Starting ivs

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I have just begun learning to start iv's, so far I have gotten one hep well in and have blown every other iv I have tried to start.
Any other med students having difficulty starting ivs? I mean I definitely dont want to show up in an anesthesia program and not even know how to start a friggin iv.
On a positive note I was able to intubate using a miller blade today! My other successful intubation was with a mac. I have intubated the esophagus twice and was unable to see the cords on two other occasions.
Any one want to give tips on iv placement or is that a no brainer that I should have learned by now?
 
MeaCulpa said:
😱
I have just begun learning to start iv's, so far I have gotten one hep well in and have blown every other iv I have tried to start.
Any other med students having difficulty starting ivs? I mean I definitely dont want to show up in an anesthesia program and not even know how to start a friggin iv.
On a positive note I was able to intubate using a miller blade today! My other successful intubation was with a mac. I have intubated the esophagus twice and was unable to see the cords on two other occasions.
Any one want to give tips on iv placement or is that a no brainer that I should have learned by now?
Click to expand...


What technique are you using? Do you think you are passing the catheter through and through the vein? What happens many times is that you will get a flash of blood when the needle passes into the lumen of the vein then the user tries to thread the catheter when actually the catheter portion is not yet in the vein lumen and it subsequently shears the superior portion of the vein with a nice resultant swelling at the site and much cursing during this time.

Know who can teach you a ton about starting IVs, this is not a troll post, but PreOp RNs do this daily on people. Watch the angle he or she starts with to get blood return and then watch to see if they lower the angle, advance slightly (to get catheter portion into the vessel lumen) and THEN thread the cath. Most RNs should be more than happy to teach you, just ask.

I hate starting access on renal pts with no central access. Often you have to use the tiny veins of the thumb, first finger or inner wrist using a 24 guager for those short procedures, often port insertions or av fistula ops.
 
MeaCulpa said:
😱
I have just begun learning to start iv's, so far I have gotten one hep well in and have blown every other iv I have tried to start.
Any other med students having difficulty starting ivs? I mean I definitely dont want to show up in an anesthesia program and not even know how to start a friggin iv.
On a positive note I was able to intubate using a miller blade today! My other successful intubation was with a mac. I have intubated the esophagus twice and was unable to see the cords on two other occasions.
Any one want to give tips on iv placement or is that a no brainer that I should have learned by now?
Click to expand...

aggressive distal traction to keep the skin taught (sic?), low angle of approach, advance just a little past the flash.

The distal traction to keep the vein stationary is the key in my opinion.
 
jetproppilot said:
aggressive distal traction to keep the skin taught (sic?), low angle of approach, advance just a little past the flash.

The distal traction to keep the vein stationary is the key in my opinion.
Click to expand...

taught=learn me
taut=tight
 
rn29306 said:
Know who can teach you a ton about starting IVs, this is not a troll post, but PreOp RNs do this daily on people.
Click to expand...


This is true...the ward nurses start them daily also....

but then why do I get calls everything on my radio (we use radios to assist running the OR) "IV help in ASU 3"....usually when I'm right in the middle of an induction or nerve block...or something else when I can't get away...
 
As one nurse taught me and it does help... think of it as landing an airplane.. make sure that when you get flashback, flatten out a bit and then thread the catheter... much better to show with hands in person.
As a student, if I blew a vein it was b/c I was taking too steep of an angle and pushing the needle with the catheter through the other side. All about repetition.
 
Along with everything that's been said about angles and advancing, after I was told "Put it in like you're going to get it!" corrected my hesitant stabbing motions (through and through was not my problem). Much success has been had after that advice.
 
Not to go into too much depth on such an easy topic, but I have a question about placement, if you see a vein clearly, do you go into the skin above the vein or do you go lateral to the vein and then move the needle towards the vein while in the skin, from the side?
 
Low snd slow is my motto. Tension helps as well. When some starting IV on 350lbs , edematous, dark skin patient sometimes its just all about luck.
 
out of towner getting into NYC cab to the driver, "say, how do you get to carnegie hall?"

cabbie, "practice, practice, practice."

have someone show you the correct technique, then just practice on easy patients (young, well hydrated) somewhere. it gets easier the more you do. if all else fails - and it will on some patients no matter what - you can go for the central line, and (sorry but "not to start a troll post" 🙄 ) a preop holding nurse won't be able to show how to do that. just about anyone can learn how to do technical skills, it just takes practice.

alternatively, if you're in a room, wait until the patient is under then ask the attending/resident if you can start a second iv. you'll have the double advantage that they will already have gotten some fluids and, as well, they will be anesthetized so they won't feel you poking around. takes the stress off of them, and you!
 
I think the ability to start an IV is core to an anesthesiologist. Perhaps this is lack of knowledge about the details of other medical services, but speaking from what I have seen in the past, other medical specialties don't really have to know how to obtain peripheral IV access. Most ICU'ers get some form of a central line, so get pulmonary, surgical, anesthesia or trauma to get a central line. Difficult stick on the floors - call IV team or central line. In my past, I have never seen anyone other than a member of anesthesia, pulmonary, or surgery start a central line in private practice. Have IV difficulty in an ICU and a MD from cardiology or renal order all kinds of incompatible gtts, tough cause they ain't gonna sticky the pt.....

However, in preop, esp on outpatients, a central line is not the answer for most patients, unless they are inpatients. The R/B ratio is too great. This is esp true in day surgery for peds, particularly ENT peds. A cut-down on peds for outpatient surgery on a regular basis is simply bad form.

My gist is that an anesthesiologist MUST master the art of getting peripheral access. I can't really think of another medical specialty that requires this as a paramount skill. Yes, a central line is always a fall-back. So get your experience where and when you can, because the fact is someone isn't going to call you on the easy sticks...The call will come after numerous people have already blown the obvious and easy sites. The tip about the 2nd line after induction is very true, you can stick and stick without stressing anyone out, other than the inpatient surgeon..... Some of the most difficult patients to obtain access on are these crusty renal pts going under MAC for a HD cath placement, something that happens to be popular at my facility.

I think most posters already acknowedge the fact that an RN can't show you how to do a central, my simple point is to get someone who does something on a daily basis, day in and out, to demonstrate a skill if you need practice. Preop RNs do alot of paperwork and IVs. Not a cut at them about job description, but that is what they do and most are very good at establishing PIVs.
 
well, personally i rarely miss an iv at this point. and it didn't take me years to master it. even on a dried-up post 5-fu colorectal patient with sclerotic veins. and i never had to have a nurse show me how to do it. it just takes practice.

i find it humorous how the nurses always jump in with the "show the young doctor how to do it otherwise they won't learn it correctly" stuff. just look at the number of nurses who've contributed to this thread. sometimes i think the tendency in the thinking is "see, i can do this better than you" and use this is some sort of insecure over-validation of their worth. doing skills =/= practising medicine.

my additional point was that there are some patients you simply aren't going to get peripheral access on. period. no one should feel bad about that. there are other techniques besides a central line (for example, intraosseous for peds and adults) that work just as well and have fewer complications. but these, again, are mid (or higher)-level skills.

however i don't think we're talking about that here, but rather a med student - like every other student, even former nursing students who've contributed so far - who's working his/her way through the learning curve. i just thought it was funny that all these nurses jumped on board with the "just ask a nurse how to do it" stuff.

to the OP, just be patient and practice. you'll get the hang of it. it takes probably 40-50 sticks before you start to feel comfortable. no one - doctor or nurse - is going to be able to get you that experience except for yourself by doing it.
 
Have a nurse in the NICU show you how. At least the ones who don't always rely on illumination to find the veins. Actually, anyone who does IVs regularly on pedi / neonates.
 
A cheaper option are the red light transilluminators that shine dark red light through tissue which is absorbed by the blood vessels and transmitted by the surrounding tissue, leaving you a perfect outline of your target. I developed a cheaper version than the $50 disposable units that I saw at the ASA, but no one wants to produce it (i.e., it's too cheap to make a profit off of).
 
When using the jellco you can take that plastic piece off the end and put a 3cc syringe in place of it. This will enable you to aspirate. Even if you have punctured through the vein you can keep on aspirating while advancing until you cannulate the vein.
 
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