I cant put in an IV for ****, should i not go into anesthesia?

[amherstguy]

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[Pilot Doc]

I was once in your place.
It's a learnable skill.

 

[Jeff05]

that's like saying - i don't know anything about medicine should i go into medical school?

not sure why some people expect to just know how to do procedures and see failure as not being skilled at something after several attempts (i'm gonna guess you've attempted to place an IV less than 100 times.)

?!?

 

[Licoricestick]

that's like saying - i don't know anything about medicine should i go into medical school?

not sure why some people expect to just know how to do procedures and see failure as not being skilled at something after several attempts (i'm gonna guess you've attempted to place an IV less than 100 times.)

And if you ask someone for help (with any procedure) - stick around and learn.
I refuse to put in IVs on the ward if the requesting person isn't there (of course the downside to that is that it's all the more embarassing when I miss...but you can't have everything in life).

PS: when I was a med student I could put a drip in, but couldn't for the life of me take blood with a needle... makes no sense I know.

 

[amherstguy]

yeah i hear you guys. its still embarrassing because im on my anesthesia sub i and i think i am making a fool out of myself by missing these iv's. i can get it in the hand nearly 80% of the time but if the patient requests it anywhere else i usually don't get it. its truly frustrating. do you guys have any techniques on vein selection or anything that can help me, i got three more weeks to make a decent impression! I really like gas but this is frustraitng the hell out of me

 

[Jeff05]

always use lidocaine - 27 gauge. its stings, but then you can dig around.
iv needle should be almost parellel to the skin. put traction on the skin distally to the needle insertion site - just make sure your traction finger is not in the way of the needle.
once you get flashback - on 18s and anything smaller - DO NOT advance. just stabilize, drop your angle - completely flat and thread it in.
there are many other methods.
ergonomics are 80 percent of it. make yourself comfortable.

 

[Bertelman]

always use lidocaine - 27 gauge. its stings, but then you can dig around.
iv needle should be almost parellel to the skin. put traction on the skin distally to the needle insertion site - just make sure your traction finger is not in the way of the needle.
once you get flashback - on 18s and anything smaller - DO NOT advance. just stabilize, drop your angle - completely flat and thread it in.
there are many other methods.
ergonomics are 80 percent of it. make yourself comfortable.

Seriously? That's pretty much counter to everything I've heard. I'm fairly successful, can get the IVs the inexperienced nurses can't get, and advance every time. As I understand, if you don't advance, the catheter may catch on the vein as you thread it. Why do you think it is better to advance with the catheter outside the vein, other than the obvious risk of possibly passing the needle through the other side of the vein with advancement?

 

[DO4lifer]

yeah i hear you guys. its still embarrassing because im on my anesthesia sub i and i think i am making a fool out of myself by missing these iv's. i can get it in the hand nearly 80% of the time but if the patient requests it anywhere else i usually don't get it. its truly frustrating. do you guys have any techniques on vein selection or anything that can help me, i got three more weeks to make a decent impression! I really like gas but this is frustraitng the hell out of me

i can't do anything besides the hand as well. its okay though, there is more than one vein in the hand and more than one hand!

my patients will have 10 peripheral lines...in their hands!

 

[Arch Guillotti]

I am the cats meow when it comes to starting IV's. I always advance just a bit after I get the flash.

 

[deleted50478]

Take a second and look at how far beyond the catheter tip the needle reaches... that is how far you need to advance after the flash. simple.

When I started, I would enter the skin a cm distal to a bifurcation as long as the vein is straight above that. I think they roll less near bifurcations, seemed to help. I also had a better time with medium sized veins compaired to the big mothers.

 

[McPoyle]

I am the cats meow when it comes to starting IV's. I always advance just a bit after I get the flash.

I know I am just a paramedic, but I do this same thing-start with a very shallow angle, get flash and wait for the chamber to fill completely (maybe advance VERY slightly in the process) advance slightly if I haven't already, and then thread the catheter. Generally I release my tamponade briefly, if blood flows up the catheter I usually take this as a good sign (provided I didn't obviously blow the vein) and then attach whatever it is I am attaching (lock or line).

Two things that I found that have helped me immensely over the years:
1. From a very early time, attempt difficult lines-for me this means I start the vast majority of my IVs while en route. I do this because it builds confidence for when I have that pt. that I really need to get a line on the first attempt (cardiac arrest, RSI, trauma, etc.).

2. Realize that I will invariably miss occasionally, and I need to own this and not make excuses. It happens, I know it hurts-we learned on each other in school-I try not to feel too bad and avoid beating myself up. This is nothing but a technical skill that I contend if can be taught to people like me can be taught to anybody.

Keep your head up, some day you will look up after starting a line and realize that you haven't missed in weeks. I guarantee it.

 

[Trisomy13]

i agree with not advancing with only 18ga and smaller. 16 or bigger, and i failed every time before i started advancing a bit before threading.

i think everyone finds their preferred way eventually. i couldn't hit the side of a barn for the first few months of CA-1.

 

[Jeff05]

the tip of the catheter is 1mm away from the needle in an 18g
less than that in a 20 and 22.
most people do not have the dexterity to advance less than 1mm.

i don't remember the last time i blew an iv.

Seriously? That's pretty much counter to everything I've heard. I'm fairly successful, can get the IVs the inexperienced nurses can't get, and advance every time. As I understand, if you don't advance, the catheter may catch on the vein as you thread it. Why do you think it is better to advance with the catheter outside the vein, other than the obvious risk of possibly passing the needle through the other side of the vein with advancement?

 

[Dejavu]

Before going to med school I was a nurse and CRNA. I remember to this day, early on, going three months without a successful IV start. Now I get calls when no one else can get a vein, so, like people have said, it is a learnable skill.
I would add to what has been said, after 35 yrs experience, that you probably need to advance the needle after the flash of blood, but only a millimeter or two.
Also, when first moving the needle toward the vein, move slow. I see people ram the needle around and wonder why they missed the flash of blood. Some pts have a really slow flashback into the hub and when moving the needle quickly you might miss it. So slow down a bit. I also agree that the angle of attack needs to be parallel to the skin, never at a 30-45 degree angle like they used to teach. In fact, more importantly, the needle should be parallel to the long axis of the vessel you are trying to enter, either vein or artery.
Also, more people get in trouble when the get a nice flashback then make their next move to pull back on the needle as they advance the cath. It should be: advance the needle a couple of mm, then advance the cath first, holding the needle still, then remove the needle.

 

[Versed0101]

I agree with advancing slightly at a low angle after flashback. The key at that point is to make sure you are advancing the catheter rather than pulling back on the needle. I've seen it many times where the needle is withdrawn before the catheter is in and it just crinkles up under the skin.

I definitely would not let this deter you from choosing anesthesiology. You will become proficient and more than likely in private practice a nurse will be starting them for you anyway.

 

[countingdays]

the tip of the catheter is 1mm away from the needle in an 18g
less than that in a 20 and 22.
most people do not have the dexterity to advance less than 1mm.

i don't remember the last time i blew an iv.

I think the point is that with big iv's you need to advance at least 1mm but not so much as to go through and through. Advancing 1-3mm may be better than zero. If you were going fast before the flash, you may have advanced it already and won't need to advance further. Approaching really flat to the skin gives you a little more room to advance after the flash without hitting the back wall.

 

[Arch Guillotti]

When I am putting in large bore peripheral IV's I pick a straight vein, go in close to parallel to the skin (quickly), feel the pop, get the flash then I advance a bit. With a 22-24 I advance a hair if anything at all. Twentys and eighteens a smidge. 16/14 IV I advance a couple of mm. If the vein is a good one sometimes I advance even further before I thread. Since I pick straight veins and I am nearly parallel to the skin I find you can advance easily without problem.

 

[anesthesiadoc]

?!?

Amherstguy,
We've all been there. You will get good, then great at IV starts if you go into anesthesia. Do NOT worry about this or let it put you off the specialty. Unless you have some parkinsonian/choreaform comorbidity where you physically are unable to have a steady hand, don't let this one get you down. You'll get it. I'm in the process of teaching our new CA-1's, and it reminds me of how most of us started out. In a few months they'll be teaching the rotators from the ER how to do it. No worries.