# IV difficulty?



## pumper12fireman (Sep 3, 2008)

Hey all, I have a coupla quick questions-

I had my first medic hospital clinical yesterday, and I had a couple of issues with IV starts. I got one straight off, had one with flash, then my pt. jerked. I also missed two others but the nurse that came in after missed their stick on the pt. as well. So, I had 5 attempts and only one real success. The nurses said to not worry, and gave me very high ratings on my paperwork. But, for some reason, it's kinda bugging me. Is this normal? I'd obviously like to get all my sticks, but how long does it take to become proficient?


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## marineman (Sep 3, 2008)

Guys that have been doing this 20 years miss sticks now and then. Don't get yourself flustered while you're still training just keep trying.


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## KEVD18 (Sep 3, 2008)

if you dont get 100% of your stick on your first day, you're a failure and you should go to mechanic school.







but seriously now, you're going to miss iv's. a lot at first, then as you find your groove, your average will get better. but throughout the entirety of your career, you will screw some up. it happens.


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## reaper (Sep 4, 2008)

There are days when I can get everyone on the first shot. Then there are days I could not hit a firehose. It happens to all of us.

One thing you need with IV's, practice,practice,practice. The more you do the better you get!


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## Bosco578 (Sep 4, 2008)

reaper said:


> There are days when I can get everyone on the first shot. Then there are days I could not hit a firehose. It happens to all of us.
> 
> One thing you need with IV's, practice,practice,practice. The more you do the better you get!



So True my friend! I cannot tell you how true this is.


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## Jon (Sep 4, 2008)

reaper said:


> There are days when I can get everyone on the first shot. Then there are days I could not hit a firehose. It happens to all of us.
> 
> One thing you need with IV's, practice,practice,practice. The more you do the better you get!


+1.

Also... I know when I was doing it, I'd have a day where I'd miss an easy one... then get so psyched out about missing IV's that I kept on missing them. I remember at least one shift where halfway though the shift I refused to attempt an IV because I was so sure I was going to miss. On that shift, one of the ED techs stood over my shoulder and talked me though it... and I got the IV. I was good for the rest of the day.


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## Grady_emt (Sep 4, 2008)

Even still I have my bad days or even a bad week where I start thinking about it too much and miss more.  It's almost like swinging a baseball bat or a golf club, if you think about it too much, you will psych yourself out and miss more.  Just take a deep breath, don't think about it and stick em'.


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## rling (Sep 4, 2008)

i missed ALOT of iv's when i was in my medic clinicals and especially in my internship.  but at some point, something "clicked" for me and my IV's have been money.   like others have said, sometimes you have your good days and sometimes you have your bad.  try not to get into a funk after a few bad sticks or else it'll drive you crazy for the next few attempts (and probably minimize your chances of success).  

things happen: the pt moves, the vein rolls, you hit a valve, skin tension gets released too soon, etc etc etc.  when you do miss an IV, try to figure out what went wrong and remember it for the next time around.


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## Sasha (Sep 4, 2008)

Dont get too frustrated, Ive been doing them for three semesters and I still occasionally forget to tamponade AND pop the tourniquet and blood tends to squirt a couple feet.


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## firecoins (Sep 4, 2008)

took me 3 months of medic rotations to get it down well.  You will always miss a few.


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## valbq2 (Sep 5, 2008)

I just finished medic school myself, and our teacher told us at the beginning of clinicals that they expect the skill proficiency of students to decrease when they get to field.  You've been sitting in class, not practicing skills at all.  You are focused on way more information at the time, and your brain can't focus on skills.  I know I missed several sticks in the hospital, and the EMT-techs had to come do it.  I felt like an idiot.  I know other people in my class had the same problem.  When I got to my intern on the ambulance, I rarely missed any.  I think we all just have our good days and bad.


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## grumpy1 (Sep 5, 2008)

When you can hit 100% of IVs is when you need to retire and move to Vegas.


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## firecoins (Sep 5, 2008)

flyingdad23 said:


> When you can hit 100% of IVs is when you need to retire and move to Vegas.



I have played that table game in Vegas.  Your better off going to Mohegan Sun and doing it there.


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## ksrrvfd (Sep 5, 2008)

*Missed IV's*

Hey I recently got my Paramedic certification and moved up on the ambulance that i was working for already. You think you feel "bad" when you miss one....wait until you have a few in a one day where you get the flash start to thread it in and realize it wont thread in because you're up against a valve....now your irritated because you got excited about the flash and then your punched in the head when it wont thread. Talk about a let down. I've been a medic for about 3 months now and have already noticed my IV skills getting better. You learn to pick better spots, start farther away from a "y" in the vein as well as look at multiple sites to start one before you even attempt the first stick. All this will make your percentage increase. I've even told my partner that it was a good call and she goes "why"? because I got the iv first try...lol...It'll get better...Keep at it and take any pointers that ppl give you.
Kevin


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## AlaskaEMT (Sep 5, 2008)

Let me suggest the shotgun technique... grab a handful of needles, stab, use the one with flash and pull out the rest.  Works every time.


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## Jon (Sep 6, 2008)

AlaskaEMT said:


> Let me suggest the shotgun technique... grab a handful of needles, stab, use the one with flash and pull out the rest.  Works every time.


Is that the same theory as "leave the bad ET tube in... you can't miss the 2nd time".


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## MSDeltaFlt (Sep 6, 2008)

pumper12fireman said:


> Hey all, I have a coupla quick questions-
> 
> I had my first medic hospital clinical yesterday, and I had a couple of issues with IV starts. I got one straight off, had one with flash, then my pt. jerked. I also missed two others but the nurse that came in after missed their stick on the pt. as well. So, I had 5 attempts and only one real success. The nurses said to not worry, and gave me very high ratings on my paperwork. But, for some reason, it's kinda bugging me. Is this normal? I'd obviously like to get all my sticks, but how long does it take to become proficient?




I'm surprised Rid or Vent haven't chimed in yet.  That's kind of odd, but I'll help out as much as I can.

IV's are a lot like intubations.  It's a skill that is easy to learn, but hard to master.  It takes time... a lot of time... as in years.  You have to feel.  Not just palpate the vein, but actually *feel* every aspect.  From feeling the vein to feeling how thick the vein is,to feeling how brittle the vein is, to feeling how the vein moves or doesn't move,to feeling how deep or how shallow it is, to feeling the needle/cath enter the vein, how they enter the vein, and how the cath advances.

A very seasoned nurse once told me this.  She was one of the "Big Guns".  You know, one of those nurses that can not only get an IV on a pt that no one else could get, but it would be at least an 18 if not bigger.  She told me, "If you can't feel it, don't stick it."

I learned how to feel.  Now I'm considered one of the "Big Guns".  And it took years to get to this level, and I'm no master by any means.

You're just now learning how to stick.  That nurse is right.  Don't sweat it.  There are several different level of IV starters.  There's "learning", "accomplished", "seasoned", and "mastery".  I'm seasoned.  Masters are few and far between.  Getting accomplished, I'm guessing, should take anywhere from weeks to months depending on how fast you learn and how often you get exposed to opportunities to start IV's.

I hope this doesn't sound arrogant.  That is not my intention.


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## VentMedic (Sep 7, 2008)

valbq2 said:


> I just finished medic school myself, and our teacher told us at the beginning of clinicals that they expect the skill proficiency of students to decrease when they get to field. You've been sitting in class, not practicing skills at all. You are focused on way more information at the time, and your brain can't focus on skills.


 
I wasn't going to respond because I would have to comment on the way a Paramedic training program is designed. Thank goodness other health professions can manage to organize their clinicals and book learning in such a way that they are complimentary and not a hindrance to "focus on skills". 

Of course, there has also been this little storm called IKE that has been distracting me. 



> grab a handful of needles, stab, use the one with flash and pull out the rest.


 
This shotgun or acupuncture technique is not always the best either especially if the patient is awake, alert or a pediatric. Creating more anxiety for the patient with a bunch of needles dangling from their arm should be avoided if possible as it can exacerbate the situation. 

Starting IVs in the hospital can be a little more stressful for beginners as there will be more people around to critique or oversee your work. 

Learn from those with experience in the ED be it nurses or the ED techs. 

Learn the techniques that put position and gravity in your favor.

Learn to properly position your own body if possible. You may not appreciate this now but as you get older, if your back spasms, so does the vein (or artery depending on your target) of the patient. 

Learn your landmarks and A&P well. Unfortunately not all Paramedic programs will go indepth with all the available veins for IV sites.

Practice palpating veins on everyone from your pets to SOs . It takes awhile to train the fingers to develop the feel. Don't forget to palpate for familiar landmarks. Good palpation skills are essential for other assessments and procedures also. 

I will say those that have taken the Phlebotomy courses usually know every vein, artery and nerve name as well as having more vein finding and sticking experience in their clinicals than many paramedics get in a year.


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## MSDeltaFlt (Sep 7, 2008)

VentMedic said:


> I wasn't going to respond because I would have to comment on the way a Paramedic training program is designed. Thank goodness other health professions can manage to organize their clinicals and book learning in such a way that they are complimentary and not a hindrance to "focus on skills".
> 
> *Of course, there has also been this little storm called IKE that has been distracting me. *
> 
> ...



You know, it's atmospheric anamolies (?sp) like IKE that you couldn't pay me to live in Florida as beautiful as your state is; let alone any part of the southeastern coastline.  Give me the delta bugs any day of the week .  However, I guess it all depends on where you grew up and what you're used to.


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## reaper (Sep 7, 2008)

Like Vent stated, learn how to FEEL the veins. I have seen to many students or new medics that feel for a vein in the hand or AC and end up sticking a tendon!!!

This is very painful for the pt and can cause major problems down the line. You need to learn what a vein feels like and not just stick the big bulging thing!!


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## So. IL Medic (Sep 9, 2008)

After a call that left me frustrated because I couldn't get an IV, I had a nurse with 20+ years of experience once tell me that getting an IV was "20% skill and 80% blind-*** luck."

You will have days of not being able to get the stick even if you used a smart cath with laser guided telemetry and you will have days that you could sink a 16 guage from across the room...blindfolded. With experience, the bad days get fewer.


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## So. IL Medic (Sep 9, 2008)

Agreed. Palpate palpate palpate. Get fresh with the pt and feel 'em up.


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## Hastings (Sep 10, 2008)

So. IL Medic said:


> With experience, the bad days get fewer.



Up to that 20% cap.

It true though. I don't care how skilled you are at it. There are going to be days that it's just not going to happen. IVs are a strange skill that way. Frustrating, too.


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## LucidResq (Sep 10, 2008)

This thread is reassuring - I just got back from an IV clinical in the ER that was pretty harsh. There were 3 that I did with ease... fast, graceful... I wanted to take a bow after I was done. There were many more that I totally messed up. 



MSDeltaFlt said:


> IV's are a lot like intubations.  It's a skill that is easy to learn, but hard to master.  It takes time... a lot of time... as in years.



Now although I'm not experienced at all in this field, this is one thing that I keep hearing over and over again and keep seeing in almost every aspect in EMS. 

So I'm starting to realize that in this long, long learning process, it's best to not let things phase me, ask for guidance, jump on any learning experience I can grab, and take constructive criticism and suggestions to heart.


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## EMT-P633 (Sep 11, 2008)

missing a few IV's on your first medic hosp clinical rotation, dont sweat it. If your medic program was like mine, then you will end up with hundreds of attempts. and or actual sticks, My program required a minimum of like 40 or 50 successfull IV's.  I think I ended up with close to or just over 200.


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## Nephemera (Oct 1, 2008)

I never have trouble finding a vein or getting a flash, but I almost always end up messing it up when I try to advance the catheter. :sad:  Any advice on what I might be doing wrong?  None of my coworkers have been particularly helpful.

I think it would've helped a lot if I'd taken an actual IV therapy class, but due to monetary issues and the lack of classes available around here, I just ended up studying on my own and getting my sticks on actual calls.  Currently going through I/99 class, with IV and drug administration stuff coming up this weekend...and I'm pretty embarrassed that I'm still so lousy at IVs.


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## KEVD18 (Oct 1, 2008)

Nephemera said:


> I never have trouble finding a vein or getting a flash, but I almost always end up messing it up when I try to advance the catheter. :sad:  Any advice on what I might be doing wrong?  None of my coworkers have been particularly helpful.
> 
> I think it would've helped a lot if I'd taken an actual IV therapy class, but due to monetary issues and the lack of classes available around here, I just ended up studying on my own and getting my sticks on actual calls.  Currently going through I/99 class, with IV and drug administration stuff coming up this weekend...and I'm pretty embarrassed that I'm still so lousy at IVs.



well, you shouldnt be embarassed that you cant start and iv without formal training.

then again, you shouldnt be starting iv's without being trained in them, so  its sort of a circular argument.

to be perfectly honest with you, if we worked together i wouldnt be particularly helpful to you either, as i fundamentally disagree with your approach. maybe thats the problem you're facing at work....

get the proper education and you'll be fine.

oh and welcome to the looney bin.


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## Nephemera (Oct 1, 2008)

KEVD18 said:


> well, you shouldnt be embarassed that you cant start and iv without formal training.
> 
> then again, you shouldnt be starting iv's without being trained in them, so  its sort of a circular argument.


I wouldn't say I wasn't trained at all, just...rather informal one-on-one training from our training director.  He sent me home with the book, tested me on it, had another medic sit down with me for maybe an hour and show me how to do things...and since then I've done practice sticks on coworkers and family members down at the office, and patients while we're on calls.  But yeah, I would've preferred an actual class.

And thanks for the welcome.


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## KEVD18 (Oct 1, 2008)

informal training and reading through the material doesnt constitute training.

what are the requirements for basics starting lines in your state? does a 1/4asssed "training program" allow you to be initiating ivs on patients? if not, id be concerned about the legal liability of blowing a line....


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## Nephemera (Oct 1, 2008)

KEVD18 said:


> informal training and reading through the material doesnt constitute training.
> 
> what are the requirements for basics starting lines in your state? does a 1/4asssed "training program" allow you to be initiating ivs on patients? if not, id be concerned about the legal liability of blowing a line....


Colorado Basics can start lines as long as they're IV certified or being trained and have ALS supervision.  Our training director is authorized to be teaching IV classes, but yeah, I wouldn't call what I've done a class.  Technically I'm still in training, trying to get all my practice sticks in with paramedic supervision.


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## VentMedic (Oct 1, 2008)

Nephemera said:


> Colorado Basics can start lines as long as they're IV certified or being trained and have ALS supervision. Our training director is authorized to be teaching IV classes, but yeah, I wouldn't call what I've done a class. Technically I'm still in training, trying to get all my practice sticks in with paramedic supervision.


 
So who does the QA/QC for the Basics on this skill?  What documentation can you show for training in case of an adverse event?


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## Sasha (Oct 2, 2008)

reaper said:


> Like Vent stated, learn how to FEEL the veins. I have seen to many students or new medics that feel for a vein in the hand or AC and end up sticking a tendon!!!
> 
> This is very painful for the pt and can cause major problems down the line. You need to learn what a vein feels like and not just stick the big bulging thing!!



I have been on both the giving and recieving end of a tendon stick. OW!!!

Even so much as get close enough to poke the tendon and good luck getting your patient to let you try attempt number 2!!


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## 41 Duck (Oct 2, 2008)

We're starting this module in a couple of weeks.  It's really the first one I've been looking forward to, as I'll actually be learning something totally new, rather than taking what I already know and adding a step or two, or a bit of extra information.

I'm sure I'll revisit this thread again after bombing a bunch of 'em.

Later!

--Coop


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## Zippo1969 (Oct 12, 2008)

hey there - don't feel bad, just practice....

I've been doing this for 12 years, and 3 years of that was spent on helicopters only...probably 90% of the time peripheral IVs were started prior to our contact with the patient, and the ones I did get to start (outside of clinicals) were big ol' honkin' external jugular veins in the air -

then i went back to ground units as a 2nd job and felt like I was Stevie Wonder trying to stick 'normal' veins for a couple shifts...

good luck on the rest of your clinicals :>)


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