Having trouble with IV's! Can't get them to thread...

HI! I am a new nurse, only 5 months old now, actually only been off orientation for a month. I am having trouble with IV's. I have no problem getting a flashback at all, but I DO have a problem getting the cathalon to thread in! I even have tried to advance the needle in some more once I get a flash, and it just seems like its stuck, and it won't go in! I work on a med surg/telemetry floor, with almost ALL elderly people. The easy sticks I have no problem with, but the hard sticks, which are MOST of my patients, I just cant get it! Its so embarassing and I feel so incompetent! I am a darn good nurse, I just need to figure out what I am doing wrong! I love my patients' and I WANT to be able to do this for them. I have tried watching other nurses but it just doesnt seem to be helping. ANY suggestions??
Sometimes if you flush gently as you try to advance the cannula it will help. I always attach an extender to my peripheral lines so I use a 10 cc syringe when starting a line. I get a flash then attach the extender and flush gently as I advance the cannula. I find that using the extender also helps my site last longer than having to access the heplock directly. The force needed to attach the needleless connectors to flush and/or give pushes seems to take a toll on the site. Especially on the fragile veins in the geriatric population.

I was going to advise to float the catheter too, but FLArn already did.You might be hitting a valve too, so pull back a bit and see if that helps.

I'll lend my two cents here. I use to be terrible... now I'm known as the "IV Ninja". Reasons you have trouble floating the catheter:1) The gauge is too large. A hard stick usually means small or tortuous veins. A smaller gauge for MANY reasons is superior to large ones. I'm generally speaking of a 22. The last hard stick I placed, it lasted 9 days before he D/Ced. Less infiltration, less external leaking, less phlebitis, easier catheter floating, less pain.2) You are entering at too steep an angle. You will surely get blood flash, but floating a catheter against a vein (as opposed to at the same angle) will be difficult or blow the vein. This is not obvious for easy sticks, but shows itself on hard ones. The angle, in some cases, is not much more than a PPD injection.3) You aren't in far enough. If at least half your needle isn't in... go further before you advance the catheter.Oh. And. Practice. You can call yourself the IV Ninja too. Volunteer to start EVERYONE'S IVs. Give it 5 years... then check back with us. =)

practice, practice, practice and more practice. This is a learned skill. Even if you are trying and blowing them and having to ask someone else to place it, that is much better than not trying at all.

Quote from SlobgobI'll lend my two cents here. I use to be terrible... now I'm known as the "IV Ninja". Reasons you have trouble floating the catheter:1) The gauge is too large. A hard stick usually means small or tortuous veins. A smaller gauge for MANY reasons is superior to large ones. I'm generally speaking of a 22. The last hard stick I placed, it lasted 9 days before he D/Ced. Less infiltration, less external leaking, less phlebitis, easier catheter floating, less pain.

Quote from imanedrnStuck on minutiae here... Isn't 9 days against CDC guidelines?

Quote from imanedrnStuck on minutiae here... Isn't 9 days against CDC guidelines?

Quote from NurseNathalieAs far as I�m concerned, this is OK for peds veins or fragile or very difficult to stick veins...

My hospital's policy is to rotate IV sites every 72-96 hours, EXCEPT for those of us in the ICUs. Our standing orders state NOT to rotate sites. To keep them in for as long as they are free of s/sx of complications. But generally patient's end up ripping them out before phlebitis or anything else develops. And many of our patient's end up with central or PICC lines.

A little trick I learned that really helped me out a lot...When you first get flashback, drop the IV almost flat with the skin and lift up before you advance- this keeps the bevel running against the vein wall instead of the tip of the needle, lessening your chances of blowing the vein

-my trick? release the tourniquet immediately after you get a good flash. i get alot of people with s*** for veins and they *always* blow if you advance with your tourniquet still on. a tip from a good friend & when i tried it my success rate went way up. -some people insist on 18s for everything but if it looks iffy, start with a 22, or a 20. it's better to have a smaller line than no line at all. i had a lady with 2 22s in once she was end stage hepatic disease and had teeny hard veins from overuse, she started destabilizing & needing better access and the docs popped in a IJ in about 3 min but when she was stable the 2 small lines served her well for fluids, meds, etc. if they'd insisted on 18s when she was admitted she would have been stuck over & over instead of twice. -you can also be hitting valves. some people are just valvey (is that a word?), they have so many & their veins are very convoluted & theres not enough straight line to get a catheter threaded! pull back a bit. try the inner arm above the elbow i have lots of luck there with super valvey people

Quote from Turd FergusonA little trick I learned that really helped me out a lot...When you first get flashback, drop the IV almost flat with the skin and lift up before you advance- this keeps the bevel running against the vein wall instead of the tip of the needle, lessening your chances of blowing the vein