Not comfortable with IV's

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Dryacku

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I start my residency this july. I feel confident with my intubation skills, doing arterial lines, and central lines. However IV's still scare the hell out of me and I feel as if I am not ready (esp on my four hundred pounders). Is this a normal concern or do most programs expect you to be able to nail this skill right away?
 
A trained monkey can do IVs given enough repetition. Just focus on learning how not to kill the patient for the first few months. The IVs will become second nature. Just do a little extra practice on you asleep patients. A second IV line can be a good idea for a lot of cases anyway.
 
I start my residency this july. I feel confident with my intubation skills, doing arterial lines, and central lines. However IV's still scare the hell out of me and I feel as if I am not ready (esp on my four hundred pounders). Is this a normal concern or do most programs expect you to be able to nail this skill right away?
Don't worry about it, you will get better.
 
I went to a medical school where all IVs were done by ancillary staff-> no experience. Internship- if a nurse came to me and told me they couldnt get an IV on someone- I asked myself if they really needed an IV and if they did then central line it was...

my first two weeks of residency I couldnt start on IV on anyone... I would try on every patient, fail, the attending would put one in.. off to sleep.. second IV time... try till I got the second IV... I joked with my colleagues that I was the little vampire.. but in time you get better and you dont think about it... I agree with the second IV in every asleep patient...

though one of the most humorous stories I remember is day 3 of residency when an attending asked me to put a 14 G in...the look of horror on my face!
 
you feel CONFIDENT with a-lines, central lines and intubation? by the sound of that you'll only need to do about 20 ivs and you will be a champ.
 
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
 
Thanks for the feedback

I'm hitting a er and then ICU rotation soon and hoping to get as much experience as i can
 
I am not sure there are many people comfortable with IVs right out of the gate. I can especially see it as I watch a medical student struggle with a huge pipe on an asleep patient.

One of the attendings showed me this as I started and I do this for all of the students who rotate with me ... borrow (not steal) some IV tubing and several IVs. Take the IV and practice putting it in and threading the catheter into the IV tubing. Yes, I know the tubing is see through and much easier, but it gets you in the habit of 1. using one hand as you hold the IV tubing and 2. to see just how far you need to advance the needle to allow the catheter to clear itself into the lumen.

Hope that helps and you understand what I mean.
 
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