I stared at the vein. It’s big! And it’s juicy! It’s literally bulging out at me, taunting me: Stab me! That’s right, stab me! I know you want me! There’s no way I could possibly miss. Absolutely no way. I steadied my hand, aimed and inserted the needle. I looked for the flash of blood in the flash chamber to indicate that I’m in the vein…and waited…
I inserted the needle a bit further…
Damn! I must’ve somehow missed!
Lesson #1: Big juicy veins do not guarantee a good start.
Sighing and with the guidance of one of my instructors, I pulled the needle back a tad. The big juicy vein was still staring at me.
Ah hah! You missed! You thought it’d be easy didn’t you?
When I inserted the needle, the vein just wiggled to the side. I have to re-aim and try again. I advanced to where the vein had shifted. Still no flash. Hmmmm. I pulled back slightly one more time, and advanced a bit more to the right. I get a tiny bit of red, just a small splash in the flash chamber. ARGH! This is kind of frustrating. I knew something wasn’t going right.
Instructor: “I think you just got the tiger stripe. Pull it out and we’ll take a look.”
Sure enough, the catheter showed tiger strips of red and air. What happened most likely was I hit the vein but then didn’t advance far enough so the needle pulled back and the vein shifted away.
Attempt #1: No start. I guess that vein got the last laugh this time.
The second attempt to get a start was on a friend who’s skin is made of shark skin. Literally.
I picked a vein I liked. It was nice and straight and near the surface. It wasn’t quite as big and juicy as the last vein. I prepared the needle and pushed against the skin to get it in.
Hmmmm…strange it’s not going in.
I pushed a little harder, but the needle would not penetrate her skin.
Okay fine, I’ll push harder. And yes, at this point I was pushing pretty darn hard.
What kind of skin does she have!??!
So I applied even more pressure, and finally I felt the needle do a ‘pop’ as the skin finally gave way. I advanced the needle. I could see the vein through her skin. I was right ontop of the vein. I pushed further, looking for a flashback.
My instructor told me to advance it a bit further, and so I did. Still no flash. It was strange because you can see the needle penetrating right into the vein, but there’s no flash so I must have somehow missed. I pulled the needle back and tried advancing at a steeper angle.
I pulled back and advanced at a smaller angle.
What on earth!?!?
My teacher decided to give me a hand and took the needle. He wiggled it around for a bit, adjusting the angle here and there. Then finally, he got a flash! He handed the needle back to me, and I advanced the catheter. Only I felt as if something was blocking the catheter from advancing. It was really hard to push it in.
Instructor: “Try pushing a little harder.”
So I did. Well I did as far as I could.
Me: “Hmmm it’s really hard to advance.”
Instructor: “Okay, lets pull it out and see what we’ve got.”
So I pulled the catheter out. And guess what? There was a kink in the catheter! Not only does my friend have shark skin, she’s got bulletproof veins! That was amusing, and rather interesting. But I still don’t have my first start. This was so frustrating!
Attempt #2: Needle vs Shark. No start, Kinked catheter.
Friend: “Have you gotten your start yet?”
Friend: “Really? You can use my vein.”
Friend: “Yeah, I got a big juicy one right here.”
I looked at his vein. Yup, it sure was a big juicy one. I’m not gonna let it fool me though! Big veins don’t necessarily equal easy starts.
Me: “Okay, if you don’t mind, I’ll try a start on you.”
Friend: “Yeah, for sure.”
So we found a cot, he jumped on. I got everything ready for the IV start.
Instructor: “Okay, I’m not even going to say anything. It’s all yours.”
He stood back. As I popped the cap off the needle, anchored the vein with my other hand and steadied my needle hand. I took a deep breath.
Okay, this one’s going in.
I made sure to visualize how the vein moved underneath the skin, and the direction in which I’ll be inserting the needle.
This is it! I’m not gonna let this one wiggle away.
I held my breath, I went in straight without hesitation. And walla! I see blood fill the flash chamber! I’m in! Awesome! I advanced the catheter, and since we were only practicing starts. I got the gauze out and applied it to the insertion site and then pulled the catheter out. It was filled with red blood, no tiger stripes and no kinks. That was strangely easy, compared to the struggle of the other two attempts. It felt good. I had a big smile on my face 😀
Attempt #3: Got a clean start.
IV day was a fun day. We practiced calculating and drawing up different doses of drugs from ampules and viles as well as mixing medications. We set up IV lines, and practiced administering medications through the drug ports as well as piggy-backing lines. Then we practiced inserting needles into catheter tubes to get the practice and feel. Next we practiced on fake thighs, doing IM injections. Then before practicing on each other, we practiced starting IV lines on mannequin arms.
It was frustrating to take so many tries before I got a start. However, looking back, I gained a lot more experience failing on my two starts than if I had gotten the start right at the beginning. If I had gotten my starts from the beginning, I wouldn’t have learned how to maneuver the needle if the start didn’t work out the first time, nor would I have gotten to see a catheter get kinked from hitting the vein’s wall and valve or see how tiger stripes happen. As one of my teachers wrote on the white board:
“If you haven’t experienced difficulty, you will remain inexperienced.”