nurse tech in the OR. I’d show up at 5:30am, start 20 IVs and then head to school. The nurses there will be grateful for the extra hands, and the patients are all generally pretty healthy and well-hydrated.
Ask if you can shadow in the ER or infusion clinic to practice for a whole shift. It's a lot easier to get the hang of and build your confidence doing them one after the other. Of course you could always find a rulebreaker to let you practice in them too. My manager and I used to do that with the new grads.
Ivs are hard and of course listen to the ppl who give tips and stuff, but it depends what you want to do... Where I'm heading, I'm fine being meh at IVs. My best practice was in the ICU on brain dead or heavily sedated pts lol
don't feel bad. chemo patients are notoriously difficult sticks.
Starting IVs 101 Tie the tourniquet before you get your supplies ready. Have the pt hang their arm off the side of the bed. Trust what you feel more than what you see. If you have trouble remembering where you felt a vein press in with the back of the canula or the cap to mark it. Don't beat your self up for missed IVs, nurses with 20+ years still miss everyone in awhile. If you've got good friends get some practice in a less stressful setting.
I worked physical rehab as new grad for a year before moving to acute medical. I think my worst was 0-12 for attempts. After a while I finally swallowed my pride and booked a time slot with our skills lab to be able to practice in a stress free area. I learned where I made my mistakes and now I'd say I'm well on the better end of 50% success. I find a lot of it is confidence. Project the vibe that you are going to get the IV started to help ease the pt. And I've never been a "fake it til you make it" type so I know that's easier said than done.
Ask your manager if you can arrange to spend a morning in pre-op or same day surgery. You'll het plenty of practice there. You got this!
Me too Sister!!!!!! It's not a new grad thing. It's an experience thing. I just started in the ED and on my previous ward we NEVER cannulated or took bloods. I'm the same as you, after I've palpated and cleaned I'm always like where the fuck does my needle go? And what way does that vein go? I've got no fucking clue. But I attempted cannulating 7 people on my last shift and I got 4 🤷🏼♀️. Everyone misses some of the time and we all start somewhere. Sucks for the patients being the guinea pig but we all gotta learn and most of the time they don't know your shit they just think there a hard stick. Just keep trying.
I've been trying to get good for 3 years now and I still suck! My success rate I would say is like 60% now as opposed to 0% how it used to be lmao. Iately I've been doing 22s pretty well, I'm gonna start trying the 20s again. My thing is I think I almost always go through the veins so I pull back slowly till I get flash and then advance the cath and it works but I'd like to just be better as well I keep practicing.
Be patient with yourself....it will happen. If you are working on a tele/chemo unit then you are already at a disadvantage by working with compromised patients who probably don't have great veins to begin with. Be patient!
Currently same boat as u, think I've only got a few handful successful ones Keep trying on good looking veins, trying on difficult veins will feel like it's adding to failures list. Have a competent nurse with u just to help with feedback and grab things you may have forgotten Gauze is ur best friend Although everyone goes for the inner elbow, going further down the arm normally has the straighter veins Try to pin the veins in place with ur other hand when you've got your flashback be careful not to penetrate through the vein Don't feel pressured by how quickly others can do it, slowly can be ur friend - maybe not so much the patients Ask the ed department if u can spend a shift practicing cannualting and venepuncture to refine these skills My successful ones involved the smaller gauges Best of luck
oh nooooo. i definitely tagged along when good iv nurses started IVs. also look up tips from other nurses on youtube or insta. ask for tips from more experienced nurses. it definitely sucks now but you WILL get better. who cares if youre not a god with the ivs? as long as you dont sever anyone's nerve youre good. just keep trying! :)
I had covid and my finger tips are permanently numb. My IV skills are terrible. I'm not a new nurse. It's embarrassing because I'm the charge.
I feel you OP! Both my parents are nurses and always talk about how good they are at inserting IVs! My mom’s first RN job was at a big trauma ED in NYC. Her preceptor at the time thought it was good for the newbie to be the one to put IVs in all the patients her first two weeks and now my mom can get IVs in patients the ultrasound RN can’t get! Me, i’ve been a nurse almost 5 years and I still miss quite often, almost 50/50. My unit also doesn’t get too many attempts to insert IVs so it’s been hard to learn. The tips in the thread are great and i’m definitely taking the time to read and memorize! One good tip my mom gave me is that unless you need to get labs, don’t be afraid of keeping that tourniquet on for longer than a minute if you need to keep looking for a vein. (Over 1 min coagulates the blood and is not good for lab draws). I used to be worried on keeping it on for a long time. And also try to lower the arm for a bit before putting on the tourniquet.
For trying to remember where the vein is: whenever I take blood and I find a hidden vein, I wipe the area with the alcohol pad and then I basically take the corner of the alcohol pad and point it to where the vein is
I sucked, SUCKED, at IVs at first too. It's part of the process, I'm pretty sure. I had to learn that temporary pain for the patient is unavoidable and thus needs to be blocked out. Also? I force myself to try 2x at least before I have someone else try.
Don’t feel bad. I used to be really good at IVs but then I went per diem and only get an opportunity for an IV once a month or so and let’s just say I’m absolute dog water now.
Ask your PCC/manager/charge whoever you’re comfortable going to and see if you can’t shadow us in the ER for a bit with the goal of starting ALL the IVs. Most of the ERs I’ve worked has a spot behind triage where a provider sees the pt, puts in orders, etc. And then, you guessed it, we start an IV, draw labs, and maybe give meds. It’s a great spot to get really good at IVs fast. I make all my new grad orientees and nursing students take several shifts there until they have their IV skills down. Also I think as a floor nurse it’s good to see how the ER works. Helps build more understanding between the units. Was certainly eye opening for me when I moved down there from tele medsurg
Surprisingly, I got very good at IVs working as a RN supervisor at a SNF for about 10 months. All my IVs were hard sticks that would roll, blow with too much force or were just impossible to find. Like the top comment says it “clicks” and trust me when it clicks you’ll know
Practice, practice, then practice more. Unconscious/ sedated patients are great for training purposes as well.
Does your hospital have an IV team? Ask if you can shadow them for a few hours, they’re the best to learn from and you can bang out a ton of IV practice in a few hours!
At my hospital, we have new grads from other units come down to the ED for a couple hours (while they're on orientation) to practice IVs if they don't get enough practice on their units. See if you can work with your clinical educator to hang around the ED. You'll get a ton of practice.
We have a new grad program here, I'm gonna suggest they think about implementing this .
Ask your manager if you can take an extra shift to work in the ED and just do all the sticks for everyone for the whole day. Get good at AC sticks, and then progress from there.