No matter if you’re a seasoned pro at starting an IV or a beginner we all hit a wall. I’m not talking a valve in the vein but trouble starting that line. We hit a slump. We may go a few days, weeks or even months without missing an IV. Suddenly you can’t hit a garden hose. These are the top things I see that make you run into trouble when it comes too starting a line. Every time I hit a slump I go through this list in my head. Step by step being mindful of my actions until get my groove back.
Starting an IV is a simple task and it starts with location. Location! Location! Location! Sometimes we all get in a hurry to start that line but getting it right the first time makes a difference. That old adage “If you don’t have time to do it right, When will you have time to do it over? ” could never be so true. Take the time to look for a great spot to start the line. Even if it comes to asking about where the patient think is the best spot. The patient maybe a help. IV size selection from the patient is a different story. Too often we pick the first site, not the best one. Take a few more seconds to look. If you blow it your going to need some bleeding control and to look for another site. Its especially annoying for you to miss only for another person in the meantime roll up and throw in an IV like it was nothing.
Position before submission… This is an old jiu jitsu concept. If that vein is going to submit to your will it first starts with position. I watched a paramedic attempt IVs multiple times on a hypoglycemic patient who was sitting on the edge of the bed. The patient was swaying back and forth like he was going to fall over. After 3 attempts the medic stepped back and said your turn. I laid the patient back on the bed and threw an 18 gauge in the patients forearm on the first attempt. You can’t get the perfect position on every IV attempt on every patient but little attempts to set yourself up can go really far.
To tourniquet or not tourniquet, that is the question. Be mindful of the patients blood pressure and history. If the patients blood pressure is high and you tie the tourniquet too tight that vein will pop like a water balloon. Many times with a pressure above 180 systolic I’ll skip it all together. If the pressure is too low the vein will collapse or a flash will be delayed.
Watch your angle. If you approach too step an angle you’ll poke through both sides of the vein. Too shallow of an approach has its own problems. Too shallow and you will glide over the skin or push the vein making it roll.
Make a mental picture. Look at the length of the IV needle especially the bevel . Many times I see IV attempts go wrong after the flash. Remember you have to advance the needle far enough that the catheter enters the vein. All too often the catheter gets advanced too early because you just entered the vein and not past the bevel The catheter and catches the wall of vein. Once this happens your pretty much out of luck. Making a mental picture of the deep veins your trying to hit by feel helps as well.
We all hit those slumps. It might be from a couple weeks vacation or just from being a little too confident in our skills. Slow down and take these steps in consideration; You’ll soon be out of that slump in no time.