Take a TB syringe, fill it with 1% lidocaine, put a 1/2" 27g needle on it. Put the tourniquet - tight, but not too tight - on the arm and let it fill up with blood. Clean the insertion site. Don't touch it or slap it with your finger after you clean it. If you do that, you just contaminated it. Rub it a few times with whatever cleaning device you are using (chlorhexidine sponge, alcohol pad, etc.) to get the vein to puff up. Bevel up, take the tip of that lidocaine 1%-filled syringe with the little 27g needle and slide it ever so gently intradermally just distal to where you want to place the angiocath. Gently and slowly inject about 0.1 to 0.3 mLs until a nice little wheal forms. Now, get the rest of your stuff ready. Re-rub the area with whatever skin prep you have (chlorhexidine sponge, alcohol pad, etc.). Take the angiocath and put it in righ where you injected the local. Go slow and deliberately. Ask for help on the geezers and the fatties when you are starting out.
A lot of first-time IV starters are tentative because they are afraid they are going to hurt the patient. This adds to your performance anxiety. If you numb the area, the patient won't feel a damn thing. The vast majority of the pain receptors you might hit are in the dermis. This is not only nicer for the patient, but nicer for you. And, you may not be too surprised to know that many patients consider this the most traumatic of the entire anesthesia experience. They will tell their friends and family that they didn't even feel you start the IV if you do this, and you'll look like a rock star.
If you are going to start anything larger than a 22g, always make a habit of numbing the insertion site. Even on the tough guys (like my dude this morning with skin like a leather chair that I plunked a 16g in after numbing his hand).
-copro
