EMT-IV students having trouble starting iv

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DarknessEMT

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First a little background, I'm in my last month of school for EMT-IV, I'm one of the best students in the class, got some of the best grades on the FISDAP exams, and have been blowing through my skills check offs. The problem is I just finished my first clinical shift on an ambulance last Sunday and I couldn't get a single successful IV started. I'd make the stick, get good flashback, but then when i advanced the catheter, no blood came out. I made six attempts on four patients, and not a single success. I went back and practiced in class Monday and my instructor said I was doing it right, but its just got me really bummed out. I mean, some of the guys just barely eeking by in class got all five of their sticks the first shift. I've got another shift this sunday, and then if I cant get all my contacts/sticks then I can ride again Tuesday, but I just feel like I've lost all my confidence.

Anybody have any tips or suggestions to make starting an IV a little easier?
 
Academic success has nothing to do with the technical ability to start an IV. You'll get better in time and with practice. Don't psych yourself out about it, watch the angle you go in (many go too deep at first), and make sure you advance a little after the flash before pushing in the catheter. Also, a smaller IV is better than a big hole. Don't be afraid to start a 20 vs. an 18, or even a 22 on some patients. Again, the most important parts of IV success is confidence and experience, both of which come with practice. Best of luck!
 
DarknessEMT said:
First a little background, I'm in my last month of school for EMT-IV, I'm one of the best students in the class, got some of the best grades on the FISDAP exams, and have been blowing through my skills check offs. The problem is I just finished my first clinical shift on an ambulance last Sunday and I couldn't get a single successful IV started. I'd make the stick, get good flashback, but then when i advanced the catheter, no blood came out. I made six attempts on four patients, and not a single success. I went back and practiced in class Monday and my instructor said I was doing it right, but its just got me really bummed out. I mean, some of the guys just barely eeking by in class got all five of their sticks the first shift. I've got another shift this sunday, and then if I cant get all my contacts/sticks then I can ride again Tuesday, but I just feel like I've lost all my confidence.

Anybody have any tips or suggestions to make starting an IV a little easier?
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Sounds like you need to go a touch deeper before you advance the catheter. Or you are just going to deep in general.
Best test scores does not = best student or mean you will automatically be good at skills. Everyone no matter how experienced or good at ivS have days where they couldn't hit the broad side of a barn.
 
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I honestly don't know, I lowered the angle like my paramedic showed me, when I got flash I advanced the needle just a hair, popped the tourniquet, inserted the catheter and occluded the vein proximal to the catheter, and then every time I'd release pressure to see if blood was flowing through the catheter, there would be no blood flow, and usually little to no blood when i withdrew the catheter. Most were good flashes, too. Although on two, the emt with us couldn't an iv started either and he's been with that station for years; he said not to get hung up on it, but its just discouraging.

Like I said I only had four patients to try to stick, half of our calls were either MVAs with no injuries or people calling an ambulance so we could come check their blood pressure/blood sugar. Lol, I got pretty good at those. I don't want to sound crass, but I hope this Sunday is a little busier than last week.
 
I did get to see two external jugular IVs, one just as a demonstration, and one on a cardiac patient. I watched the paramedic stick a 16ga needle in her neck, push something I can't remember that "pretty much chemically defibrillates her heart" and flush it all within like 30 seconds. That was one of the most amazing things I've ever seen. It's too bad I have to do my second shift at a different station, the two guys I worked with were awesome.
 
Why are you removing the constricting band at that point? That stays on until you're ready to flush.

You get your flash, you lower the needle, advance a little further. Sounds like your initial angle is good, perhaps too high or even too low. For me, personally, depending on the vein, I find somewhere in the area of a 20 degree angle works well.
 
teedubbyaw said:
Why are you removing the constricting band at that point? That stays on until you're ready to flush.

You get your flash, you lower the needle, advance a little further. Sounds like your initial angle is good, perhaps too high or even too low. For me, personally, depending on the vein, I find somewhere in the area of a 20 degree angle works well.
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Yeah, that's what we learned in class, but I was jut doing it like my paramedic showed me. He said the tournequit was just there to get the vein to pop up and tto release it when you advance the cath to make sure you have good blood flow.
 
constricting band comes off before you detach the needle from the catheter unless you are going to draw blood.
 
I'm the world's worst medic at IV starts, but I'm continually improving. What it sounds like to me is not advancing your catheter far enough. Be sure to twist and separate the catheter from the needle assembly, then put it back together, before you actually poke.
 
Wes said:
I'm the world's worst medic at IV starts, but I'm continually improving. What it sounds like to me is not advancing your catheter far enough. Be sure to twist and separate the catheter from the needle assembly, then put it back together, before you actually poke.
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I'm with this guy, went through 11 months of Medic school and tons of clinicals and still suck at IV's. It is very frustrating.. just keep at it you will get it soon or later!
 
Thanks for the advice and encouragement, I'm just stressing because I have to get 3 more and I only have two more shifts to get them. And repeating the course isn't an option, I've spent all of my meager inheritance from my granddad on this, I just can't afford to fail. I did one fine on my paramedic on my first shift and another on a classmate, but for some reason I jut couldn't get any on my patients. I mean, they were all elderly and former cancer patients, but I feel like I should have gotten at least one. I don't know, I really need to stop obsessing over this.
 
Can you practice on a classmate? Having the stress of the situation with a real pt isn't really going to help you focus on the skill and manikin arms can be tapped with a straw so thats not really an indicator of how well you're doing...
 
My IV experience

I got to where I could pretty much nail it every time in the back of a rig but in the ER or stationary environment I couldn't hit it to save my live. Nurses would always give me a hard time asking if they needed to shake the bed for me.
 
Damn, forgot to post a follow up. I got all my sticks, one extra even, and three more patient contacts than required! The EMT I was paired with was a great teacher, I can't believe I forgot to write his name down. There were a couple of patients that had good veins in their hands, but he talked me through going in the AC that I could barely see.

Man, now that I've got that out of the way, there's only the Fisdap comprehensive exam, and the skills practical exam, and then I get to take the NREMT. Better start working on my resume!
 
So I'm confused, if you fail to get the required IV sticks, then you fail the entire EMT course as well and cant get an EMT license at all?

If you can still get your EMT license then who the heck cares if you have some piece of paper saying you get to stick people with needles in an ambulance(but cant actually do anything with the IV you established because you are just an EMT Basic).
 
hogwiley said:
So I'm confused, if you fail to get the required IV sticks, then you fail the entire EMT course as well and cant get an EMT license at all?

If you can still get your EMT license then who the heck cares if you have some piece of paper saying you get to stick people with needles in an ambulance(but cant actually do anything with the IV you established because you are just an EMT Basic).
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Tennessee has different entry level standards than the rest of the states.
 
Tigger said:
Tennessee has different entry level standards than the rest of the states.
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Yeah, we're training to be EMT-IVs, if I hadn't gotten the required sticks that would have been it, no chance to just get certified EMT-B. It sounds really hard, but my instructor says its really rare someone can't get all their sticks, and honestly, starting IVs isn't all that difficult, it's just kind of intimidating more than anything. And it'll probably make the transition to AEMT a little easier, at least I hope.
 
I've had a day where I missed every single IV I started and they all had huge veins. It takes practice, starting an IV on the training arm is different than a real person.
 
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