# Practicing IV cannulation.



## Melclin (May 11, 2009)

I was wondering how everyone learnt to place IVs (did you spend time on those creepy severed dolls arms, cadavers, tomatoes , or just dive right in on the real thing) and if anyone knows of a way, or a neat little trick of practicing. You know like cheap adhoc moc ups (I saw an of cut of latex over an old BP cuff tubing once that looked alright).

I often see and hear of "health workers of the lower order and ability", as one snob of a doctor said once, buggering up phlebotomy and IV cannulation. I don't want to be one of them.   

Also I saw a video of army medics practicing on each other once. Anyone learn that way? What do you all think of that?


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## Hastings (May 11, 2009)

Melclin said:


> I was wondering how everyone learnt to place IVs (did you spend time on those creepy severed dolls arms, cadavers, tomatoes , or just dive right in on the real thing) and if anyone knows of a way, or a neat little trick of practicing. You know like cheap adhoc moc ups (I saw an of cut of latex over an old BP cuff tubing once that looked alright).
> 
> I often see and hear of "health workers of the lower order and ability", as one snob of a doctor said once, buggering up phlebotomy and IV cannulation. I don't want to be one of them.
> 
> Also I saw a video of army medics practicing on each other once. Anyone learn that way? What do you all think of that?



Usually you learn by starting IVs on other students. Best way.

And don't be nervous. I went into Paramedic school passing out at the thought of blood. Now I actually kinda like getting IVs.


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## HotelCo (May 11, 2009)

Hastings said:


> Usually you learn by starting IVs on other students. Best way.
> 
> And don't be nervous. I went into Paramedic school passing out at the thought of blood. Now I actually kinda like getting IVs.



We don't practice on other students. If we did, I sure as heck wouldn't want someone practicing on me. 

Do it at your clinicals, just dive right in to the real thing.


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## Sasha (May 11, 2009)

We got two attempts (Notice I said ATTEMPTS) on a fake arm, and then were made to practice on eachother. I didn't think the fake arm was any kind of substitute for a real person, and despite my deathly fear of needles going in (They almost dropped me out of the program because of the needle fear), I'm glad we practiced on eachother.

Of course it was really stressful the first couple times I got and gave an IV (I didn't want to hurt anyone.) but after that it was easy.


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## Veneficus (May 11, 2009)

i had to qualify on the diemboied cool-aid bleeding arm, but then my clinical preceptors put the word out for others to make sure i attempted all the hard iv sticks in the ED. 

After a few obese, iv drug abusing, chemotherapy, dialysis patients, you'll be the master.

Most of the problems I see with IVs in field providers is the modification of technique or shortcuts "because it is different out in the field." (I am still waiting for somebody to explain to me how science works differently outside the hospital.)


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## BossyCow (May 11, 2009)

My class used the arm, and I got really good on it... but it did nothing to prepare me for an actual human being. You can't see the little marks on the pt. that show where the veins are like you can on those fake arms. 

You have to just do them on humans over and over and over and over and over again.


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## marineman (May 11, 2009)

Stabbed the rubber arm twice, then started on other students. Practice in as many uncomfortable situations as possible and you will get better quickly. In class we turned off all the lights, tied an arm to the underside of a table and put a bunch of crap on the floor we had to crawl over to start an IV, and we didn't get to carry a flashlight. If you can do it with your eyes closed upside down in an awkward position you can do it in the back of an ambulance, upright while not moving. Moving is still kind of tough for me trying to learn not to bounce out when we hit a bump but I'm getting there. 

On a side note we did the same scenarios in class for intubating, mannequins are easy but upside down in the dark putting an ET over a combi in less than 15 seconds (class rule) is still tough.


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## Wee-EMT (May 11, 2009)

We practiced on eachother. The only problem was, we got used to eachothers veins. Other then that, you'll get lots of practice on your clinicals. Some students got up to 30 live starts a day!


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## Melclin (May 12, 2009)

Hastings said:


> And don't be nervous. I went into Paramedic school passing out at the thought of blood. Now I actually kinda like getting IVs.





I wouldn't say I'm nervous so much. I've done it on myself a couple of times cos I nicked some cannulas from uni. Officially though, this isn't allowed. I just thought there might be some common trick of the trade type thing that I wan missing, that was good for practice. Oh well.  

"I actually kinda like getting IV's"-- haha, yeah I was in the ED the other day with appendicitis and the doc tried a couple of sites (I have invisible veins) and I had a good chat with him about technique, learn't a few things. It was the most fun I'd had all week getting the line in. What odd people we all are.:blush:


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## LucidResq (May 12, 2009)

1. Practiced on some tubing, just to get the angle and procedure down. Just getting comfortable with the equipment. 

2. Practiced on fake arm. 

3. 10 + sticks on each other. 

4. 10 + sticks in the ER. 

5. Practice on myself. (I know... I know...)


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## Amack (May 12, 2009)

In class, we did live sticks on each other. Then, what i found was a relatively inexpensive and coarse replication of the the real thing for practicing "muscle memory technique" was to get a a hold of a bunch of IV caths and some straws (take some from Dunkin Donuts or McD's...and put them in a thin paper towel roll (empty of course) and then to cannulate the straw inside of the roll....it's a bit a coarse and the palpation technique is useless...but it helped me practice when i was bored on those overnight shifts lol


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## ResTech (May 13, 2009)

Our program no longer permits practicing on each other anymore... apparently the programs insurance does not like this activity. So we utilized a training arm which is adequate for developing a technique. 

And the nursing lab has two very sophisticated IV training computers... where you see an arm or hand on the screen and you have to select a vein, and then physically pick up a IV catheter like device and start your IV as normal. The computer tracks the insertion and is a pretty awesome tool. Each cost around $10,000 though... but very cool.


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## HotelCo (May 13, 2009)

Sounds like a waste of money. Nothin is substitute for doing IVs on a person.


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## ResTech (May 13, 2009)

It is a lot of money but wouldn't look at it as a "waste of money". If you actually got to use it you would be in awe Im sure. It teaches you technique... as in getting all your equipment, using it in the proper order, getting used to the appropriate angle for insertion, etc. And it gives you real time feedback and a percentage score of how well you did. 

Its not meant to replace actual pt. cannulation... its just an aid to help students gain confidence and provide a level of quality assurance prior to students going into the field or the hospital and sticking actual patients.


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## Shishkabob (May 14, 2009)

I have big veins.  So big that when I go to ER's the nurses start poking at them and asking if they can stick a 14g inside of them.



I'm going to wear gloves to medic school from now on.


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## drdique (May 14, 2009)

*Bananas?*



HotelCo said:


> Sounds like a waste of money. Nothin is substitute for doing IVs on a person.



Though there is no substitute for live tissues, try the cheap banana alternative.
This is more for those learning for the first time, and working to improve insertion technique. Use a good old banana in it's peel. The skin provides a similar resistance and sometimes comparable thickness for insertion. Try and take advantage of the few linear 'ribs' that run the length of the banana. just practice inserting the needle/cath, leveling off, advancing the cath, and attaching a dropset. I found it was beneficial in developing muscle memory that is helpful when you're bouncing down the road. This is where i started, moving to classmates, clinical practicum patients, and then bouncing down the road on actual pt's.....lock-up your veins!


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## Melclin (May 14, 2009)

drdique said:


> Though there is no substitute for live tissues, try the cheap banana alternative.
> This is more for those learning for the first time, and working to improve insertion technique. Use a good old banana in it's peel. The skin provides a similar resistance and sometimes comparable thickness for insertion. Try and take advantage of the few linear 'ribs' that run the length of the banana. just practice inserting the needle/cath, leveling off, advancing the cath, and attaching a dropset. I found it was beneficial in developing muscle memory that is helpful when you're bouncing down the road. This is where i started, moving to classmates, clinical practicum patients, and then bouncing down the road on actual pt's.....lock-up your veins!



Yeah cheers, I'll try that. That's the kind of thing I'm after. I know how to do it and I have done it, its just a matter of doing it 5000 times so I can do it with my eyes closed under a bench, upside down while singing the score from westside story. And I can't really practice that much on myself.


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## paccookie (May 14, 2009)

In EMT school, we had to do two or three successful sticks on the fake arm and then one successful stick on a classmate.  Then 20 sticks in the field.  In paramedic school, we had to do one or two sticks on the fake arm, one or two sticks on a classmate, 20 hours of IV clinicals (out-patient surgery - all we did was start IVs), total of 75 successful sticks on actual patients in field time and clinicals.


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## el Murpharino (May 14, 2009)

I remember an article in JEMS, or one of those magazine articles, that mentioned having someone tape straws to their arms (doesn't have to be anatomically correct) and put a sweater on as to cover the straws.  The straws give you that feedback "bounce" you're looking for when palpating a vein, and the sweater makes it so that you can't actually see it; you need to feel it and go from there.  Of course the obvious hazard of going too deep and puncturing someone's arm would be a factor here, so proceed with caution.  Better yet, you can tape the straws to your mannequin arm and cover it with the sweater arm.  If you're ambitious, fill the straws with red kool-aid and secure the ends of the straws to give you that "flash" that everyone so desperately wants to see.  

DISCLAIMER  ** I'm not advocating or saying not to use this method - especially on a live person.  There are people out there who have used it and may, perhaps, use it in the future.  I have personally never used it, so I can't attest to it's efficiency. **


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## Jon (May 14, 2009)

Sasha said:


> We got two attempts (Notice I said ATTEMPTS) on a fake arm, and then were made to practice on eachother. I didn't think the fake arm was any kind of substitute for a real person, and despite my deathly fear of needles going in (They almost dropped me out of the program because of the needle fear), I'm glad we practiced on eachother.
> 
> Of course it was really stressful the first couple times I got and gave an IV (I didn't want to hurt anyone.) but after that it was easy.


Our program was similar. We demonstrated IV/IM/SQ injections on dummies, then went to practicing on one another... and then we went out in ambulances and drove arond the block, starting IV's on each other. I was stressed... and I was just 2 years out of practice. I was even more scared being the human pincushion. One of my fellow students managed to thread the IV cath like a needle though my arm... in, out, in again.


I've also heard of the "straw method"... seems like a good idea.

I don't really like this... I think we should have spent more time on mannequins, before going to live practice.


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## frogtat2 (May 14, 2009)

we have "the arm" that we use initially.  After that, we use the Basics on our crew!  hahahaha  actually, they volunteer, we don't draft anyone.  And we stick each other when too.


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## Afflixion (May 19, 2009)

granted i did both my B and P through dept of the army schools we started on each other right away in 68W school we did about 10 sticks each day for close to 6 mos. Those that couldn't stick got booted


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## nibejeebies (May 20, 2009)

Heres how our IV training went. 

Instructor calls me to the front and every one gathers around.  Sits me down and rolls my sleve and demos a 'stick' then every one had to do it on the dummy arm once (With out the koolaid) 
Then we each had to get 10 'sticks' with an instructor hovvering over our shoulder. Once she was satisfied with our technique, she would pass us and we were cleared to do IVs in the fields on clinicals.  TN only requires 5 perfect sticks in the feild, but my instructor wanted us to have at least 10 in a moving bus, and 10 in the ER. 

I winded up turning in 49 sticks by the time my clinicals were over. 

Practice on a human imo is the only way you can get good at it.


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