Nothing instills confidence in a patient than the nurse's ability to start an IV with the first stick. When I was a new grad, we didn't have an IV team, so I learned very quickly to start IVs on some of the toughest arms and hands in the business. At my new place, we have an IV nurse that comes around and starts IVs. He's the greatest -- I think he can get a 16-guage in a turnip. But I think it's hampering a lot of nurses' ability to start an IV. Lots won't even try anymore, and instead of using the IV nurse as a backup after the "two sticks and I'm out" rule, they just call without even looking at the arm.
It's very much a learned skill, and it takes a lot of practice (and a lot of missed attempts) before you get really "good" at it (meaning most IVs started after 1 or 2 sticks). But you've got to at least put the tourniquet on. And get the skin wet with alcohol wipes. And shave a lot of hair to clear the landscape. Maybe a few warm blankets. Maybe a few minutes dangling the arm off the edge of the bed. Maybe pumping the arm with a BP cuff.
You just have to try. Or else every IV pump will be your nemesis. Every beep in the night will set your heart into panicked tachycardia. You'll find yourself (and your patient) putting up with hours and hours of sleepless nights, while that IV pump beeps, and you never wonder why that 1000cc bag running at 150cc/hr is only 1/3 empty after a 12-hour shift.
And meanwhile, your patient wonders if you have any idea what you are doing.
So if you're a new grad, don't depend on that IV nurse (if you're lucky enough to have one). Seek opportunities to attempt really hard sticks. Enter the room with bravado, and declare that you will get that IV started with at most two sticks (you can always ask forgiveness later for lying through your teeth). Because when you get that IV...
You're Superman.
I've never worked in a hospital with interns, but we do work with a group of residents. I have never seen a physician start an IV, or transport patients to tests, or provide any sort of "nursing care" such as starting IVs. I would think, unless you had a lot of opportunities, each IV stick would be a difficult one. Even after a week of not trying, I can tell my touch has worn off. Another important influence is whether I get that first stick of the night. If I miss it, I find I have a harder time with follow-up IV attempts. No doubt that's a mind thing. -eric
Posted by: Eric | June 24, 2005 at 03:54 AM
This is a great post.
Since I am training in the "kinder, gentler" era of medicine (where EVERYTHING is compartmentalized), my only experience in starting IVs was during my ER rotation. I became much more comfortable (and successful) during those four weeks, but man, did I feel bad for those first few victims.
Sometimes I wish I kept up the practice, because most psych RNs don't even try to place IVs. And it'd be nice to be able to place one myself with ease, grace, and flair (on the first try) without having to go through the trouble of contacting the "stat nurse".
Posted by: Maria | June 20, 2005 at 03:50 PM