Did you even try?

[emt_cookies]

I was under the impression all LPN/LVNs had to have their IV certification by now, but I may have been mistaken. I know all new LPN/LVNs are required to be certified along with the medication class.

Anyway, I was doing paramedic clinicals at a private EMS since everyone else was filled. It's right down the street from my house and a great way to get geriatric assessments in (except this place was dead. I get more assessments in when I am working, but I can't use them since my school doesn't have a contract with the company).

So we're called for an IV start. Usually, this means that the nurses have poked the patients so many times that it's cruel for them to try again. I think I've seen about six times on both arms before they called my partner to do an IV start.

We're waiting for the nurse to bring us their supplies and we're looking at his veins without the tourniquet on. He has really good veins it looks like and my preceptor wonders why they called us. We check for a fistula and confirm with the nurse there is no reason not to use the other hand.

Since I'm the student, I get to do the IV start the first time. With the tourniquet on, his hand veins are good, a lot better than the ones I've seen in the ER. They are tiny though, but you can still feel them and I have a choice of a 22 and some other tiny size. However, his forearm vein is huge. It is bigger than my ac. Granted, you can't see it but you can feel it.

So I go for the hand vein in case I blow it so the other medic has something to work with. I have it in quickly and I am withdrawing the needle while the other EMT hands me stuff. The nurse walks in and informs us he is a hard stick.

Yeah, no. He is not a hard stick. Maybe he was a hard stick the first time because he was dehydrated, but this time around he had freaking garden hoses for veins. They had a 250 cc bag with medication in it w/ a pump, but they may have dripped fluids before. We don't think they even looked since he had several suitable veins on his hands and that really, really easy one on the forearm.

[BlaqueKatt]

I'm a notoriously hard stick, my veins both roll and collapse. I warn them, tell them which veins are good, and they get two tries per arm, then call someone else(I figure 4 tries is fair, after that the person is going to be feeling pretty bad, and likely to miss again). For some odd reason they usually don't listen to me and go straight for the hand(I normally wish them luck on it), the only person that has ever gotten that was an anesthesiologist that grabbed a butterfly needle from the peds cart. my wrists are a 50/50 shot(If I'm dehydrated, you won't get it-have had a nurse actually pierce the tendon, that did not feel good, especially when she argued with me-I yanked it out), forearms, the veins look great, nice and ruler straight, but they roll and if you do manage to get it, they'll blow within five minutes, if you manage to not go straight through it. So far the only 100% guaranteed, you'll get it with your eyes closed is the one that's somewhat buried in my right elbow. I do have several scars on my forearms and wrists from IVs and many of them are from a friend that was an RN and bought me lunch to let her practice on me, she wanted to work on someone with rolling veins.

[emt_cookies]

When I am in the ER, I usually ask patients which hands they write with and which hands they have had IVs in previously. I learned the hard way when we were in an ambulance and blew the only vein we could find on the patient because we didn't ask how they usually mess with her.

This patient wasn't able to tell us anything though. There is a chance they had given him fluids recently and that's why he wasn't a hard stick.

[Sapphire Silk]

If you had tried a 22 on the big forearm vein, you probably would have blown it. The vein can collapse around the angiocath if it is too small.

The nurses may not have tied the tourniquet tightly enough to get good fill. This is a common error. Or they may have left it on too long, blowing the vein.

Or they might not have advanced the angiocath slightly, to get the cath past the vein wall and into the vein. This is perhaps the most common error I see.

Hard to say. There are a lot of ways to screw up starting an IV.

[jedimaster91]

IV starts are definitely more of an art than a science. There are certain times I don't even attempt it and call the experts. Like a patient with one, teeny, tiny, fragile vein and that's it. I'm not sticking it and blowing the one shot we have. I'll let either the ER nurses or the IV team do it.

[42_42_42]

IV starts are pretty much the one thing I am completely dreading in nursing school. I am such a hard stick myself, so I know how painful it is to feel like pincushion. I hope I'm one of those lucky people that seem to have a knack for it.

[kpzra]

IV's are hard at first, but after a few hundred you get used to them. My worse one was having to do a head stick on a baby. We chose that over an IO and the nurse tried to chew us out. The doc was just happy that we got enough fluids in to be able to get a better, limb vein.

Oh, and when you first start doing them in class, be prepared to wear long sleeves when not in class, your arms will look like you are a junkie...LOL

[Beckpatton]

I think anyone who can find a good vein in under 4 tries should get a medal! The ones who get it on the first go should be Sainted!

I have deep veins, doesn't matter how fat or slim I am, my veins have always been hard to get to. It's a family thing, mum and my Nan are the same. When I know I need to give a blood sample I always make sure I am well hydrated, and I always warn them before hand. I tell them that laying down usually helps, some take this advice some don't.

A month ago I had to have some blood taken, I walked in and gave the nurse my usual spiel about deep veins/laying down yadda yadda and she opted to try with me sitting up first.

She tried my left arm, took a couple sticks, and the vein she was chasing ran away. She switched to the other arm, and got that on the first go. We had 4 vials to fill, and halfway through vial 3 it started to slow down.

She had enough blood for that vial, said it might be the vial itself so switched to the 4th one. Straight away the blood slowed down even more, so she started fiddling with the needle, trying to open the vein up more I guess, when suddenly I felt warm and woozy.

I started telling her that I was feeling a bit off, starting to black out a little (my vision was starting to darken), it came back, and I was just starting to say "oh no, it's better now" when BOOM! I fainted!

Not a little passed out, swooning in my seat. I mean dead to the world, floating in an abyss of darkness, warm and toasty, super confused, dead to the world fainted!

The poor nurse, I scared her good, (even though it's happened to her before) I came to with her fanning me, my doctor taking my pulse and slapping my hand and the receptionist just staring at me in horror! I was at my local GP, they have a pathology service in back.

I couldn't believe it, it's never happened to me before, not while having blood taken anyway! I don't know what was different this time, 4 vials isn't a lot of blood I don't think, obviously my blood pressure dropped but who knows why.

Funny part is, if she'd had me lay down like I suggested it wouldn't have happened! Now I have 2 excuses for the future, I have deep veins and I faint!

[taurinejunkie]

I almost fainted the one time I donated blood. Getting the bag hooked up went as well as could be expected, and then I was given a wad of paper towels to squeeze lightly so I could get the blood running, and get the whole thing over with a bit quicker. Challenge Accepted. I squeeze lightly, don't feel a difference, tighten my grip, nothing, start working my arm like the wad of paper towels is a dumbbell and I'm at the gym... whoa, getting dizzy here, I better stop messing around. Yeah, next time a nurse talks to me, I'll listen and do as s/he says.

[Teskeria]

The only person who ever successfully got an IV in me in less than 5-6 attempts was the night supervisor in a neo-natal unit. (friend of the nurse's aide, they asked her to help when I started getting hysterical at the amount of attempts, I have a needle phobia, 4th or 5th IV (hospitalized for months due to accident - new IV every few days), and at least 4 people had tried multiple times). Aide (who I really liked, nice friendly helpful lady)called and asked if she could help. She came in, and promised if she didn't get it in the first time, she'd give me her entire paycheck. Of course it wasn't till she was done they mentioned where she worked. Compared to a baby that fits in your hand, my veins were huge, and she was quick.