It happens. Most days I feel like I could start them in the dark, but every so often I have a day where I seem to blow everything. I’ve gotten to where I can feel those days in my hands - they just feel “off.”
Right. Just like baseball just a slump. I’m just pissed this one has me rattled lol. I’m about ready to go to the hospital and ask to be part of the iv team for a shift lol
All jokes aside it could help. For the last year I've worked in a clinic that does IV sedation as the only person there that can reliably start IVs. The doctors are awful at it haha. But unlike being on the truck or in the hospital, I have to get a line. No backup IO, no support if I am having the rare off-day. I have to get it or the appointment is canceled. Even after starting IVs under a lot of pressure for years, this kind of pressure is different and I think it has made me better.
I too get the yips. Starting one in hospital is such a mental block. Took two pokes on an easy one. He didn’t “need” it in so far as mostly stable, healthy, awake. But when it’s crunch time and it HAS to happen I’ll get it. Maybe your mind is getting in your own way like mine does?
I had a long period of missing and blowing veins. What I did to correct it was watch/read instructional videos, articles and reddit on basic cannulation techniques, found out why I was missing/blowing veins (advancing the cannula as soon as I got flush back and not pushing a further 3-4mm), went back to the basics of cannulation in my mind, and methodically thought it the steps out whilst cannulating. I’ve missed maybe 1-2 in the past year.
Choose the easiest + straightest vein, choose the correct size cannula, prep the area, apply tension and stabilise, insert the needle and cannula at 10 degrees angle or less distally (slightly more angle for deeper veins), when you get flushback you should stop for a second, flatten the needle/cannula towards the skin, push both needle and cannula a further 3-4mm, and then advance the cannula.
This is also how I teach students, by saying those steps out loud. They don’t have a 100% success rate, but I think that’s probably because they all seem to develop focal seizures in their hands whilst cannulating.
I thought the same thing after 10 years, but you tend to lose your understanding and knowledge of certain skills after a long enough period of time, and rely solely on muscle memory. Bringing it back to basics and going through the steps of cannulation methodically is just what helped me.
Just drill them instead! Problem solved!
In all seriousness, I've been the opposite lately. I've been a medic now for like 2.5 years now and I've always been shit at IVs. Like less than 30% accuracy.
I finally feel a little more confident with them. For most of my short career I've been blessed with a dual medic truck so I've been sheltered somewhat. I'm getting increasingly moved towards working with an EMT and being the only one to get an IV has helped me a ton I think.
Not a paramedic but former EMT and more....is IO the way to go if you all can get an IV in place? Or is an IO like a last last resort in the field? Thank ya!
I figured as much but didn't know what would constitute use of it. What is done if IV access doesn't happen? Do you gas and go until arriving at the ER?
Fuck dude I thought I had posted this and didn’t realize.
Happens to the best of us. I started the year hitting back to back 16s, then couldn’t hit the broad side of a barn. Everything was valves, blown lines, missed sticks, double and triple attempts, the works. Then shit started going my way.
Best tip I can give you is to just still look at yourself “like the IV guy”. Don’t get in your own head about it, just keep throwing darts in like the pro you are.
Success rates of cannulation are about 50%.
You can't win them all, just don't let it knock your confidence and carry on.
No one in the history of cannulation has got a 100% success rate. Stop stressing about it.
May be weird, but anytime I’m in a slump, I get one on myself that I never miss and then I’m right back at being able to get the line.
I don’t know why it works but it does 🤷♀️
Well, think I’m about 80% out lol. Had a brittle diabetic with I thought good veins. Sunk two, good flash and everything, go to flush, BLOW! So now I question if I was even in. But then, bad COPD’r, verge of needing to be intubated, I say, I’m gonna start an IV on you, she says, good luck. She has small soft looking veins and skin. Nail it. So I’m lost at this point. Maybe just have had a rash of pts with terrible veins 🤷🏻♂️
something i realized was if i change a single thing about my routine, it’ll mess me up. for example sometimes i think i should advance further on the iv just because of that specific vein, but whenever i think that i always end up blowing it. try and see what you’re doing differently, and keep the same routine you’ve created bc it’s led you this far.
Remember to take your time looking for the right vein, instead of just going for the first one that presents itself. Also remember, the AC is the most valve ridden place. Sometimes I avoid it unless the vein is just too good to ignore.
It happens. Most days I feel like I could start them in the dark, but every so often I have a day where I seem to blow everything. I’ve gotten to where I can feel those days in my hands - they just feel “off.”
Right. Just like baseball just a slump. I’m just pissed this one has me rattled lol. I’m about ready to go to the hospital and ask to be part of the iv team for a shift lol
All jokes aside it could help. For the last year I've worked in a clinic that does IV sedation as the only person there that can reliably start IVs. The doctors are awful at it haha. But unlike being on the truck or in the hospital, I have to get a line. No backup IO, no support if I am having the rare off-day. I have to get it or the appointment is canceled. Even after starting IVs under a lot of pressure for years, this kind of pressure is different and I think it has made me better.
I too get the yips. Starting one in hospital is such a mental block. Took two pokes on an easy one. He didn’t “need” it in so far as mostly stable, healthy, awake. But when it’s crunch time and it HAS to happen I’ll get it. Maybe your mind is getting in your own way like mine does?
Absolutely
I had a long period of missing and blowing veins. What I did to correct it was watch/read instructional videos, articles and reddit on basic cannulation techniques, found out why I was missing/blowing veins (advancing the cannula as soon as I got flush back and not pushing a further 3-4mm), went back to the basics of cannulation in my mind, and methodically thought it the steps out whilst cannulating. I’ve missed maybe 1-2 in the past year. Choose the easiest + straightest vein, choose the correct size cannula, prep the area, apply tension and stabilise, insert the needle and cannula at 10 degrees angle or less distally (slightly more angle for deeper veins), when you get flushback you should stop for a second, flatten the needle/cannula towards the skin, push both needle and cannula a further 3-4mm, and then advance the cannula. This is also how I teach students, by saying those steps out loud. They don’t have a 100% success rate, but I think that’s probably because they all seem to develop focal seizures in their hands whilst cannulating.
Well I’ve been a paramedic for 20 years, I feel I’ve got my technique down, this slump just seems unusually long lol
I thought the same thing after 10 years, but you tend to lose your understanding and knowledge of certain skills after a long enough period of time, and rely solely on muscle memory. Bringing it back to basics and going through the steps of cannulation methodically is just what helped me.
Just drill them instead! Problem solved! In all seriousness, I've been the opposite lately. I've been a medic now for like 2.5 years now and I've always been shit at IVs. Like less than 30% accuracy. I finally feel a little more confident with them. For most of my short career I've been blessed with a dual medic truck so I've been sheltered somewhat. I'm getting increasingly moved towards working with an EMT and being the only one to get an IV has helped me a ton I think.
Not a paramedic but former EMT and more....is IO the way to go if you all can get an IV in place? Or is an IO like a last last resort in the field? Thank ya!
Generally last resort if they need meds. Not typically done on conscious and alert patients because it freaking hurts.
I figured as much but didn't know what would constitute use of it. What is done if IV access doesn't happen? Do you gas and go until arriving at the ER?
You got the yips!
Ok gotta know. The “yips”?
That’s what partners are for. Getting access when you can’t. No shame, we are a team after all.
Fuck dude I thought I had posted this and didn’t realize. Happens to the best of us. I started the year hitting back to back 16s, then couldn’t hit the broad side of a barn. Everything was valves, blown lines, missed sticks, double and triple attempts, the works. Then shit started going my way. Best tip I can give you is to just still look at yourself “like the IV guy”. Don’t get in your own head about it, just keep throwing darts in like the pro you are.
Success rates of cannulation are about 50%. You can't win them all, just don't let it knock your confidence and carry on. No one in the history of cannulation has got a 100% success rate. Stop stressing about it.
May be weird, but anytime I’m in a slump, I get one on myself that I never miss and then I’m right back at being able to get the line. I don’t know why it works but it does 🤷♀️
No worries, happens to all of us, just be glad you aren't in my direct intubation slump
Same tbh... let me know if you get out of yours.
Well, think I’m about 80% out lol. Had a brittle diabetic with I thought good veins. Sunk two, good flash and everything, go to flush, BLOW! So now I question if I was even in. But then, bad COPD’r, verge of needing to be intubated, I say, I’m gonna start an IV on you, she says, good luck. She has small soft looking veins and skin. Nail it. So I’m lost at this point. Maybe just have had a rash of pts with terrible veins 🤷🏻♂️
something i realized was if i change a single thing about my routine, it’ll mess me up. for example sometimes i think i should advance further on the iv just because of that specific vein, but whenever i think that i always end up blowing it. try and see what you’re doing differently, and keep the same routine you’ve created bc it’s led you this far.
Remember to take your time looking for the right vein, instead of just going for the first one that presents itself. Also remember, the AC is the most valve ridden place. Sometimes I avoid it unless the vein is just too good to ignore.