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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