If you would have listened to me

[MnR]

I had a lovely trip to the ER with pain I thought was my appendix. I got send back and my nurse was a really nice guy, who just had a slight listening problem.

They were starting an IV for me and he asked me where I normally get them. I told him on the back of my hand because my inside arms just do NOT like to cooperate. He looked me over and said that I had a large vein on my inside arm that he just knew he wouldn't miss. So one poke... "Damn, I hit right next to it." I just sighed and looked over at him and said, "Try my hand." He laughed and said maybe next time but he was gonna leave that one in and try to slid right next to it, since it was right up against my vein. Poke number two... he got in, got a flash but couldn't advance the cath... so he left them in and started checking my other arm. The lady came to take my blood so he removed the IV things and she poked and got it right away, so he figured he'd try one more time there. Poke the third... flash, then nothing. He got frustrated and gave up and got another nurse... who slapped my arms and hands a bit and then decided to... Use my hand!!

New nurse got it in one shot. Original nurse looked at me and said, "I guess I should have listened to you huh?" Ya think?

[RealUnimportant]

Makes you wonder why he even asked! I'm kinda the same way; unless you have the patience of a saint & the aim of William Tell, there's no way you're getting into my arm veins...

[Teskeria]

If I say use my hand, and they attempt to use my arm, I will cover my arm with the other hand, raise my voice quite a bit and say a variation of 'Oh, apparently you didn't hear me. USE MY HAND!! My arm veins only look good UNTIL you try to use them, then they disappear.' If they attempt to persist, I will then loudly ask for their supervisor. Have only had to do that twice. I have a pretty strong fear of needles and can barely handle getting IVs or even blood drawn. I tend to get hysterical when they do multiple tries. Before I learned to get nasty, I had nurses attempt 5 or more times before giving up while I was in hysterics.

[Mytical]

Want to hear something odd/crazy? At <local hospital> they swore up and down my veins in my arms could not be used .. four people tried twice each when I was admited to the er..and they got ONE to work. Yet at <hospital far away> where I was finally taken..they loved my veins. Wished every patient had such good veins. Never missed once. Weird huh?

[MnR]

I'm lucky in that I have no issues with needles. I've long joked that I should offer myself up as a pin cushion for nurses in training. They can draw blood just fine from my inner elbow veins, but they can't get IV's to start. Something about valves or something.

His main argument against using my hand was that if they need to do a CT with contrast they need a 20 gauge and my hand veins might be too small. I told him they've done it just fine before, I was just too tired and in pain to argue. His buddy got it in just fine, even with a 20 gauge.

[Sapphire Silk]

I'm firm about no IVs in my left antecubital space (AC), inside crook of the elbow. My main vein there takes a 90 degree turn and is next to impossible to cannulate. I also have scar tissue inside the vein from phlebitis that makes it very difficult to get a line anywhere in my left hand/forearm.

Don't hesitate to tell a nurse to stop and use a different vein if you KNOW that's not a good spot.

[BlaqueKatt]

Don't hesitate to tell a nurse to stop and use a different vein if you KNOW that's not a good spot.

Heck I'm a firm believer in "you get two tries per arm, per person, these veins are good, these veins cannot be used if I'm at all dehydrated, good luck!"

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.....

[raudf]

I'm flat honest with nurses, back of right hand for IV, left inner elbow for draws. Draws are fine in the back of the right hand, but do NOT try an IV in the left arm or hand. I don't like anything being on my left hand, since it's my main hand (I don't wear rings or bracelets on that hand/arm) and the only vein visible in any shape or form on that arm is in the very crook of the elbow...

Fortunately, most nurses get that the moment they look at the arm. I was very grateful when in the delivery room, the nurse ask me which hand I used and put it in the opposite! I could have hugged her!

My hubby just had an abdom CT done and he said they only tried 5 times for the contrast IV when they finally just had to admit defeat. The contrast wasn't as important they said. My hubby is a very, very, very hard stick.

[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.

[kpzra]

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.

[trailerparkmedic]

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]

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.

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).

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.