Just curious

[Veneficus]

Pediatrics are great fun too.

I want the little laser thing they have in the PICU. That'd be cheating though.

???

Laser thing?

For an IV? Really?

Damn kids and their toys.

What helped me was having one of the most outstanding nurses in the world for a clinical preceptor.

She asked other nurses if they had hard sticks, told them not to try until I did.

Don't look for easy patients to start lines on, look for the hardest.

Think about what you are doing and did, even when you fail, learn something from it.

Once you get a catheter or two in the frequent flyers that get a dozen or so needle sticks per visit, have had Chemo, radioation therapy, and are on dialysis, the rest are gravy.

Also, live for the moment, do not psych yourself out before you start. Don't worry about the ones you have failed. At that moment in time, you are the best at IVs in the world, and nothing in the world exists but you, the needle, and the vein.

You need confidence. It goes a long way. Why do you think surgeons all think they are the greatest surgeon to ever live?

Right or wrong, they always know what they are doing, and they always do it like they cannot fail.

 

[Melclin]

???

Laser thing?

For an IV? Really?

Damn kids and their toys.

What helped me was having one of the most outstanding nurses in the world for a clinical preceptor.

She asked other nurses if they had hard sticks, told them not to try until I did.

Don't look for easy patients to start lines on, look for the hardest.

Think about what you are doing and did, even when you fail, learn something from it.

Once you get a catheter or two in the frequent flyers that get a dozen or so needle sticks per visit, have had Chemo, radioation therapy, and are on dialysis, the rest are gravy.

Also, live for the moment, do not psych yourself out before you start. Don't worry about the ones you have failed. At that moment in time, you are the best at IVs in the world, and nothing in the world exists but you, the needle, and the vein.

You need confidence. It goes a long way. Why do you think surgeons all think they are the greatest surgeon to ever live?

Right or wrong, they always know what they are doing, and they always do it like they cannot fail.

You're right in saying you need confidence. But you don't get confidence from 20 fails on the hardest sticks in the world if its the first 20 sticks you've done. In fact, I think it takes you backwards. Sure once you've had your 4th, 5th and 9th successful sticks on captain has-good-veins...go nuts with the challenges. Once you've established yourself in your own head as the king of the world when it comes to poking punters (about two sticks after your first successful one), then hit up the 250kg diabetic. Just so long as you know from experience that your failure with the fat arse doesn't mean you're not fit for the job two weeks after you start because you're 0/3.

Its often said here that you're only as good as you're last job and true or not, its often how it feels. If you're a few weeks in, and confidence is an issue, I'm not sure a challenge is what you're looking for.

 

[Jon]

???

Laser thing?

For an IV? Really?

Damn kids and their toys.

[YOUTUBE]Bh7bYNAHXxw[/YOUTUBE]


I'm pretty sure what he is talking about is a transillumination tool... I've seen multiple varieties, many of the newer ones use red LED's - An example: http://www.veinlite.com/

They are not laser beams. Sorry.

 

[Veneficus]

You're right in saying you need confidence. But you don't get confidence from 20 fails on the hardest sticks in the world if its the first 20 sticks you've done. In fact, I think it takes you backwards. Sure once you've had your 4th, 5th and 9th successful sticks on captain has-good-veins...go nuts with the challenges. Once you've established yourself in your own head as the king of the world when it comes to poking punters (about two sticks after your first successful one), then hit up the 250kg diabetic. Just so long as you know from experience that your failure with the fat arse doesn't mean you're not fit for the job two weeks after you start because you're 0/3.

Its often said here that you're only as good as you're last job and true or not, its often how it feels. If you're a few weeks in, and confidence is an issue, I'm not sure a challenge is what you're looking for.

While it sounds counter intuitive to start with the hardest first, I would say while the experience is rather disheartening at first, it has helped me become a better provider in the long run.

The way I saw it, I was expected to fail, and I just wouldn't accept that.

IVs like anything else just require practice. The more you do, the better you get. There is no secret substitute for practice on real people.

The op missed less than a handful if I understand correctly. If it was his first 100 or so I think I would be concerned.

In the meanwhile, game on.

 

[MSDeltaFlt]

I'm in the Intermediate class and having some trouble with IV's, I can get the flash most of the time but have trouble with advancing the cath, I'm hoping I'll get it in time with practice but I was just wondering...how long did it take before you got a successful IV? I'm hoping I'm not the only one that hasn't got it yet. I've been doing really good in class with my grades but I'm just wondering if maybe I'm not cut out for real world, and it makes it worse that I'm one of the only ones in class that doesnt already work in EMS. Thanks

Kali,

9 times out of ten if you get a flash but then are unable to advance the catheter, you are nolonger in the vein. You have either pulled out of the into the adipose tissue/vein wall, or have advanced too far the other way, or have done the same thing by going left or right.

Either way you need to learn to make sure that once you get a flash you do not move the needle at all. Just make sure you advance the catheter only.

 

[kali27]

I actually got 3 in a row today! It was awesome...I just went in like I knew exactly what I was doing and it worked like a charm. The nurse I was with told me to just fake it like I was an expert and it worked lol. Felt really good not thinkin I was a total failure lol. Thanks everybody for the advice it really helps a lot!

 

[Basermedic159]

I'm in the Intermediate class and having some trouble with IV's, I can get the flash most of the time but have trouble with advancing the cath, I'm hoping I'll get it in time with practice but I was just wondering...how long did it take before you got a successful IV? I'm hoping I'm not the only one that hasn't got it yet. I've been doing really good in class with my grades but I'm just wondering if maybe I'm not cut out for real world, and it makes it worse that I'm one of the only ones in class that doesnt already work in EMS. Thanks

It's something you get a "feel" for. My own personal way that I do it, that some may not agree with is, when I am ready to actually take the IV and stick the pt's arm, I take the catheter, remove the cover, slightly move the catheter up the needle to insure an easy advancement. I then take the catheter and VERY SLIGHTLY BEND IT using the protective cover. I never start on top a vein. When I find a good vein I go to the side and as soon as I get flash I advance the catheter and secure the IV. Everyone does it different but, thats how I do it. Good luck!

 

[airbornemedic11]

Practice

Practice, practice, practice. This is one of those skills you just gotta learn on the job. It'll help if your fellow students will offer their arms for practice.
Find someone with big AC or forearm veins. I like to hold their arm with a beer bottle grip 1) to control any nervous patient so they don't jerk away, and 2) to control the vein. I use my thumb to pull down on the vein and straighten it out to where I want it. Don't break the skin slowly. You'll blow the vein. Do it in one smooth, fluid motion. Don't worry about punching through the entire vein, you'll feel resistance. That's when you stop the forward needle motion. Then move to a lower angle and advance the catheter. Now in order to advance the catheter you might want to let go of that bottle grip and use that hand to do the advancing. Or, after some practice, maintain that bottle grip and advance the catheter with the forefinger that is holding the needle. This comes with practice. Hope this helps. Hooah.