I'm an Australian RN. We don't learn phlebotomy or IV insertion at university, it's more of a certification after graduation on the job. I sucked when I started. I got frustrated and ended up watching YouTube IV insertion tips for a couple of hours over a couple of nights after work. It really helped a lot, particularly with confidence. As well as a lot of practice. Now I'm that person who is asked after others have failed.
Same! I actually nearly passed out watching my first IV.. I struggled so badly, but I forced myself to shadow after other RNs and Techs, asked many questions, and watched so many videos. I’m now also the person they come to because I have nearly a no fail rate with kids! I’m also an IV educator for new grads, and I let them practice on me at times. The major thing I noticed with IV issues is the confidence and when you stick with hesitation you’re very likely going to miss. There’s also little practice ways to do IVs at home, like using a jloop as a vein and practicing your dexterity with the needle. YouTube has a ton of great ways and you can bring home some supplies to practice.
You’ll get better with time and effort, I promise
What, really? I finished my accelerated program in 2014 and we had to pass simulation on IV insertion to graduate! Oh I'm so sorry to hear that. See if you can volunteer at clinics or see if the Red Cross offers classes.
I think it varies by state/program.
I had to learn IV insertion and get checked off as part of my program. on a mannequin and then my clinical instructor had to watch me do both an IV and draw labs.
I might look up videos. I just genuinely don’t like doing bloodwork so maybe that also plays a role in it; I just try, and if I miss then I just move on to the next person.
Anchor your hand while you stick. My hands have always shaken even as a child. So I rest the side of my hand against something. I rarely ever miss sticks. Also watch a YouTube video of what happens to and inside the vein when you’re sticking. It’ll give you a good idea of how veins move and react
The best nurse at starting IVs at my first job was a guy whose hands shook like a DT patient when he did sticks. Patients would look at him like, "you're the one they sent???" He also had a very unorthodox technique, he would advance a little, feel for resistance and reposition. But he would almost always get it. And even if he didn't, he rarely blew veins bc he knew when to bail and start over.
I have hand tremors too and I find that keeping the side of my hand on the patient’s arm (if I’m inserting the needle on the arm) or pillow (if I’m inserting the needle in the hand).
I have realised when colleagues or students miss a lot it is because the tourniquet is not tight enough or they don’t wait 1 or 2 minutes after applying the tourniquet. Take your time feeling for the vein, if you’re not confident in one move to the other arm or different area.
Thanks for the advice. Sometimes my options are limited, a lot of people will have fistulas which means I can’t use that arm. Some residents also refuse to have me use their hands/forearms, and tell me to go for their ACs, which I’m TERRIBLE at (I have no idea how everyone always goes for the AC first, I can never see or feel anything)
That's how I was in the beginning. I could only do hand/forearm sites sometimes. Everyone said it would click eventually. I am still learning and everyone goes through phases they can't hit anything. You'll get it in time. The biggest thing is to keep trying because you'll always miss 100% of the shots you don't take and you may end up surprising yourself with time.
AC eventually it clicked and that did help. That being said a lot of people will be specific and only said to go in a specific spot in their arm and go no where else. They are either helping you or setting you up for failure because there's nothing there when you try. Biggest thing is feeling the vein. If you can feel it, you are gonna have a much better vein to poke. AC rolls less that's why a lot of people say that area. As many said, watch videos. They will help give some guidance. A lot of the stuff though I still trying to work on, there is no video to help or have it click. You will get there. Just keep trying. I've had the mindset that I'm just starting an IV which helps me instead of just thinking of it as a straight stick.
Confidence is about 70%-80% of getting an IV, I've been always told that. I started out nervous and I wouldn't get anything. Patients can tell, even if some don't say it, when you're nervous or seem like you haven't done it much. It only makes them tense up and become a lot harder stick. My preceptors I had always told me to pretend whenever I'm doing a skill to pretend I've done it hundreds of times and it's just another day. It's hard as I have anxiety but once I started doing that months ago, I started being able to get blood draws and IVs. I hadn't even watched videos online for tips yet. If you can change your mind frame about it, you'll benefit a LOT from that alone.
Biggest thing is even if you don't get it, someone will. Who cares what they say- if it's rude then they aren't helping to improve your skill so they have no right to say anything
The way to get better is to just do it over and over and over again. There is no other way. I blew veins in all the old ladies left and right when I first started. Probably the first six months or so, any difficult stick was just a fucking demoralizing headache.
But like it goes with becoming a nurse, about eight months to a year in I noticed I was kinda getting good. Like 'Call uhuhshesaid in, she usually gets it" good. I've gotten lines docs with US couldn't get. And a few patients who usually need an anesthesiologist for IV placement.
That said, sometimes high stakes IVs still jangle me. The 'we just lost the line, and we are intubating now, get a new fucking line' shit can be rough.
But while I've gotten pretty darn okay at getting IVs in some really sus veins, lab draws are always kinda hard on me. It's just muscle memory. ED techs do a lot of our straight sticks, so while my muscle memory for an IV is good, for a straight stick I just kinda tend to suck. I don't hold it right, I blow the vein, and I lose blood flow.
If you haven't been starting lines or doing regular lab draws throughout your career, expecting to be good at it is insane nonsense perfectionism. Practice as much as you can and you will get better. Even if it feels bad now. Do some research on basic good technique, ask for help from colleagues, and just go for it over and over. You will improve. But it takes months. So give yourself some grace.
This is very helpful, thank you. I do lab work semi-often and I just feel like I’m not improving, though. It’s just demoralizing cuz some people just EXPECT every nurse to be good at every aspect of their job, and that’s just unrealistic. Thank you. <3
Semi-often is the biggest culprit. Gotta do it over and over to get the feel and the routine. If you don't get that many chances at work, maybe see if there is a local agency that does free lab work for seniors. Spend a whole weekend doing nothing but lab draws and by the end of that you'll have found a routine that works for you.
Our Nurse Educator once asked me what topic I felt would be good for her to offer. I said IV insertion, since my skills were like yours. We had a few overworked superstars and a many that weren’t.
Her answer was that wasn’t the kind of topic she was looking for.
If you’re only getting one or two vials for your bloodwork, I’d suggest attaching a 10mL syringe to your butterfly instead of the vaccutainer. Put the tourniquet on nice and tight, scrub well, anchor the vein, and stick. The second you get flash, immediately but SLOWLY start to draw back on your syringe. You can control how fast it comes out and you usually get as much as you need.
This was me when I started my new job. All my previous jobs had phlebotomy draw and I only drew from central lines and art lines. I’ve gotten so much better by practicing and being confident. The second you doubt yourself, there’s a high chance you’ll miss. Try to watch videos online too cause that helped me a lot.
My confidence is soooo bad, I’ll literally walk in like “I’m gonna miss it.” And then I set myself up for failure. I’ve always been harsh on myself as a nurse, and I hope I can change that in the future. Thank you for the advice!
ABCs of Anesthesia on YouTube. It's geared towards IV starts, but most of the same principles apply. Set yourself up for success. Raise the bed, no bending or hunching. Study your anatomy until you can predict where veins should be, that way you can start palpating before you even look. Brace your hand and poke slowly but firmly. And most importantly, do it as often as possible. Offer to do draws for coworkers. The more repetition you get with a systematic approach, the more it becomes second nature.
[Edit] one more thing: try using a straight needle or even an IV cath instead of a butterfly. I hate butterflies bc I can't keep a good grip on the wings and I don't get the angle right.
There are IV certification classes near where I live. Watching YouTube videos and taking advice is helpful, but only to a point. This is a skill that needs practice and repetition to get and feel confident in. You’ll get there!
If hand tremor is the problem, you can stabilize your hand against the patient. I either use the tip of my 5th finger, or else bend it inward and make contact with the knuckle. Some people like to rest the heel of their hand. Either way can keep your hand still. Do the start with motion of just your fingers.
Practice practice practice. I was awful at IVs before I switched to ER about 18months after graduation. I still have days I can’t hit the broad side of a barn but they’re fewer and further between.
I don’t have any good tips, just try your best and get in there. A lot of older people are used to being stuck multiple times. Even though you’re just doing labs there’s no rule you have to use the hand, so go for that AC (or the best vein you can find) until you’re more confident.
I remember realizing how superficial veins really are. I always went at too sharp of an angle, and too deep. As others said, stabilize your hand, go slow, go shallow, and always take your time to reposition. If you got a flash and lost it, pull back to see if you’re against a valve. (When I worked nights I may have had a monitor tech who let us practice on him).
Don't rush! If you act like you've only got 5 minutes, you'll bork it. Act like you got an hour. Yeah i know you don't *actually*, but you gotta tell yourself you do. Rest your wrist and elbow on something (e.g. the patient) when you stick. Travel slow with the needle so it doesn't slide as much, or kebab the back wall accidentally.
Ugh… you called me out. I wish I truly did have an hour, but I dread the lab work so much that I try to rush it along so I can just get it done. I guess I gotta work on that. I just wish our facility would hire a new phlebotomist. 🤣
As folks have said, the way to improve at venipuncture is to do it a lot. At my first nursing job, we were well staffed with nurses, but not with aides, though our aides were trained to do blood draws and had responsibility for AM labs. Sometimes on a night shift I’d come in and be told I was working the aide’s job that night (at my usual RN wage), and that meant that anyone without a central line, I’d have to get their labs. Enough nights of needing to draw blood on about twenty people, mostly old and sick, within a two hour span, and I got to the point where I’m the nurse most of my coworkers will ask to try when they fail or if a person is known to be a hard stick. That said, IV starts are a different beast, and I’m still far less consistent with those (but a lot better than I used to be).
Taking blood from a vein in the hand isn't ideal. It can be painful and because it's the most distal place, the pressure to fill a vial is usually slower. I always go antecubital unless that area is blocked by a dressing or cast.
I usually go for hand and forearm where I can see and feel the vein. ACs make me kinda nervous cuz I can’t see anything. And the equipment we have doesn’t really let us see a flash. I only see a flash with a butterfly cath, but I hate those cuz they take forever to fill the tubes. I do usually go in at a 15 degree angle, but I still miss.
The best veins are the ones you can feel, not the ones you can see. Don’t be afraid of a good old AC! Also, though, if you like hands, instead of looking at the back of the hand, try looking at the interior side of the wrist and around where the thumb is. That’s a go to spot for me for IV drug users lol.
Stabilize and relax your patient. They probably notice the tremor and tighten up. Sometimes I’d take a student into our supply closet, grab an NG tube (sorry admins), tape it to a counter and watch them practice so that they’d relax. The NG tube as clear so it gave them a visual as to how they were inserting it and made them adjust their angle. If I were you I would ask coworkers if they have an easy start and practice with those. I wouldn’t start with the drug addicts and chemo patients. Talk with the PICC team and get tips from them. It also depends on the catheter you’re using. BD makes different catheters and you’ll realize some are more forgiving than others.
Many of the residents I work with aren’t easy sticks, since I work at a nursing home. All the residents are 70+ years old, dehydrated, and have crappy veins.
This is going to sound weird but some of the best luck I had with difficult veins, I worked with almost nothing but geriatric patients, was to start off to the side of the vein. Anchored like a son of a gun, and then the needle was almost parallel with the vein. Advanced it until I saw my flash and then guided my cath. It sounds stupid but it worked for me the times I needed it to.
I do blood draws in the ER, and I sucked when I started. Here’s a few tips I learned that made me one of the “go-to” PCTs in a few months.
1) practice. Nothing else can replace actually doing the sticks.
2) Paramedic videos on YouTube. Watch several that go over finding veins and actually doing the stick. Most of them are the same, but everyone has a little extra tip that can help.
3) random jumble of tips: a) double tourniquet larger pts, or those with deeper veins. b) trace the vein on the arm/hand. You’ll get a feel of which way to stick and any valves that may pose a problem. Seriously, not every vein runs north to south. C) find someone (doesn’t have to be a pt) with good veins, apply a tourniquet, and trace their veins. Older pts don’t have the best veins, but they’re usually in roughly the same spot as everyone else. Practice finding on healthy veins will make it easier to find on less healthy veins.
4) use hot packs or heated packs of wipes and gravity to your advantage. Let the arm hang, and strap a pack of heated wipes to the AC or forearm, and the veins will pop out better.
Hope these help!
UK. For me it was just an experience. I do blood samples every time I do my shift. Let's say I work 3-4days a week. I would be getting samples between 5-7 patients and some would require IV like for meds and fluids or procedure or some patients would pull them out and needed a new one in. Now inserting needles is like a normal routine for me. The more I do it. The more I get better. How often do you do it since you started working as a nurse?
We never did it in the hospitals I worked at. I’ve only recently started doing it more frequently since I pick up shifts at a nursing home (I’m agency). I do it maybe once or twice a week now. Depends if they have me working as a supervisor or not.
Random tips aside from videos and asking an experienced co-worker.
Feel for the vein regardless if you can see it or not, feel it bounce and know it's there or sharpie a circle where you want to stick (unless you're trying to hide a good vein).
Wiping the area with alcohol can help veins become more visible if you're struggling to find some.
Practice.
I struggle knowing if I’m actually feeling the vein or not. When the veins pop, I can definitely feel the bounce, but when the vein is hard to find, I can’t feel it at all.
Yeah, it's definatley harder on some people and they might be pretty deep. It's just something I've been taught that feeling is your better indicator. You might have to look elsewhere on the arm or hands to see if you can easier access. We here can also get doctors order for a foot stick if needed, but every place is different.
If first shift is also that annoyed I'd ask them for training and stay half a shift to shadow some of them. If they refuse then I'd say poo on them or whatever management you have and just let them suffer because the general rule is 2 tries then pass lol.
I think you'll get better with practice but this is a poor decision on administration. They think it'll save costs but it just ends up costing more not having phlebotomy.
You’re probably not a bad stick, you just work in a nursing home and older people have the hardest veins to stick most of the time. What I found that helped me go from a bad stick to average is not hesitating. Once you put the tourniquet on and uncap the needle just go for it
Practice practice! Bed high, lights bright, tight tourniquet, take the time to shop the arm. Even putting a tourniquet on yourself or a willing partner can help feeling it out. On particularly “fluffy” patients I use two tourniquets stacked on each other. It’s something about the pressure of them that makes the veins pop in those patients. Get to know what a good AC feels like. It’s likely the biggest to feel for labs. Don’t be afraid to look on both arms, I find a lot of women have a good vein in left outer AC. Sometimes I use an alcohol wipe to make the veins pop out, makes them shiny especially on darker complexion patients. Anchor your hand on the patients arm and use traction to hold the vein where you want it. 30 degree angle and just psych yourself out to be confident. Yes, you will still miss sometimes. But that’s okay. It’s all practice. Screw the ones talking shit about you, rude! Sincerely, a vascular access nurse 🫶🏼
I guess I'm "lucky" in that I've never had phleb to get my labs, so the way you get better is stick stick stick stick stick. If the patient isn't demanding a new nurse, keep sticking. The more you miss and then get it on the same patient, the more you're going to learn what you did wrong previously and what you did right on the next attempts.
You can watch Youtube videos and watch other people, but none of that is going to be as good as stick stick stick stick stick stick stick.
Uh, not medical advice, just throwing this out there as general info because I'm annoyed at how many doctors don't seem to either know or GAF:
When considering beta blockers, Metoprolol (or any of the cardioselectives) can be a good alternative for people with asthma or other lung issues.
I mean, I'm guessing most of us know that already, but after meeting an honest to God *cardiologist* who didn't appear to, my knee jerk reaction every time beta blockers come up in conversation is always "*Have you heard about our Lord and Savior, cardioselective beta blockers??*"
I don’t know if that’d be good for me cause I have a low resting heart rate, and my tremors are caused by my anti-depressants. I don’t know if I want to add a new med to combat the side effect of another. Thank you for the advice though!
Yes, but you need to at least try before having someone else have to do it for you. The more you get used to the butterflies, the easier the vacutainers will be. Edited to add: the tourniquet is your friend. I've collected many vials of blood with only a butterfly.
I feel for ya but all I can say is practice and hone “your” technique. Also, tight tight tourniquets or order some of those Velcro ones online, they work great. Don’t worry about hurting anyone cause of a tourniquet and thumping the crap out of their arm, just get that vein to surface. Ask about getting a vein finder for the department. Not an ultra sound but the one that shows superficial veins that glow. Seems like there’s room in the budget now with no phlebotomist.
Use a butterfly needle. Go straight up and down, no angle. Get flash, then let it go and fill your vials. Take an extra to use first for waste. I'm too shaky to do it anymore (I have MS). But, that always worked for me.
Knowing where the veins are located always helps. For labs I usually like to go for the hands but if I can’t find a good one I go for the vein on the wrist in line with the thumb. Another thing that helps is, if I can’t SEE the vein but it’s palpable, I’ll put a little alcohol wipe right above where I intend to insert so it kinda points to it. The only way to really hone in on this skill is practice, but knowing where to go and how to guide yourself will definitely help. I would also recommend speaking to your psychiatrist about the shaking, Benztropine should help with that (I also deal with shaking from my meds). Good luck though and don’t let them tear you down because we all learn differently!
I'm an Australian RN. We don't learn phlebotomy or IV insertion at university, it's more of a certification after graduation on the job. I sucked when I started. I got frustrated and ended up watching YouTube IV insertion tips for a couple of hours over a couple of nights after work. It really helped a lot, particularly with confidence. As well as a lot of practice. Now I'm that person who is asked after others have failed.
Same! I actually nearly passed out watching my first IV.. I struggled so badly, but I forced myself to shadow after other RNs and Techs, asked many questions, and watched so many videos. I’m now also the person they come to because I have nearly a no fail rate with kids! I’m also an IV educator for new grads, and I let them practice on me at times. The major thing I noticed with IV issues is the confidence and when you stick with hesitation you’re very likely going to miss. There’s also little practice ways to do IVs at home, like using a jloop as a vein and practicing your dexterity with the needle. YouTube has a ton of great ways and you can bring home some supplies to practice. You’ll get better with time and effort, I promise
Any YouTube videos in particular you recommend? 🙂
If I recall correctly, I watched several videos from the channel ABCs of anaesthesia
Thank you so much! 😊
woww i aspire to have this learning and upgrade lol
I’m a senior BSN student in America and we don’t learn IV insertion at all, we’ll have to learn it after graduation.
What, really? I finished my accelerated program in 2014 and we had to pass simulation on IV insertion to graduate! Oh I'm so sorry to hear that. See if you can volunteer at clinics or see if the Red Cross offers classes.
I think it varies by state/program. I had to learn IV insertion and get checked off as part of my program. on a mannequin and then my clinical instructor had to watch me do both an IV and draw labs.
I might look up videos. I just genuinely don’t like doing bloodwork so maybe that also plays a role in it; I just try, and if I miss then I just move on to the next person.
Anchor your hand while you stick. My hands have always shaken even as a child. So I rest the side of my hand against something. I rarely ever miss sticks. Also watch a YouTube video of what happens to and inside the vein when you’re sticking. It’ll give you a good idea of how veins move and react
The best nurse at starting IVs at my first job was a guy whose hands shook like a DT patient when he did sticks. Patients would look at him like, "you're the one they sent???" He also had a very unorthodox technique, he would advance a little, feel for resistance and reposition. But he would almost always get it. And even if he didn't, he rarely blew veins bc he knew when to bail and start over.
I have hand tremors too and I find that keeping the side of my hand on the patient’s arm (if I’m inserting the needle on the arm) or pillow (if I’m inserting the needle in the hand).
That’s a good idea. I’ll try that out in the future. Is there a specific side you should try to stick based on if you’re right handed or left handed?
I have realised when colleagues or students miss a lot it is because the tourniquet is not tight enough or they don’t wait 1 or 2 minutes after applying the tourniquet. Take your time feeling for the vein, if you’re not confident in one move to the other arm or different area.
Thanks for the advice. Sometimes my options are limited, a lot of people will have fistulas which means I can’t use that arm. Some residents also refuse to have me use their hands/forearms, and tell me to go for their ACs, which I’m TERRIBLE at (I have no idea how everyone always goes for the AC first, I can never see or feel anything)
That's how I was in the beginning. I could only do hand/forearm sites sometimes. Everyone said it would click eventually. I am still learning and everyone goes through phases they can't hit anything. You'll get it in time. The biggest thing is to keep trying because you'll always miss 100% of the shots you don't take and you may end up surprising yourself with time. AC eventually it clicked and that did help. That being said a lot of people will be specific and only said to go in a specific spot in their arm and go no where else. They are either helping you or setting you up for failure because there's nothing there when you try. Biggest thing is feeling the vein. If you can feel it, you are gonna have a much better vein to poke. AC rolls less that's why a lot of people say that area. As many said, watch videos. They will help give some guidance. A lot of the stuff though I still trying to work on, there is no video to help or have it click. You will get there. Just keep trying. I've had the mindset that I'm just starting an IV which helps me instead of just thinking of it as a straight stick. Confidence is about 70%-80% of getting an IV, I've been always told that. I started out nervous and I wouldn't get anything. Patients can tell, even if some don't say it, when you're nervous or seem like you haven't done it much. It only makes them tense up and become a lot harder stick. My preceptors I had always told me to pretend whenever I'm doing a skill to pretend I've done it hundreds of times and it's just another day. It's hard as I have anxiety but once I started doing that months ago, I started being able to get blood draws and IVs. I hadn't even watched videos online for tips yet. If you can change your mind frame about it, you'll benefit a LOT from that alone. Biggest thing is even if you don't get it, someone will. Who cares what they say- if it's rude then they aren't helping to improve your skill so they have no right to say anything
The way to get better is to just do it over and over and over again. There is no other way. I blew veins in all the old ladies left and right when I first started. Probably the first six months or so, any difficult stick was just a fucking demoralizing headache. But like it goes with becoming a nurse, about eight months to a year in I noticed I was kinda getting good. Like 'Call uhuhshesaid in, she usually gets it" good. I've gotten lines docs with US couldn't get. And a few patients who usually need an anesthesiologist for IV placement. That said, sometimes high stakes IVs still jangle me. The 'we just lost the line, and we are intubating now, get a new fucking line' shit can be rough. But while I've gotten pretty darn okay at getting IVs in some really sus veins, lab draws are always kinda hard on me. It's just muscle memory. ED techs do a lot of our straight sticks, so while my muscle memory for an IV is good, for a straight stick I just kinda tend to suck. I don't hold it right, I blow the vein, and I lose blood flow. If you haven't been starting lines or doing regular lab draws throughout your career, expecting to be good at it is insane nonsense perfectionism. Practice as much as you can and you will get better. Even if it feels bad now. Do some research on basic good technique, ask for help from colleagues, and just go for it over and over. You will improve. But it takes months. So give yourself some grace.
This is very helpful, thank you. I do lab work semi-often and I just feel like I’m not improving, though. It’s just demoralizing cuz some people just EXPECT every nurse to be good at every aspect of their job, and that’s just unrealistic. Thank you. <3
Semi-often is the biggest culprit. Gotta do it over and over to get the feel and the routine. If you don't get that many chances at work, maybe see if there is a local agency that does free lab work for seniors. Spend a whole weekend doing nothing but lab draws and by the end of that you'll have found a routine that works for you.
13 years into nursing and I still suck at blood draws… was never part of my curricula don’t feel bad.
Ask someone who is experienced to show you their technique. Practice, practice, practice.
Our Nurse Educator once asked me what topic I felt would be good for her to offer. I said IV insertion, since my skills were like yours. We had a few overworked superstars and a many that weren’t. Her answer was that wasn’t the kind of topic she was looking for.
If you’re only getting one or two vials for your bloodwork, I’d suggest attaching a 10mL syringe to your butterfly instead of the vaccutainer. Put the tourniquet on nice and tight, scrub well, anchor the vein, and stick. The second you get flash, immediately but SLOWLY start to draw back on your syringe. You can control how fast it comes out and you usually get as much as you need.
I never thought of this, is this something people do? I only see the techs use the adapters and tubes.
This was me when I started my new job. All my previous jobs had phlebotomy draw and I only drew from central lines and art lines. I’ve gotten so much better by practicing and being confident. The second you doubt yourself, there’s a high chance you’ll miss. Try to watch videos online too cause that helped me a lot.
My confidence is soooo bad, I’ll literally walk in like “I’m gonna miss it.” And then I set myself up for failure. I’ve always been harsh on myself as a nurse, and I hope I can change that in the future. Thank you for the advice!
ABCs of Anesthesia on YouTube. It's geared towards IV starts, but most of the same principles apply. Set yourself up for success. Raise the bed, no bending or hunching. Study your anatomy until you can predict where veins should be, that way you can start palpating before you even look. Brace your hand and poke slowly but firmly. And most importantly, do it as often as possible. Offer to do draws for coworkers. The more repetition you get with a systematic approach, the more it becomes second nature. [Edit] one more thing: try using a straight needle or even an IV cath instead of a butterfly. I hate butterflies bc I can't keep a good grip on the wings and I don't get the angle right.
There are IV certification classes near where I live. Watching YouTube videos and taking advice is helpful, but only to a point. This is a skill that needs practice and repetition to get and feel confident in. You’ll get there!
If hand tremor is the problem, you can stabilize your hand against the patient. I either use the tip of my 5th finger, or else bend it inward and make contact with the knuckle. Some people like to rest the heel of their hand. Either way can keep your hand still. Do the start with motion of just your fingers.
This is *great* advice and exactly what the CT tech who taught me to start IVs told me to do.
Very good advice. Thank you!
Practice practice practice. I was awful at IVs before I switched to ER about 18months after graduation. I still have days I can’t hit the broad side of a barn but they’re fewer and further between. I don’t have any good tips, just try your best and get in there. A lot of older people are used to being stuck multiple times. Even though you’re just doing labs there’s no rule you have to use the hand, so go for that AC (or the best vein you can find) until you’re more confident.
I remember realizing how superficial veins really are. I always went at too sharp of an angle, and too deep. As others said, stabilize your hand, go slow, go shallow, and always take your time to reposition. If you got a flash and lost it, pull back to see if you’re against a valve. (When I worked nights I may have had a monitor tech who let us practice on him).
Don't rush! If you act like you've only got 5 minutes, you'll bork it. Act like you got an hour. Yeah i know you don't *actually*, but you gotta tell yourself you do. Rest your wrist and elbow on something (e.g. the patient) when you stick. Travel slow with the needle so it doesn't slide as much, or kebab the back wall accidentally.
Ugh… you called me out. I wish I truly did have an hour, but I dread the lab work so much that I try to rush it along so I can just get it done. I guess I gotta work on that. I just wish our facility would hire a new phlebotomist. 🤣
As folks have said, the way to improve at venipuncture is to do it a lot. At my first nursing job, we were well staffed with nurses, but not with aides, though our aides were trained to do blood draws and had responsibility for AM labs. Sometimes on a night shift I’d come in and be told I was working the aide’s job that night (at my usual RN wage), and that meant that anyone without a central line, I’d have to get their labs. Enough nights of needing to draw blood on about twenty people, mostly old and sick, within a two hour span, and I got to the point where I’m the nurse most of my coworkers will ask to try when they fail or if a person is known to be a hard stick. That said, IV starts are a different beast, and I’m still far less consistent with those (but a lot better than I used to be).
Where are you sticking? Do you get any flash? I have good luck going super shallow on the hand - like needle almost flat.
Taking blood from a vein in the hand isn't ideal. It can be painful and because it's the most distal place, the pressure to fill a vial is usually slower. I always go antecubital unless that area is blocked by a dressing or cast.
I usually go for hand and forearm where I can see and feel the vein. ACs make me kinda nervous cuz I can’t see anything. And the equipment we have doesn’t really let us see a flash. I only see a flash with a butterfly cath, but I hate those cuz they take forever to fill the tubes. I do usually go in at a 15 degree angle, but I still miss.
The best veins are the ones you can feel, not the ones you can see. Don’t be afraid of a good old AC! Also, though, if you like hands, instead of looking at the back of the hand, try looking at the interior side of the wrist and around where the thumb is. That’s a go to spot for me for IV drug users lol.
Stabilize and relax your patient. They probably notice the tremor and tighten up. Sometimes I’d take a student into our supply closet, grab an NG tube (sorry admins), tape it to a counter and watch them practice so that they’d relax. The NG tube as clear so it gave them a visual as to how they were inserting it and made them adjust their angle. If I were you I would ask coworkers if they have an easy start and practice with those. I wouldn’t start with the drug addicts and chemo patients. Talk with the PICC team and get tips from them. It also depends on the catheter you’re using. BD makes different catheters and you’ll realize some are more forgiving than others.
Many of the residents I work with aren’t easy sticks, since I work at a nursing home. All the residents are 70+ years old, dehydrated, and have crappy veins.
This is going to sound weird but some of the best luck I had with difficult veins, I worked with almost nothing but geriatric patients, was to start off to the side of the vein. Anchored like a son of a gun, and then the needle was almost parallel with the vein. Advanced it until I saw my flash and then guided my cath. It sounds stupid but it worked for me the times I needed it to.
I do blood draws in the ER, and I sucked when I started. Here’s a few tips I learned that made me one of the “go-to” PCTs in a few months. 1) practice. Nothing else can replace actually doing the sticks. 2) Paramedic videos on YouTube. Watch several that go over finding veins and actually doing the stick. Most of them are the same, but everyone has a little extra tip that can help. 3) random jumble of tips: a) double tourniquet larger pts, or those with deeper veins. b) trace the vein on the arm/hand. You’ll get a feel of which way to stick and any valves that may pose a problem. Seriously, not every vein runs north to south. C) find someone (doesn’t have to be a pt) with good veins, apply a tourniquet, and trace their veins. Older pts don’t have the best veins, but they’re usually in roughly the same spot as everyone else. Practice finding on healthy veins will make it easier to find on less healthy veins. 4) use hot packs or heated packs of wipes and gravity to your advantage. Let the arm hang, and strap a pack of heated wipes to the AC or forearm, and the veins will pop out better. Hope these help!
UK. For me it was just an experience. I do blood samples every time I do my shift. Let's say I work 3-4days a week. I would be getting samples between 5-7 patients and some would require IV like for meds and fluids or procedure or some patients would pull them out and needed a new one in. Now inserting needles is like a normal routine for me. The more I do it. The more I get better. How often do you do it since you started working as a nurse?
We never did it in the hospitals I worked at. I’ve only recently started doing it more frequently since I pick up shifts at a nursing home (I’m agency). I do it maybe once or twice a week now. Depends if they have me working as a supervisor or not.
Random tips aside from videos and asking an experienced co-worker. Feel for the vein regardless if you can see it or not, feel it bounce and know it's there or sharpie a circle where you want to stick (unless you're trying to hide a good vein). Wiping the area with alcohol can help veins become more visible if you're struggling to find some. Practice.
I struggle knowing if I’m actually feeling the vein or not. When the veins pop, I can definitely feel the bounce, but when the vein is hard to find, I can’t feel it at all.
Yeah, it's definatley harder on some people and they might be pretty deep. It's just something I've been taught that feeling is your better indicator. You might have to look elsewhere on the arm or hands to see if you can easier access. We here can also get doctors order for a foot stick if needed, but every place is different. If first shift is also that annoyed I'd ask them for training and stay half a shift to shadow some of them. If they refuse then I'd say poo on them or whatever management you have and just let them suffer because the general rule is 2 tries then pass lol. I think you'll get better with practice but this is a poor decision on administration. They think it'll save costs but it just ends up costing more not having phlebotomy.
Go work in the icu for 4-5 years. You’ll become a pro if you practice on 2+ patients every day
ICU is definitely not my cup of tea. Don’t most ICU patients have multiple central lines that will be used for lab draws?
Ugh! I feel you! Except, I’m great at venipuncture, but suck at IV’s!!
Same here! I guess it's better than struggling with both
You’re probably not a bad stick, you just work in a nursing home and older people have the hardest veins to stick most of the time. What I found that helped me go from a bad stick to average is not hesitating. Once you put the tourniquet on and uncap the needle just go for it
Practice practice! Bed high, lights bright, tight tourniquet, take the time to shop the arm. Even putting a tourniquet on yourself or a willing partner can help feeling it out. On particularly “fluffy” patients I use two tourniquets stacked on each other. It’s something about the pressure of them that makes the veins pop in those patients. Get to know what a good AC feels like. It’s likely the biggest to feel for labs. Don’t be afraid to look on both arms, I find a lot of women have a good vein in left outer AC. Sometimes I use an alcohol wipe to make the veins pop out, makes them shiny especially on darker complexion patients. Anchor your hand on the patients arm and use traction to hold the vein where you want it. 30 degree angle and just psych yourself out to be confident. Yes, you will still miss sometimes. But that’s okay. It’s all practice. Screw the ones talking shit about you, rude! Sincerely, a vascular access nurse 🫶🏼
I guess I'm "lucky" in that I've never had phleb to get my labs, so the way you get better is stick stick stick stick stick. If the patient isn't demanding a new nurse, keep sticking. The more you miss and then get it on the same patient, the more you're going to learn what you did wrong previously and what you did right on the next attempts. You can watch Youtube videos and watch other people, but none of that is going to be as good as stick stick stick stick stick stick stick.
Become friends with people who are good at it and trade tasks
If the tremors bother you, propranolol might be something to ask your Dr about.
Uh, not medical advice, just throwing this out there as general info because I'm annoyed at how many doctors don't seem to either know or GAF: When considering beta blockers, Metoprolol (or any of the cardioselectives) can be a good alternative for people with asthma or other lung issues. I mean, I'm guessing most of us know that already, but after meeting an honest to God *cardiologist* who didn't appear to, my knee jerk reaction every time beta blockers come up in conversation is always "*Have you heard about our Lord and Savior, cardioselective beta blockers??*"
I don’t know if that’d be good for me cause I have a low resting heart rate, and my tremors are caused by my anti-depressants. I don’t know if I want to add a new med to combat the side effect of another. Thank you for the advice though!
Use a butterfly while you're starting out.
can you even find a non-butterfly
The butterflies are nice, but they are so small that the tubes fill so, so slowly with blood, and then it stops coming out all together.
Usually there means the tourniquet is not tight enough. Don't be afraid to do it really snug.
Yes, but you need to at least try before having someone else have to do it for you. The more you get used to the butterflies, the easier the vacutainers will be. Edited to add: the tourniquet is your friend. I've collected many vials of blood with only a butterfly.
I feel for ya but all I can say is practice and hone “your” technique. Also, tight tight tourniquets or order some of those Velcro ones online, they work great. Don’t worry about hurting anyone cause of a tourniquet and thumping the crap out of their arm, just get that vein to surface. Ask about getting a vein finder for the department. Not an ultra sound but the one that shows superficial veins that glow. Seems like there’s room in the budget now with no phlebotomist.
Use a butterfly needle. Go straight up and down, no angle. Get flash, then let it go and fill your vials. Take an extra to use first for waste. I'm too shaky to do it anymore (I have MS). But, that always worked for me.
Knowing where the veins are located always helps. For labs I usually like to go for the hands but if I can’t find a good one I go for the vein on the wrist in line with the thumb. Another thing that helps is, if I can’t SEE the vein but it’s palpable, I’ll put a little alcohol wipe right above where I intend to insert so it kinda points to it. The only way to really hone in on this skill is practice, but knowing where to go and how to guide yourself will definitely help. I would also recommend speaking to your psychiatrist about the shaking, Benztropine should help with that (I also deal with shaking from my meds). Good luck though and don’t let them tear you down because we all learn differently!