Tips & Tricks

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Chance Reaves
MSN-Ed,RN
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Outline

Nursing Points

General

  1. Think it through
    1. Visualize the process
    2. Setup what you need
  2. Bring two of everything
    1. Only show one set to make the patient comfortable
      1. And to show your confidence
    2. Having a second set allows you to try again
    3. It’s more efficient
  3. Know how the IV works
    1. Bevel up
    2. Bevel is farther down the line, so a flash doesn’t mean you’re in
    3. Advance the entire unit another 2-3 mm once there’s a flash, then advance the catheter
  4. Bigger isn’t better
    1. Be confident in the size of catheter you can place
    2. Don’t be overzealous – do what’s safe and what’s effective
  5. Traction
    1. For excessive skin or movement, create traction to make the skin taut to keep the vein in one place
  6. Mark the spot
    1. Use a cap to mark the location of vein or insertion point
    2. After cleaning, the mark will remain visible
  7. Locating
    1. See & feel
      1. Ideally, place IVs in veins that you can see AND feel
    2. Feel
      1. If you can’t see a vein, but can feel it, this is your second best option
    3. See
      1. If you can’t feel a vein, but you can see it, this is another option
  8. Keep a free hand
    1. Use your non-dominant hand as a free hand to secure devices, apply pressure, etc.
    2. If you lose the vein, your free hand will allow you to palpate the location of the vein while placing the IV.
  9. If you miss…don’t fish!
    1. Don’t fish for the vein
      1. Causes shearing and tearing of tissues
      2. Is uncomfortable to the patient
    2. Retract the whole IV unit just to above the bevel, then redirect to the vein
  10. Speak with confidence
    1. Tell your patient “I’m going to put in your IV” instead of “I’m going to try to put in your IV.”
    2. Greater confidence for you and your patient
    3. This also gives you a positive mindset, improving confidence.

Patient Education

  1. Educate your patient on the procedure you’re about to perform
  2. Instruct the patient to be still during the procedure to minimize discomfort and reduce the number of attempts to place an IV.

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Transcript

Okay guys, in this lesson we’re going to talk about 10 tips and tricks to help you get your successful IV starts. Number one, think it through. So what does that mean? That means that you need to be thinking about the entire process from start to finish, what supplies you need, what Ivy selections. You’re going to think about, um, what catheter size, all of those things, including even future therapeutic management. You want to be thinking about this all the way from start to finish. Number two, bring two of everything. Why would you want to do that? Well, first off, you want to make sure that you have a backup. How unfortunate would it be if you start to get an IV and the vein blows and you have a really good vein, but the problem if you don’t have the staff down the hall that you can yell at.

You don’t have your coworkers and your friends to help you out and now you have to lower the bed or you have to go back and go get more supplies. That’s extremely frustrating for both the patient and yourself. So always bring two of everything. The trick here only show one and go in with the confidence and knowing that you’re only going to put that one in. Number three, know how the view works. Knowing how the entire device works is going to be to your benefit. There’s always a bevel that sticks out about two to three millimeters past the end of the catheter. When you insert it, what’s going to happen is you’re going to get into the vein and know that you’re going to have to go just a little bit further before the IVs actually in the vein. What you don’t want to do is get just a flash and have the only the bevel and then you’d try to push it in.

You end up kinking the IV. You don’t want that. The other thing is you always want to know where that bevel is, so bevel up all the time. Number four, bigger isn’t always better. What do I mean by that? What I mean is that you need to be able to have the confidence to put those IVs in and be confident in the size that you get, but you also don’t want to be overzealous. Just because you can put an 18 in doesn’t mean that you should, so always keep that in mind. Number five is traction. Anytime you go to set that Ivy, you want to anchor that Ivy down by applying traction and just a little bit of tautness to that skin to make sure that vein doesn’t move. Number six, Mark the spot. This is one of my favorite tips because it’s actually really cool.

What you can do is use the end of the cap of the IV to market spot. You push it into the right spot where it’s supposed to be and then you twist it and turn it. The great thing about this is after you’ve located your Ivy, you can do this to keep your spot. Instead of using a pin or some other thing that’s going to get wiped off of the court prep. By doing this, it allows you to continually see the spot where you need to go. Number seven, locating. There are three different ways that you can look at your specific IB site. You can either feel it, you can see it, or you can do both and obviously you want both. You want to be able to see and feel the Ivy that you’re going into. The next best thing you could do is pick a vein it you can feel.

You obviously want to be able to feel that Ivy, even if you can’t see it, it’s going to give you a greater likelihood of success. And lastly, you won’t see it. If you can see it, then that’s great and it’s always best to feel it. But if seeing the vein is your only option, that may be your only option. So use those tips when you’re selecting your IV site. Number eight, keep a free hand. I’m right hand dominant, so I’m gonna use my right hand to always place the IV, but I always want to keep my left hand free. It allows me the freedom to reach across, to grab the necessary supplies. All of those other things. You don’t have to call on other people to help you. Number nine, if you miss don’t fish. What I mean by this is that I’ve seen tons of nurses hurt their patients by actually fishing for the vein and when I say fish, what I’m talking about is the IVs almost inserted to the level of the vein and they actually will sweep side to side.

That actually causes tearing in the shearing of the tissues and it’s extremely painful. The patient also, you can ruin your stylette, you can ruin the IB catheter and you’ve got to start over anyway. What you need to do is retract the entire unit back to the surface, but don’t pull the whole Ivy stylette and the cannular out. You want to back up as far as you can and then redirect. You want to back up and redirect. You don’t want to sweep side to side. That just causes harm to your patient. And number 10 and this is probably one of the most important ones, is to speak with confidence going into your patient’s room and telling them, Hey, I’m here to put your IV in. I’m going to put your IV in. Not, I’m going to try always have that confidence. When you go put those IVs in and you’re going to have greater success.

I hope that these 10 tips and tricks are going to help you with your Ivy catheterization. Now go out and be your best self today, and as always, happy nursing.

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Nursing Clinical 360

With the rapid expansion of the COVID-19 pandemic many schools, instructors and students are left wondering what just happened?Students can’t access the tools and onsite clinical help they desperately need and instructors are trying to piece together online learning that prepares their students for success.It is because of this uncertainty and abrupt change that we have developed the Nursing Clinical 360 Course.Featuring:38 Highly Detailed Nursing Skills Video Lessons18 Health Assessment Lessons26 IV Skills Videos42 Case Studies30+ Care PlansWe want to give students the practical knowledge they need to feel confident going into a clinical or practical situation, as well as give instructors a concise library of online resources to handle the sudden demand for distance learning.

Course Lessons

1 - Head to Toe and Health Assessment
Intro to Health Assessment
Barriers to Health Assessment
The 5-Minute Assessment (Physical assessment)
Adult Vital Signs (VS)
Pediatric Vital Signs (VS)
General Assessment (Physical assessment)
Integumentary (Skin) Assessment
Neuro Assessment
Head/Neck Assessment
EENT Assessment
Heart (Cardiac) and Great Vessels Assessment
Thorax and Lungs Assessment
Abdomen (Abdominal) Assessment
Lymphatic Assessment
Peripheral Vascular Assessment
Musculoskeletal Assessment
Genitourinary (GU) Assessment
2 - IV Insertion
Supplies Needed
Using Aseptic Technique
Selecting THE vein
Tips & Tricks
IV Catheter Selection (gauge, color)
IV Insertion Angle
How to Secure an IV (chevron, transparent dressing)
Drawing Blood from the IV
Maintenance of the IV
IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)
Needle Safety
IV Drip Therapy – Medications Used for Drips
IV Drip Administration & Safety Checks
Understanding All The IV Set Ports
Giving Medication Through An IV Set Port
How to Remove (discontinue) an IV
IV Placement Start To Finish (How to Start an IV)
Bariatric: IV Insertion
Dark Skin: IV Insertion
Tattoos IV Insertion
Geriatric: IV Insertion
Combative: IV Insertion
Tips & Advice for Newborns (Neonatal IV Insertion)
Tips & Advice for Pediatric IV
3- Nursing Skills
Nursing Skills (Clinical) Safety Video
Bed Bath
Linen Change
PPE Donning & Doffing
Sterile Gloves
Mobility & Assistive Devices
Spinal Precautions & Log Rolling
Restraints
Starting an IV
Drawing Blood
Blood Cultures
Central Line Dressing Change
Inserting a Foley (Urinary Catheter) – Female
Inserting a Foley (Urinary Catheter) – Male
Trach Suctioning
Trach Care
Inserting an NG (Nasogastric) Tube
NG (Nasogastric)Tube Management
NG Tube Med Administration (Nasogastric)
Stoma Care (Colostomy bag)
Wound Care – Assessment
Wound Care – Selecting a Dressing
Wound Care – Dressing Change
Wound Care – Wound Drains
Pill Crushing & Cutting
EENT Medications
Topical Medications
Drawing Up Meds
Medications in Ampules
Insulin Mixing
SubQ Injections
IM Injections
IV Push Medications
Spiking & Priming IV Bags
Hanging an IV Piggyback
Chest Tube Management
Pressure Line Management
4- Nursing Care Plans
Purpose of Nursing Care Plans
How to Write a Nursing Care Plan
Using Nursing Care Plans in Clinicals
Nursing Care Plan (NCP) for Abdominal Pain
Nursing Care Plan (NCP) for Acute Respiratory Distress Syndrome
Nursing Care Plan (NCP) for Alcohol Withdrawal Syndrome / Delirium Tremens
Nursing Care Plan (NCP) for Alzheimer’s Disease
Nursing Care Plan (NCP) for Angina
Nursing Care Plan (NCP) for Aortic Aneurysm
Nursing Care Plan (NCP) for Appendicitis
Nursing Care Plan (NCP) for Arterial Disorders
Nursing Care Plan (NCP) for Asthma
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Nursing Care Plan (NCP) for Benign Prostatic Hyperplasia (BPH)
Nursing Care Plan (NCP) for Cardiogenic Shock
Nursing Care Plan (NCP) for Cardiomyopathy
Nursing Care Plan (NCP) for Cholecystitis
Nursing Care Plan for Cirrhosis (Liver)
Nursing Care Plan (NCP) for Congestive Heart Failure (CHF)
Nursing Care Plan (NCP) for Constipation / Encopresis
Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis
Nursing Care Plan (NCP) for Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder)
Nursing Care Plan (NCP) for Endocarditis
Nursing Care Plan (NCP) for Dehydration & Fever
Nursing Care Plan (NCP) for Gestational Hypertension, Preeclampsia, Eclampsia
Nursing Care Plan (NCP) for GI (Gastrointestinal) Bleed
Nursing Care Plan (NCP) for Heart Valve Disorders
Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)
Nursing Care Plan (NCP) for Inflammatory Bowel Disease (Ulcerative Colitis / Crohn’s Disease)
Nursing Care Plan (NCP) for Leukemia
Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder)
Nursing Care Plan (NCP) for Myocardial Infarction (MI)
Nursing Care Plan (NCP) for Neutropenia
Nursing Care Plan (NCP) for Pancreatitis
Nursing Care Plan (NCP) for Parkinson’s Disease
Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)
Nursing Care Plan (NCP) for Schizophrenia
Nursing Care Plan (NCP) for Seizures
Nursing Care Plan (NCP) for Spinal Cord Injury
Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)
Nursing Care Plan (NCP) for Vomiting / Diarrhea
Nursing Care Plan (NCP) for Acute Kidney Injury
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Osteoporosis
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Rheumatoid Arthritis (RA)
Nursing Care Plan (NCP) for Disseminated Intravascular Coagulation (DIC)
Nursing Care Plan (NCP) for Diabetes Insipidus
Nursing Care Plan (NCP) for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care Plan (NCP) for Lymphoma (Hodgkin’s, Non-Hodgkin’s)
Nursing Care Plan (NCP) for Thrombocytopenia
Nursing Care Plan (NCP) for Sickle Cell Anemia
Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)
Nursing Care Plan (NCP) for Hyperthyroidism
Nursing Care Plan (NCP) for Post-Traumatic Stress Disorder (PTSD)
Nursing Care Plan (NCP) for Glomerulonephritis
Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia
Nursing Care Plan (NCP) for Renal Calculi
5- Nursing Concept Maps
Concept Map Course Introduction
Coronary Artery Disease Concept Map
COPD Concept Map
Asthma Concept Map
Pneumonia Concept Map
Bowel Obstruction Concept Map
Gastrointestinal (GI) Bleed Concept Map
Congestive Heart Failure Concept Map
Hypertension (HTN) Concept Map
Breast Cancer Concept Map
Amputation Concept Map
Sepsis Concept Map
Stroke Concept Map
Depression Concept Map