beginner IV

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nfronk

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So my EMT-I class has been going on for a couple weeks and last night was IV IM and SQ night and i missed the veins 2 times, they are going to do another night for IV's but i'm just wondering should i be having trouble, most people in my class did it in their first try.
 
I have no EMT/Paramedic experience and currently on my field internship as a paramedic. My preceptor said it, my clinical preceptor says the same thing, and i have to agree with them on this. IV's is nothing but monkey skills. You learn how to do'em and then you just need practice practice practice. After my clinical rotations i was giving IV's left and right. Some people gets lucky on their 1st try and some people miss. I had a 25 year medic vet tell me "there are veins you WILL miss and not all of them are perfect." Even he still has hard time getting certain veins. IV's is nothing to be concern about right now cause you'll be giving them over and over if your in this profession for a long time. What i learn is assessment, assessment, assessment, thats what all students need to focus on the most.

Hope i was helpful ^_^
 
Thank you that is very helpful, its just super frustrating when most of my class got one their first try.
 
Don't let it get to ya bro, i'm sure and positive in due time you'll get more IV's than you could ask for.
 
I went 0-18 for a while when I first started.


You'll get the hang of it
 
IV's just take practice (more the better!), patience, and a good preceptor when first starting out. Don't get discouraged. You will have good days and bad with your sticks. I was lucky to have a great RN in the ED as a Medic student... she would call me for every stick and make me do it until I got it. Most preceptors give you one shot.... but not her. Her philosophy was your only gonna learn by doing.... I usually always got it at least on the 2nd stick... and this helped my confidence. If u only get one try and blow it... well that sucks... but if u get to try again and are successful... that's awesome.

Some patients veins just suck. I've had some patients that we stuck 2-3 times in the ambulance and the ED nurses stuck 4 or 5 (literally) before they got IV access.

I've had patients that looked like they had great veins and yet the catheter just wouldn't advance.

It will come... take every chance you get at starting IV's... it's the only way to become proficient.
 
IVs are really fun. What you can do is push a little bit on the patient's veins to see if they slide out of the way. Learn how to read them. I got my first established IV on my second try. My partners, it took a little bit long which sucked for me!

Good luck and experience is the only thing you'll learn from with IVs.
 
The others in your class got lucky. Like Noctis said, practice and you'll get it. You have plenty of time. Focus on assessment and you'll be a better paramedic. Not every patient needs an IV like some people think, but EVERY patient needs a good assessment.

While you're gaining a good assessment of your patient which will lead to better patient management, you can have your "expert" IV starting buddies doing the monkey work.
 
Who are you doing your IV's on? We have been using a prostetic arm. In Maine, we cannot just do IV's on each other in class. That is what the 100 hours of hospital time is for!
 
Having been absolutely atrocious at IV access, I believe I am qualified to speak on this topic:

The first thing you need to do is prepare mentally. Even down to what you say to your patient. Instead of saying "I'm going to try and give you an IV" say "I'm going to give you an IV". If you go into it saying "I'm going to miss this IV", you are.

When you're preparing to start an IV, place the tourniquet on the patient's arm. After that, prepare the rest of your equipment. This will allow plenty of time for the veins to "plump up". The first thing I do is look for veins. If you look and can't find one, try feeling. Remember, some veins will appear as nothing but faint blue shadows.

Some tricks of the trade...
Close your eyes when you feel for the veins. This will prevent your eyes from playing tricks on you. If you find nothing, trying placing another tourniquet. Place it on top of the first or place them "one above, one below". There is also a device called Veinlite EMS to aid in finding veins, which I will provide a link for at the end of my post. I had a patient last weekend with a possible MI who said "Good luck getting an IV on ME"... using double tourniquets I got bilateral 18s. The doctor at the ER was very pleased lol

When you perform the venipuncture, hold the catheter in a way that's comfortable for you. When I started, I held the catheter between my thumb and middle finger using my ring and pinky fingers for stabilization. That was ineffective because I was using my two weakest fingers for support, which didn't allow me the stability I needed, especially for difficult to access veins. Today, I lay the catheter between the second and third knuckle along all four fingers and advanced the catheter with my thumb, sliding the needle and chamber back by moving my fingers back. Unorthodox, but it works best for me. Take a catheter and hold it a few different ways, see what works best for you.

Go in at a low angle. This lowers the likelihood of you going into the vein and out the other side. Hold tight traction, but not too much. Not enough, the vein rolls. Too much, you flatten out the vein. Go in until you see the flash, slide the catheter in just a little more, anchor down right against the skin, advance the catheter and slide the needle out.

There are countless other techniques to try, but in the end there will be times when you just won't be able to get an IV. If your patient is critical, there are alternatives to peripheral IV access.... EJs, IOs, etc.

Remember, you JUST started. It's going to take time for you to become proficient.

Hope this helped...

Veinlite EMS: http://www.veinlite.com/pics/Veinlite EMS Flyer e-mail.jpg
 
http://www.uscav.com/Productinfo.aspx?productID=10311&TabID=1287

29386.jpg


I use one of these on patients with crappy veins when I need, and not want, an IV. It works and makes the veins nice and plumpy.




Though there will be days where you just suck. Trust me, I know. Some days you'll hit every vein, then miss the HUGE ones for the next week. ER IVs are much easier than field IVs for some reason, at least to me, so keep at it and get them while you can.
 
You'll get better in time with more practice. Try to stick every patient who gets an IV in the ER and when doing clinicals try to get an IV as much as possible in the truck. Don't stick your stubbed toes and such but if there is even a CHANCE that they'll get one in the ER, do it for them.

It's a skill and like any skill it needs practice. When I first started I had about a 45% success rate, I'm up to about 75-80% after three months or so on my own. :)
 
Linuss said:
http://www.uscav.com/Productinfo.aspx?productID=10311&TabID=1287

29386.jpg


I use one of these on patients with crappy veins when I need, and not want, an IV. It works and makes the veins nice and plumpy.
Click to expand...

I'm not an ALS provider (or IV Tech) so this doesn't really apply to me (yet), but I'm just curious to know: Does using that device have to be approved or allowed by protocols, or is it close enough to a tourniquet or rubber constricting band that it doesn't need special permission?
 
I agree with the others who said your classmates just got lucky. My instructor says it takes around 100 to really become proficient, and even then I've heard some medics say they sometimes have bad days and can't land a single one. In my clinical shift last night I attempted 5 IV's, landed 4. You'll get there - don't get discouraged - it takes lots and lots of practice! :)
 
nfronk said:
So my EMT-I class has been going on for a couple weeks and last night was IV IM and SQ night and i missed the veins 2 times, they are going to do another night for IV's but i'm just wondering should i be having trouble, most people in my class did it in their first try.
Click to expand...

I will tell you what helped me when I was in my EMT-I program. I went to my local hospital and got a job as a "Lab Assistant II" also known as a "Phlebotomist". In my state, and in most states, you are not required to have a phlebotomy certification, you can actually be trained on the job.

I was getting about 20-30 sticks a day, and learning all about collection procedures for CMP/BMP, CBC/H and H, BNP, PTT, Lactate, Beta HCG, and tons of other tests. Now, when you are using a vacutainer your angles and depth you insert the needle are a bit different, so it won't help you with IV's in the sense that I will be like practicing them.

What this will help you with is learning how to feel for veins, dealing with hard sticks, etc. Whenever I walk up to a patient to stick them, I rarely ever go with what my eyes are telling me to stick unless it is blatantly obvious.

I will usually put my finger on the area I am looking at, and feel for a vein, pushing it down slightly and feeling it open back up. You will eventually get to where you can feel out a vein with your eyes closed. You could have a huge vein that looks fine and dandy, but get absolutely nothing from it because of scar tissue, etc. This is why I will not necessarily go for the biggest vein, I will usually feel around and get what I feel comfortable with.

Also, don't be afraid to ask your patient questions like, "Have they ever had problem getting IV's or drawing blood in this arm?"

Good luck in your studies. You'll get it.
 
Don't worry too much. Here is the aftermath of one of the first IVs in my class. Blood stinking everywhere from an AC stick.
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And of course as soon as someone figured out that a blood filled cath worked like a fountain pen, we all had to write our names on paper towels. :-)

4b79d63b-03b2-5188.jpg
 
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