Monday, March 16, 2009

Call me a sadist....

but I love starting IVs.

I bring this up because my coworker/friend L had a patient whose IV went bad and needed a new one. Poor L... *amazing* at blood draws, but not so good with IVs. She gave it a stab (ha ha) and it didn't quite work out, so she asked if I had some spare time to start it for her.

Luckily I had a sweet and easy patient load tonight (I didn't hate my job today!) so I was totally cool with taking out 5 minutes to give it a go. And everything was set up for me. I just had to do it :)

Found a hand vein pretty easily. I probably could've gotten one higher up the arm in a non-bendy spot but I'd rather get an easy not-as-awesome place in one shot than making 2 attempts at a better location. Plus, as the patient said, she may be going for a procedure tomorrow and they'll probably want to throw an 18 gauge in the AC. I don't know the obsession with 18s in the AC. I hate them. Make the machines beep "Downstream Occlusion" all damn night (grumble grumble)

Anyway, I get it in the vein in one go. It's hard to express the feeling of satisfaction you get when you see the flashback of blood in the catheter. It's an instant-gratification dopamine burst that gives you an "I rule the world" feeling for at least a few minutes.

Conversely, *not* getting an IV site in one go can really fuck with your mood for the rest of the day. And fuck with your IV starting skills as well. Kind of odd.

Anyway, I get it in, everyone's happy. It's taped up and flushes well. Go me!

I remember the first IV I ever started, during my preceptorship in L&D. You can't ask for a better unit to start IVs in. Everyone's full of fluid with beautiful sproingy veins. I was nervous as hell. Tried to remember all my steps from the class. And got it in in one go (thanks to the beautiful sproingy veins).

I remember smiling and telling the patient "Congratulations: You were my very first IV start!" to which she replied "Thank you *SOOOO* much for waiting till *after* to tell me that!"

I got the same kind of joy last week when I started an IV in a patient without being able to see the vein. I know some nurses (like super Resource E from the previous post) who were taught not to look at all, but to only go by feel. But for me, there's a level of confidence I needed to have before trying something blind.

This poor woman's IV had infiltrated while she was receiving a medication, and she waited until there was a definite area of fluid accumulation before telling me that it kinda hurt... C'mon people. If it didn't hurt 20 minutes ago and it hurts now, tell someone!

Anyway, I gave her arm a look-over and didn't see anything. Maybe a shadow of a vein? So i decided to feel around, and felt a good lump by her wrist. Why not give it a go, I thought. So I popped the needle in... nothing. Hmmm. I prodded the vein with the other hand, figured out where I should be aiming, and changed the needle's trajectory slightly. *Boom* flashback. I felt like king of the world, if, again, only for a few minutes till the dopamine wore off.

The first time I felt like a real nurse was when I learned to start IVs. Any trained monkey can pass pills. But starting an IV takes finesse. I hope to one day be like a nurse I met during clinical. She was the go-to gal for any hard stick. I saw her get an IV in an 88lb dehydrated lady in one shot, after 4 other nurses had tried and failed. I want to be her.

Someday.... :)

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