# Starting IVs Next Week, any Tips?



## jjesusfreak01 (Sep 2, 2011)

My Intermediate class is starting IVs next week any I was wondering if anyone has tips to keep me from looking like an idiot my first time. This can range from ways to keep from poking yourself to "how to tape like a boss". Thanks in advance!


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## AlphaButch (Sep 2, 2011)

Understand that sometimes you won't get the IV. Don't beat yourself up about it. I've seen alot of students get intimidated by IVs after 1 or 2 patients and then get scared to try more. 

Hopefully you'll have a good preceptor or nurse that you can pose questions to or can assist you with site recognition and/or monitor your performance providing good feedback. Take their feedback and use it to learn, don't let your ego close your mind. 

I had good days and bad days with IVs while doing my clinicals, it was pretty frustrating at times. My biggest problem was palpating to find a site, which I fixed by studying more anatomy and doing blindfolded site finding on a training arm (just find the site blindfolded, then take off the blindfold before cleaning and sticking).


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## DesertMedic66 (Sep 2, 2011)

Paients don't really like when you say "I've never done this before but I've seen it done on YouTube"


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## fast65 (Sep 2, 2011)

Like alpha said, don't get discouraged if you miss some, especially your first time. Just take your time, don't get in a rush and focus on what you're doing. 

A little tip that I found helped me a lot was to let the flash chamber fill up all the way before trying to advance the catheter. If you only get a little flash, drop your angle and advance the needle a little more until the chamber fills.

Oh, and don't forget to pop the tourniquet, it's kind of embarrassing having your pt. say "is this supposed to stay on?"  Plus it helps reduce the bleeding if you don't occlude well enough.

Sent from my mobile command center


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## medic417 (Sep 2, 2011)

AlphaButch said:


> which I fixed by studying more anatomy and doing blindfolded site finding on a training arm (just find the site blindfolded, then take off the blindfold before cleaning and sticking).



I agree the key to success is feeling rather than seeing.  Often I will just visit with a patient and be feeling while I am making eye contact with them.  Once I feel the site I want then I look down. 

Now I wonder what your patients think when they see you coming at them with a needle and a blindfold?:unsure:


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## EMTSTUDENT25 (Sep 2, 2011)

Almost everyone in my class, including myself, had a bad habit of "re-touching" the area of insertion causing us to have to re-clean the area.  We lacked confidence.  Our instructor would always say "the vein is still there, it didn't go anywhere!"  I think remembering to drop your angle helps a great deal as well.  When I was doing my county 911 clinical I had an EMT make me a little toy to practice on...He took a styrofoam coffee cup and taped cut up pieces of drinking straws all around to act as a makeshift arm and vein.  He gave me a 20g and said go to town.

Oh, also, its a good idea to make sure you've got all your materials(cut tape, tagaderm...) within reach, it gets kinda tricky if you have to do that while occluding and what not. Just my 2 cents.


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## usafmedic45 (Sep 2, 2011)

Do unto others as you would have them do unto you.


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## mycrofft (Sep 2, 2011)

*OG notes*

You will learn to "know" the distance to pierce and advance through training and experience. Mistakes in practice are golden, not so good later on if you were just lucky in class. Notn only have the materials handy, but do not get all excited if you are using a system that allows a bit of blood to escape before attaching the tubing; I've seen IV's started then screwed up when the matador lunged for bleeding control and jostled the catheter hub.
Oh, and don't wear any wackerish tee shirts.


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## DESERTDOC (Sep 2, 2011)

Taping.

Function over form.  It amazes me as to the lengths people go to, to do intricate time wasting taping puzzles.

KISS.  Tagaderm, opsite, or whatever you use and 3 pieces of tape.  I have never needed anything different.

Also, remember as you go up is size, to advance a bit more so that the larger bore is well within the vein.

Slow movements hurt.  _Controlled _speed is less painful for the patient.


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## mcdonl (Sep 2, 2011)

Familiarize yourself with the equipment. This may sound silly, but for the longest time I would carry pieces in my pocket and every now and again take them out just so I can visualize the connections and parts. Searching, and looking quizically at your equipment before sticking a patient can be a little unsettling for them.

Learn to feel the vein. I almost never go for the one I can see, it is the one you can feel that is best.

And, when you introduce yourself... say something like I normally work in an ambulance and need a certain amount of hospital time for my new license level. Makes them feel at eased, and sometimes they think ambulance people are cool.


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## ArcticKat (Sep 2, 2011)

mcdonl said:


> And, when you introduce yourself... say something like I normally work in an ambulance and need a certain amount of hospital time for my new license level. Makes them feel at eased, and sometimes they think ambulance people are cool.



Why say anything about his status at all?  Just introduce yourself and tell them you're there to start the intravenous line.  Act like a duck, all calm and cool on the surface but paddling like hell underneath.


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## mycrofft (Sep 2, 2011)

*Re TAPING*

Oh, heck yes!!!


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## Cup of Joe (Sep 2, 2011)

Act calm, cool, and confident.  It will definitely impact the patient and they will be more at ease.  On the surface, act like you've done it a thousand times, but do it like you were starting the IV on one of your parents.


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## usafmedic45 (Sep 2, 2011)

> Why say anything about his status at all? Just introduce yourself and tell them you're there to start the intravenous line. Act like a duck, all calm and cool on the surface but paddling like hell underneath.



Exactly.  If you tell me you're a student, you're not touching me unless I know you really well.


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## medic417 (Sep 2, 2011)

ArcticKat said:


> Why say anything about his status at all?  Just introduce yourself and tell them you're there to start the intravenous line.  Act like a duck, all calm and cool on the surface but paddling like hell underneath.



Some clinical sites require students to introduce themselves as students and to ask if the patient minds them performing the procedure.


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## jjesusfreak01 (Sep 2, 2011)

Cup of Joe said:


> Act calm, cool, and confident.  It will definitely impact the patient and they will be more at ease.  On the surface, act like you've done it a thousand times, but do it like you were starting the IV on one of your parents.



My mom bruises easily and they blow pretty much every vein they hit on her, so this is good advice, I think???


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## HotelCo (Sep 2, 2011)

DESERTDOC said:


> Slow movements hurt.  _Controlled _speed is less painful for the patient.



This. Pierce the skin fast, and then advance slowly. Don't understand what I'm talking about? Have someone start a line on you, but have them slowly pierce the skin. 

The majority of my patients tell me they didn't feel a thing.... The same can't be said when my partner does it. 




Sent from my iPad using Tapatalk


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## lightsandsirens5 (Sep 2, 2011)

Good advice from everyone so far! 

Just remember to not be like me on your first stick. I don't know what I did (or didn't maybe?) do, but this was the result. :-S My poor partner. :-( I felt horrible!
	

	
	
		
		

		
			





 Aftermath of an AC stick gone bad. :-S


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## Cup of Joe (Sep 2, 2011)

lightsandsirens5 said:


> Good advice from everyone so far!
> 
> Just remember to not be like me on your first stick. I don't know what I did (or didn't maybe?) do, but this was the result. :-S My poor partner. :-( I felt horrible!
> 
> ...



Could be worse....it could have been YOUR blood on his arm...that would be interesting to explain to your instructor....:rofl:


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## jjesusfreak01 (Sep 2, 2011)

Awesome picture, I need more of these to take in and show my classmates during our first IV lab.


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## Strap (Sep 2, 2011)

medic417 said:


> Some clinical sites require students to introduce themselves as students and to ask if the patient minds them performing the procedure.



Not to mention, we wear shirts that say "EMT Student" and ID cards that say "Student".


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## MrBrown (Sep 2, 2011)

Everybody needs a 14ga. drip in the AC, now, chop chop! 

Brown has found vein stabilisation is most important, as is proper explaination to the patient "we need to put a drip in for fluid/medicine, here comes the sharp scratch" works well here.


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## lightsandsirens5 (Sep 2, 2011)

jjesusfreak01 said:


> Awesome picture, I need more of these to take in and show my classmates during our first IV lab.









the table after the same stick.


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## ArcticKat (Sep 3, 2011)

My favorite trick is to find a bifurcation.  A point at which 2 veins converge into one.  Slide in between them and you're bound to hit the vein because there's one on either side.


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## FreezerStL (Sep 3, 2011)

> Brown has found vein stabilisation is most important



Once I've found a site I like, I'll always lightly push the skin in a perpendicular direction with my finger. It gives me a good idea how much of a "roller" the vein is, as well as letting me know how much I'll need to stabilize it.

Good luck ^_^


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## usafmedic45 (Sep 3, 2011)

lightsandsirens5 said:


> the table after the same stick.



Good G-d man...I've done cutdowns that were less bloody....


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## abckidsmom (Sep 3, 2011)

usafmedic45 said:


> Good G-d man...I've done cutdowns that were less bloody....



Lol, at first glance I thought that's what I was looking at!  

Here's a tip:  occlude the catheter just beyond the tip, where all you are compressing is the vein.  Many catheters can be pinched off with a little pressure, but some (those spring loaded ones) are super space age plastic the is too resilient to be pinched.

Wise medic say...the less blood on the outside of the patient,the more skills in the medic.

Ice cream for the entire crew if you spill blood on the floor staring an IV


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## lightsandsirens5 (Sep 3, 2011)

usafmedic45 said:


> Good G-d man...I've done cutdowns that were less bloody....



Well, I know..... But hey, it was my first stick and to be honest, as soon a blood started squirting everywhere, I kind of stared at for a few seconds thinking "WTF did I forget?" Then my partner occluded the cath in his own arm and got things back under control. Lol!


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## jjesusfreak01 (Sep 3, 2011)

Taping Suggestions?


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## abckidsmom (Sep 3, 2011)

jjesusfreak01 said:


> Taping Suggestions?



Veniguard.

Otherwise, a criss crossed skinny piece, a 2x2, and 2 fat pieces over the site, with one more to secure the line.  And if they are diaphoretic, just wrap around and around the arm


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## usalsfyre (Sep 3, 2011)

I've found Venigaurds to be great...until something around the IV site gets wet. At that point standard tape seems to hold better to me.

For the diaphoretic or combative patient? Coban. It's not pretty, but it sure hold the line in well.


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## EMT-IT753 (Sep 3, 2011)

Coban is definitely a great alternative. I like to have that or gauze on hand for the elderly with super thin skin. Getting tape back off of those frail arms can be painful.


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## KingCountyMedic (Sep 4, 2011)

If the vein has a pulse, don't poke it.


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## ArcticKat (Sep 5, 2011)

Reminds me of a call I did last night.  2 hour transport of a 16 year old male with a splenic rupture.  14 ga in the right AC, 16 ga in the Left AC.  I didn't start the lines, otherwise I'd have selected better sites.  

Over the 4 hours while he was in the system he received 7 litres of saline and Ringers, and 1 litre of pentaspan.  

On arrival at the trauma centre a paramedic student on practicum tripped over the 14ga line and dislodged the IV.  She extracted the remainder of the cathalon and my patient bled a substantial amount.  I didn't see it but the medic student started yipping about how the IV line was in an artery and couldn't stop the bleeding.  She had to stand there and hold direct pressure for several minutes.

Personally, I would think that an IV with a cath located in an artery would likely not run all that well and actually have significant back pressure with blood entering the tubing.  I had no problems bolusing through the line.  In addition, after 8+ litres of fluid and most of his red cells in his belly somewhere, his clotting was likely not quite up to par.  Finally, I doubt the student had much experience in removing an IV cath that large and the hole left...especially after a traumatic removal like her feet made would allow for much more blood loss than she might have ecpected from an 18 ga.


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## usafmedic45 (Sep 5, 2011)

> If the vein has a pulse, don't poke it.



And if you do, whatever you do, don't push epi through that line unless you want to experience the full wrath of your medical director.


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## usafmedic45 (Sep 5, 2011)

> Personally, I would think that an IV with a cath located in an artery would likely not run all that well and actually have significant back pressure with blood entering the tubing.



Depends on the patient's BP.  It won't flow rapidly but you should get some flow.



> 14ga line and dislodged the IV



Good luck with getting a 14 into most people's brachial artery without having a massive amount of vasospasm.

BTW, if it's not a steel needle, it shouldn't do any more damage whether you rip it out or gently remove it.  IV catheters are, after all pretty darn flexible.  Also, rather surprisingly, in my experience, most arterial lines bleed less than their venous counterparts upon removal.


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## ArcticKat (Sep 5, 2011)

usafmedic45 said:


> Depends on the patient's BP.  It won't flow rapidly but you should get some flow.



It poured through there in a steady stream, not even a drip to count.  His pressure was hard to stablize.  LP12 was taking pressures every 5 min, if it dropped below 90 systolic I'd bolus him, the next few pressures would be up between 110 and 120/40, then back down.  Most times I can get the drip rate titrated to maintain the systolic, but I couldn't on this kid....I was playing catch up all night.



usafmedic45 said:


> most arterial lines bleed less than their venous counterparts upon removal.



That's been my experience as well, a little direct pressure and it's good as new, but then, my experience is mainly with ABG acquisition, not a 14ga in an artery.

Remember though, if the IV was put into an artery thinking it was a vein, then it would be facing upstream too, not down.

He ended well though, lost his spleen but came through surgery last night with no complications.


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## jjesusfreak01 (Sep 5, 2011)

usafmedic45 said:


> And if you do, whatever you do, don't push epi through that line unless you want to experience the full wrath of your medical director.



What's wrong with pushing a vasoconstrictor directly into a smooth muscle lined artery?


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## jjesusfreak01 (Sep 8, 2011)

So, had my first set of pokes tonight. Missed both. First was on an older classmate known to have bad veins, but i'm blaming that miss on the instructor because she stopped me before I could advance the needle far enough to let the catheter slide easily, and then told me I missed because I didn't go far enough. This was a cephalic vein, I believe. Second was a hand vein, and while the miss was on me, my instructor didn't let me stick the vein I wanted to, and made me go for a slightly deeper one that ran into a junction (and probably a valve). 

I'm thinking I might have more luck if they just stayed quiet while i'm trying to stick...we can do the CISD after i've taken the needle out of my classmate's arm. 

And yes, I know i'm blaming my instructors here, but i'm going to hit all sorts of veins on Monday...that'll show em.

Any more tips on site choice and advancing the catheters?


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## KingCountyMedic (Sep 8, 2011)

Wrap a penrose or tourniquet (or whatever you like to call it) around your own arm and just spend time feeling your own veins. Switch arms, wrap one over your leg, etc. etc. Get a friend and do the same thing. If you have kids see if you can coax them into letting you do this as well. Just looking at different sites on dif types of people without ever poking them can be very educational. Good luck!


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## ArcticKat (Sep 9, 2011)

jjesusfreak01 said:


> Any more tips on site choice and advancing the catheters?



I'd love to help you out with more sage words of advice, but you'd never believe me.

Keep up the good work.


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## jjesusfreak01 (Sep 15, 2011)

I think my problems haven't been site choice actually, i'm just having problems now with hitting hand veins. I haven't missed an AC or cephalic, or really anything above the hand. I think I have at least a workable technique for advancing the needles and catheters successfully. I think I might not be stabilizing the vein well before poking, letting it slip out of the way as the needle advances. I know i'll figure it out, I just don't want to look like a doaf when i'm trying to do blood draws during clinicals.


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## Mohrenberg (Sep 16, 2011)

Would love for this thread to keep going, I've enjoyed the tips given thus far! I'm having most trouble with getting those slippery veins to stay still! I must have tried 10 times on my sister over the last month or so before I finally got a good stick on her. I can't believe she still let's me try....she must be EMO haha

I'm also having trouble with getting a flash, but the catheter only threads about 1/4 of the way off the needle before stopping.


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## jjesusfreak01 (Sep 16, 2011)

Mohrenberg said:


> I'm also having trouble with getting a flash, but the catheter only threads about 1/4 of the way off the needle before stopping.



You're probably not advancing the needle far enough before threading in the catheter. Remember the catheter doesn't extend to the tip of the needle, and you can get flashback as soon as you poke the vein, so you are likely hitting the vein and then pushing yourself off the vein when you try to push the catheter in (ie, the catheter isn't going into the vein, its hitting the outside of it). When you get flashback continue moving the catheter in but drop your angle to near parallel so you don't poke through and blow the vein.


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