Tuesday, March 17, 2020

ER nurses are really good at IV's.  Patients who profess to have "bad veins, being a really hard stick" and ask for someone "very experienced with difficult veins" are frequently not all that difficult....if you know where to look.    It begs the question, "how do you get good at starting difficult IV's if you don't do it often enough to get good at it?"  Often patients who will pick their IV spot have done so repeatedly, so "that one good vein"  is no longer a viable option.  

Here's what doesn't help:  Snarky and stupid  comments, superior attitudes, and straight up  challenging.  I'll let you decide which is which.  
1.  "Oh, good luck with that"
2.  The last nurse who tried an IV stuck me 15 times (bullshit.  There isn't a nurse on the planet who would do that many sticks.  Most are 3 and done, I'm 2 and done myself).
3.  I can't have any IV's in my hand.  "Why?"  I don't like them there
4.  I'm left handed, suck my thumb, text with that hand, etc, etc, etc.  
5.  It just always hurts if you put it there.
6.  I can only have a butterfly, and a really small one,  
7.   I've never had an IV there before
8.  You get one try.
9.  Trying to explain things to a 10 month old
10. Telling kids "it's not going to hurt".  I never lie.  It will hurt.  I say "pinch", not beesting like many of my cohorts.

I tell the ones who demand the best that I'm better than average with 40 + years of experience.
I tell them I only try an IV if I'm confident.  That is most of the time.
For those who tell me "I usually get blood drawn in this vein", (AKA choosing your IV site) I will always try there first.  Even if I think it's not going to work.  Even if I am dead certain it's not going to work.   You can blame yourself for that, having painted me into a corner.   I have forgotten more places to try IV's than you will ever dream of, even if you are an IV drug user.  And that's saying a lot.

The current trend of using ultrasound for IV's has hit a frenzy in my ER.  There are a few docs who are good at it, really good.  Now we have training available for RN's and paramedics who want to learn, but I will definitely not be one of them.   I have found that with so many people wanting to use the ultrasound and practice this shiny new skill, it has taken the art out of it.  IV starts will go the way of the dinosaur.  As will I, I suppose.  As will I.