If you would have listened to me

[trailerparkmedic]

Quoth emt_cookies

One thing that scares me is that some nursing programs don't really teach IVs till the end of the course. We get it at the end of our first semester but most of the associate programs teach it at the third or fourth semester.

I started 3 IVs in nursing school. I started 5 IVs on my first day at work. I'm still not ER good at them, but I'm at least floor good. I'm actually really good with crackhead veins.

The problem was I learned IVs in my second semester, and then had clinical on Saturday on a floor that was 99% post-op so everyone already had their IVs. I did one or two in OB, none in Peds (3rd semester) and my final semester was in the ICU where everyone came from the ER with IVs and had central lines if they were going to be long term. I got pretty good at sticks for blood cultures there, but that's so much easier than IVs.

[Sapphire Silk]

Quoth emt_cookies

One thing that scares me is that some nursing programs don't really teach IVs till the end of the course. We get it at the end of our first semester but most of the associate programs teach it at the third or fourth semester.

My program teaches them in the first semester, which is a total waste. First semester students are too green to be starting IVs. We're considering moving the skill back to the capstone course or eliminating it entirely.

Starting IVs is a purely technical skill, and is usually retaught to new grads during hospital orientation. I've had to take an IV class at every hospital where I've ever worked, and be supervised on 3 sticks before I could go on my own . . . even with all my experience.

And yet . . . IVs is a purely technical skill, meaning any trained monkey can be taught how to do it. It is MUCH more important to teach student nurses the critical thinking skills they need to use the nursing process.

Quoth 24601

Generally I wouldn't ask in the ambulance (lack of time to do everything), but if someone said not to use an certain spot, I used another. In the ER I would ask, as I once had a patient who had a dialysis shunt in their left arm no one told me about. I would have felt it when I checked, but it saved both of us some time.

ACK! NEVER start an IV in a dialysis shunt! If you screw it up, you've just destroyed their ability to get dialysis. I knew a nurse who did this once; the nephrologist shit a brick over it.

I will start an IV in a port a cath if the patient has one. That's perfectly legit. But most nurses (who don't work chemo, hospice, or home health) don't know how to access them. I routinely taught my fellow ER nurses how to do it (it is sooooo easy).

Quoth trailerparkmedic

I started 3 IVs in nursing school. I started 5 IVs on my first day at work. I'm still not ER good at them, but I'm at least floor good. I'm actually really good with crackhead veins.

You're the exception rather than the rule. Most hospitals have IV teams and don't like students starting IVs. The hospital where I do clinic won't let us do it. I do wish they would; I'd love to have them give it a go.

[WoodenSunshine]

I was fine for years in both inner elbows until a couple of years ago my right arm veins started to roll. I tell the nurses every time I give blood, do my left arm.

I did have a D'oh moment before one of my surgeries (nervousness, probably). They tried to find a vein in my right arm for my IV and I had completely forgotten. After poking me twice, I told them to try my left arm. Worked like a charm

[42_42_42]

Out of everything that I'll be taught when I start the nursing program proper next summer (finishing up my pre-nursing courses right now, going for my BSN), learning how to start IVs is the thing I fear the most. Probably because of all the times I've been a living pin cushion. If I'm at all dehydrated no one but an anesthesiologist or nurse anesthetist is going to be able to get one started, at least that's been my experience. The night before surgery, I drink water constantly right up to the cut off time because otherwise in the morning, an IV will be next to impossible to get started. Can't prep like that for ER visits, though, as they're unexpected events and all. Fortunately, needles don't scare me and I have a fairly high pain tolerance for needle pricks.

[Geek King]

I don't know if it helps anyone, but the folks who have been the best at getting IVs in, in my limited experience, were the nice ladies in the cancer center where I had to get some preventative chemo done. They drop chemicals into people all day, and many times have to start IVs for just that treatment. So they get lots of practice, and they learn all kinds of tricks to get muley veins to pop up. I had one particular bad day for my veins, and got to see several of those tricks.

[Zaiida]

Never had a problem with getting blood drawn though it is funny when they look at my arms and say they may have to try a few times because my veins look difficult. They are always surprised when they get it in the first go.

One thing I don't get is their insistance that I get blood drawn from my non dominant arm - I don't have one. Well I write with my right hand but my left arm does everything else and they still insist on drawing on my left. It's such a bother when I go to use my arm for a few days, I'm bruised and in pain (my body does not like intruisions it can overreact to it). I don't do anything with my right arm other than write so why don't they use that?.

Last time I had blood drawn it made me double take when it came out a very dark, dark brown. First time that has happened. I knew I had coffee running through my veins and now I have proof.

[wagegoth]

I've had good luck with former medics. They seem to be the only ones who can get the veins in my arm.

[Mishi]

Quoth BlaqueKatt

I have had a nurse try to start an IV in my wrist, miss and end up in the tendon, and have the nerve to argue with me that it didn't hurt.....

Me too! It was my inner elbow, not my wrist though and she got quite annoyed with me. The only place that is good for tests is my left inner elbow, the vein tries to hide and if you want more than one vial, it has to be done with a 23g + a butterfly. As for IVs, my left wrist and hand have the only good veins.

The last blood test I had, the phlebotomist was polite until she saw what it was for, then she was extremely bitchy with me right up until I wished her a good weekend as I was leaving. She was lucky that she only needed one vial because she blew the vein and the bruising is finally almost gone after two weeks. Oh noes, a young lady is having a quantitive HCG...she must be a slut and thus is worth of derision.

[PepperElf]

had to have an IV in for a while to combat dehydration. they tried my hands and couldn't get anything.

finally they said, we will try one more vein and if we can't get it we'll have to go to your elbow and you'll be immobilized.

thankfully that last being was a good one - one in my right forearm.

[Shalom]

Those of you who have read my previous posts on the subject know that I am a total needle-phobic, to the extent that I freak out just thinking about needles and elbows.

So I just had a blood draw last Friday. The details are a bit hazy after seven Valiums (does that pluralize as Valia? I wonder) but even under that much sedation, I wouldn't let them use my elbows. Told the guy I had really nice veins in my right (dominant) hand, why not try there? He said, fine by me. I looked in the other direction, and he stuck me with this tiny needle. Barely felt it. Didn't even freak out. Two days later and you couldn't even see where he got me without a magnifying glass. Thank God for benzodiazepines...

(Of course then I had to have them call me a cab to get me and my bicycle home. I'd taken the Valium on the way, figuring on the usual time to onset being about as long as it would take me to get there, and I timed it just about right, the effect beginning a half block away from the place (which had the amusing effect of me calling three times to remind me of the address, which I kept forgetting as soon as I hung up), but it made for an interesting conversation when I staggered in with the bike.

"You can't bring that bike in here."

"Evidently I can, because I just did. Now if you mean I'm not allowed, that's another question..." Yeah, I get literal sometimes. I put the bike out in the hallway and nothing happened to it. The cab company had to send a minivan so I could fit the bike in the back. I don't remember the ride home at all, but apparently I did get there.)