My Perspective in Starting an I.V.

Photo credit: http://www.caperture.net/
Photo credit: http://www.caperture.net/

After sharing my experience on how I became a hero for starting an IV on a patient who’s having a heart attack and how I was told I saved her life, I was just inspired to write my perspective on starting an IV. I will not however give the details or the exact procedure on how to do it. On the other hand, I would tell you what it takes to be a good  IV starter or some would say IV therapist.

A lot of patients would ask me if I could start their IV every time they are in the ER or even in the hospital. Funny how my colleagues would tell me that certain patients would ask for me to start the IV on them, like they would not want anyone else to touch them except me. Even my co-workers would ask me to start an IV for their patients. The first question patients would ask you as you enter the room is how good are you in IV insertion. At times I would tell them that it’s my first time. I can just imagine the scared look on their face when I tell them that. But some patients would be able to immediately tell that you have been doing this for a while.

I have worked in the ER for about 9 years now here in the U.S. and I have been trained to start IV’s. I have dealt with IV drug abusers, chemo patients and other patients with vascular problems. We call them hard sticks. Some patients, you can only start IV’s on just one arm because the other arm may have an AV graft for dialysis or they may have mastectomy on that side and for some, you just can’t use for obvious reasons like, fracture, traumatic wounds, infections, amputation, etc. In some cases, when the arms are just impossible to find a vein, you use the foot. This is true especially for kids.I have 2 special cases when I have to use the groin to start an IV. The first one because that was the preferred site of the patient since all of her veins have been used for some reason or another. The other case was during an emergency situation as a last recourse. This patient had a blood sugar of 29 and she needed an amp of D50 iv immediately since she was already acting confused and diaphoretic and after an attempt to put an Intraosseous access by the MD had failed. I have started an IV on patients from newborns to the geriatric population, each with different degree of challenges and difficulty.

The first key to start an IV is to establish rapport with the patient. You should introduce your name to the patient and explain what you will be doing. Explain why it is necessary to put the IV and the benefits for doing so. Earn their trust. If necessary, tell them how long you have been doing this. Act with confidence. Let them see and feel that you know exactly what you are doing. Acknowledge their fear especially when you are dealing with pediatric patients. Be honest with them. Don’t tell them it doesn’t hurt because it certainly does. But tell them you will make the experience as painless and as quick as possible. And don’t forget to smile. A smile makes a lot of difference in easing the anxiety of patients.

Based on my experience, I would say that patience is really the key to getting an IV started right. In a non-emergency situation, it is very important to find a good site for the IV. You should explore all the possibilities before making an attempt. Do not ever stick the patient blindly and dig. Most patients are aware of that and they hate it. I seldom do blind sticks unless it is really an emergency. Just remember, always take your time.

Another key to finding the right vein to start an IV is to listen to your patients. They usually know their body and they know exactly where their good veins are. In the event that you are not confident about starting the IV on the site they pointed, tell them honestly and offer an alternative site if you think you can get it. You don’t want your patients to get upset and blame you if you didn’t get it because you did not listen to them in the first place.

Starting an IV is a very important procedure in the emergency room. We used IV to draw blood specimen, to give IV medications and hydrate patients with IV fluids. In a life and death situation, IV placement is very crucial to saving a person’s life. The sooner you place the IV, the better the chances for the person to survive. Therefore, as an IV therapist, placing an IV is not just a procedure for me. It is not just a skill. More than anything else, it is a life saving measure.

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  • Every time I do start an IV insertion, I always say “so help me God or in Jesus Name”..then after I’m done doing an IV, I do thank God every time I hit it and even if I do not…I admit that I’m not good enough in IV insertion and still on the process on learning on it..And I hope and pray that someday I may hit the vein just once or in a “one try-hit” for the sake of my patients or clients in helping them to lessen the pain they suffer…Because the highlight is I myself do have fear on needles…hehehe…;)

  • Conquering the fear of I.V. insertion is very easy, just relax & concentrate, focus on the visible vein, but you better choose the straight one,insert the needle with precision & make sure that you that with a 15 degrees angle , you would know that the needle is in once you feel that feeling like when you hit an I.V. tube with a needle. Always remember it is just you, the needle & the vein. If you can keep that in mind then it would be easier for you to do I.V. insertion. I have done alot of I.V. insertions & the doctors whom I have assisted in the past called me “sharp shooter”.

    • drew

      well done, sharp shooter! great job.

      • You’re very much welcome Drew. I’m always happy to help. I would like to invite you to join us here on Facebook the FB account is called Global Nurses Institute. Thanks very much! God bless! YOu can do it. You are an excellent nurse you haven’t figure out how to unleash you expert side yet. 🙂

    • thanks for the advice,,hehe., I’ll take note of that..i hope someday they also called me “sharp-shooter”…
      and also conquering my fear on needles,,hahaha,,because I cry when somebody also do an administration of IV to me..so I know the feeling on that situation so I really hope to do less pain to the patient, 🙂

  • zhelle

    when i started working here in KSA, i would have 10-15 patients whom i made IV insertion daily..thanks for my experience, it helped me alot..

  • regie

    Most important is getting rid of self-doubt, and ensuring that one has a steady hand. Patience and practice are also important aspects in terms of IV insertion.

  • marky boy

    I agree.. starting an IV line is crucial specially for an emergency situation… except in arrests that are cardiac in origin where CPR, and defibrillation are most crucial,. IV meds are important but these things needs to go first…

  • smiley

    I been working for almost 2 years as staff nurse but i admit that with regards to this matter im quite afraid until now…got nervous evrytym the blood came down but still manage to do this the problem i hesitate to do it again and pass the task to the doctor or to my co workers…need help i badly need one imwant to be effecient as i could be pls. Tell me how to get rid this fears! Thanks guys