If you just started a new medication or suspect that your shaky hands are being caused by something you're taking, speak with your doctor as soon as you can. If you work in an area with vital monitors on the walls, place the BP cuff on the arm and hit the venipuncture setting on the monitor. When you have inserted the needle correctly, you will see a flashback of blood in the flash chamber. Policy. Thanks for sharing! Sometimes patients know where they have good veins, and where others have tried and failed. To use or not to use topical/intradermal lidocaine, that is the question. I've started many IV's on all ages. :). 9 Posts. It is NOT a problem at all. Check that the IV is infusing into the vein by occluding the vein (pressing down on it to block its flow) distal to the site of the IV (away from the torso). You might also see this flashback in the catheter, depending on the size and type of catheter you are using. These are not typical tools for IV starts but they may come in handy for the ultra-hard sticks. Here's what might be going on if you're shaking after waking up and what you can do about it. But neurologist Michal Gostkowski, DO . Ideally, you should use a large bore needle for patients who are likely to become surgical patients and those who might need a blood transfusion or emergency medication later on. Then get the IV while they laugh awkwardly. Has 7 years experience. In its advanced stages, this condition can severely disrupt some of the most basic tasks and parts of life, such as eating, drinking and dressing yourself. Warm the arms with blankets, compresses, k-pads, whatever you have, and you will get bigger better veins to poke. Better yet, if you can avoid tourniquets all together, then thats great. You will also want to use universal precautions, so put on a pair of clean gloves as you will be possibly interacting with the patient's blood. An inflated blood pressure cuff makes a fantastic tourniquet and doesn't pinch arm hairs or skin like those little rubber straps that come in the IV start kit. Things that make it worse are: being nervous, too much coffee, being hungry, being angry, being excited, holding my hands in certain positions, being tired. 30 seconds in an up-and-down, side-to-side motion. FunnyI was a little leery upon seeing the first pic in the article, as that particular position is something I never do. you might consider asking if you can do a week working for the lab doing phlebotomy. Has 7 years experience. Thought it was all anxiety for a long time. Its better to aim shallow and take a little longer to hit the vein than it is to go in at too deep of an angle and end up going right through and blowing it. Has 14 years experience. Turns out hyperthyroidism will do that to ya! Let us know if you have any other tips, and well add them to the list! she shrieked, "My gawd, he's shaking like a leaf!!! There are two forms of floating. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. You can also run your finger up the vein, pushing the blood out on the way back towards the patient while holding down pressure on a distal piece of the vein so it cant refill with blood. . Stability to insert the needle pops into the chamber if the IV.! Just a suggestion I've found helpful. If you do go into psych you will very rarely have IV's to worry about. This has profound effects on many parts of your body, mostly aimed at increasing your alertness, muscle strength and ability to run away from danger or turn to face it. If you find that you are unable to fully advance the catheter, odds are youve run into a valve, or the vein turned. Then I wiggle out the cramp and proceed without problem. My hands and body started shaking very bad and my leg was literally hopping off the floor! If your patient is anxious, ask the CNA or family member to support them. Practice various methods of holding it (not in front of a client!). IV needle: The IV needle allows you to access your patients vein. Ya cant really tap your foot when on a laddar can you. Specializes in ER, progressive care. It can be appealing to keep attempting an IV insertion, especially if the patient tells you it's OK to do so. The good news with this method is that your target is in plain sight, and should be relatively easy to aim at. It should slip in easily. Try twisting/rolling the catheter if its curvy, but if it is straight, back up just a bit, and try to float it. Typically you should go in bevel up, but there is such a technique as going bevel down. This gives the veins time to become plump while you set up your supplies and mentally prepare for success. . This study guide will help you focus your time on what's most important. Enough sleep the impression that you don t let your hands shake a little more 60 Are shaking or trembling, this is to minimize air embolism, permit access, and warm enough to vasoconstriction A medication I take times can make any nurse feel really anxious, too of sleep night! You always need an extra couple of millimeters more than when you first get a flash of blood. I once had a clinical instructor call me on having shaky hands during an IV push. You all are wonderful and thank you again! Now I know what was causing the anxiety! Some people swear by this method, but I prefer the first method. You need to be comfortable to spend some time and be able to be dexterous in that position. You only need about 1.5 inches of valve free vein (just look at your catheter), so this is your best bet to not have to worry about valves. I used to have shaky hands too, but I have found that if I just visualize the cannula with flashback, I am more relaxed. This is to minimize air embolism, permit access, and promote venous flow towards the neck. If youre placing the IV to draw blood or for an upcoming procedure, place the cap to keep the IV sterile. I haven't missed any because of this, but I am sure I am making my patients uncomfortable and I am uncomfortable and might break clean/aseptic technique while focusing on just trying to stick the vein. I would love to add to this with one of my tips. Tie a wide elastic band above the vein. After the thyroid got straightened out, my hands steadied up. Whether you are a seasoned nurse or in your first semester of nursing school, you will experience the terror and exhilaration of starting a challenging IV. By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. I've had several pts ask me if I'm all right, and ask if I have low blood sugar, LOL. Turn the temperature down in the room if you are sweating. You also need to do the same thing for chronic steroid users and those with fragile veins or history of chemotherapy. Our veins have valves all along them to prevent the back-flow of blood and keep it moving towards the heart. Also keep in mind that if you can see a vein, then its not all that deep. allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 This helps the catheter navigate through little turns, bumps, or other obstacles in the vein. It may be an up-and-down or . 7y. Id say 15 degrees max for an initial approach angle, but probably even less most of the time. An intravenous (IV) injection is an injection of a medication or another substance into a vein and directly into the bloodstream. Intention tremor starts when you're reaching for a target, like a keyhole as you unlock your door. I am a naturally nervous person. Some days the moon is just right, and you get every IV start on the first try; other days, you go home wanting to be nothing more than a Walmart greeter. Specializes in NICU, PICU, Transport, L&D, Hospice. Using a blood pressure cuff also minimizes painful pinching for folks with friable, loose skin. Get to know who is good at placing IVs where you work at and every time someone needs an IV go with that person to start it. There you have it, twenty-five years of IV tricks and tips rolled into a 1400-word article. Simply pull your fingers back with the opposing hand and hold for a couple of seconds. 33 Articles; He has even less right to pinch or retain it.". Our members represent more than 60 professional nursing specialties. No biggie. swelling of the joints. Hi all, I was wondering if you guys had any tips on steadying hands. Updated: Friday This pressure from the saline flush will open the valve, and while continuing to slowly push saline, you can simultaneously wiggle and advance the catheter through the valve. d. Administer glucagon, 1 mg IM. The first part of the bevel might be in, but if you start threading before you get the rest of it, the sharp jagged edge of the bevel can tear the vein wall, and that sucker is gonna explode. I know it sounds kooky, but it worked for me! This memory aid is especially important if the unit is hectic and there are multiple emergencies going on. For patients experiencing hypotension or those with fragile veins, you may find using a manual blood pressure cuff instead of a tourniquet more useful. I love my job, I have respect for all those working in the field puncturing veins! I am mainly set on being a psych nurse (adult ideally, not geripsych), so my impression is that I won't be doing too many blood draws and IV starts (correct me if I'm wrong.) Place the arm in a dependent position and give gravity some time to work its magic. Relax! Watch a few, then try a few, and with more and more experience you will see yourself rise to become the next IV boss. From parents passing out in the procedure room to grown men crying at the sight of a needle, to watching a child with cancer not even flinch at her "owie," I've seen it all, and you know what, it's pretty amazing! On my second IV start on a patient, I had a woman who was kind of "high strung" and she was watching me like a hawk. Stress, anxiety and nervousness are a common cause of shaky hands. I could feel the pricks of hot sweat begin to freckle my forehead. IV . Cover the site with a hot moist towel or awarm blanket. Thank you! Think of them as little french doors that open every time your heart beats to allow blood to go through, and then close every time there is a pause so that gravity or other forces doesnt pull the blood back away from the heart. Sleep helps to regulate your automatic nervous system, as well as your heartbeat and blood pressure, keeping body tremors in check. Thank you!! If you absolutely have to feel without gloves, at least put some on after youve located a vein before you play with needles. Some say to sit, some say to raise the bed up to your height and stand (if you can). The main symptom of essential tremor is trembling, particularly of the hands. I am an ER nurse and have dones thousands of IV starts. The catheter should always be smaller than the vein youre inserting it into, otherwise, youre going to blow it. Apply firm pressure for at least two minutes on the gauze over the insertion site. The plastic catheter is softer and is the only thing you should be threading into the vein. I only use this site for an IV when I have to. Specializes in Peds, PACU, ICU, ER, OB, MED-Surg,. Practice various methods of holding it (not in front of a client!). The longer you have the tourniquet on, the pressure in the vein is going to keep rising, and once you poke a hole in the vein youve significantly weakened its structure. I hope I'm replying to your response correctly LOL Yes, they added pictures to my last article too - which is great because I'm still learning how to do that! I have also seen people use two tourniquets, but I think that may be a bit painful. . large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs. Specializes in Certified Oncology Nurse with master's degree.. Chloraprep and alcohol really piss veins off. Often times it's the back-pressure that can make those fragile veins (especially in the elderly or those with scleroticveins) pop. It is usually caused by lesions involving the brainstem, thalamus, and cerebellum. I thought, in near panic. A tremor is a rhythmic, uncontrollable movement of part of your body. So often, we emulate how we were shown to hold the cannula. Look for clear skin, preferably where veins are visible and the IV cannula will fit well. In addition, each tip is represented by an equally helpful song title for better memorization. Hey all! Thanks for reading my article! Ideally, you should start the IV in the lowest veins and work upward. yay, nursing! Open the start kit: Remove the rubber band from the tourniquet, tear off about 5-6 inches of tape and tear this piece in half and set it aside. Clean the area widely and vigorously to prepare possible veins nearby. I only get shaky on the littlest of babies and toddlers now. I hope this might help you:lol: Reply. Put the lights on so you can appropriately assess both arms and place the IV safely. This technique causes vasodilation making the vein/s fuller and easier to feel. Any new nurse, new to IV's, is going to be nervous. Tremor is a neurological disorder that causes shaking movements in one or more parts of your body, most often in your hands. Therefore, unless you are the only available clinician (like I am at my outpatient infusion clinic), you should hand over the needle after two attempts, leaving the greatest opportunity for success in the next set of hands (pun intended). Lack Of Sleep Sleep affects you in both physical and psychological ways. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. I have a tremor. Even while youre still shopping for the right vein to stick, you can already use the alcohol swab. Despite how unnerving it is, all nurses need to know how to start an IV line safely and correctly. After the thyroid got straightened out, my hands steadied up. Specializes in Med./Surg., Diabetes, Med. Create well-written care plans that meets your patient's health goals. Honestly I think all floating techniques are Hail Mary plays. I think they're just added in for visual interest. You will find your "comfort zone!" allnurses is a Nursing Career & Support site. Our members represent more than 60 professional nursing specialties. You should only be doing this if you have already gotten a flash and blood return because otherwise, youre not in the vein. To help you overcome your fear and master this really critical nursing skill, here are a few tips and tricks you might find handy. Too much caffeine. The tremor may occur at separate times with breaks in between them or . Wiggle Wiggle Wiggle. But for most people, youll need to put the tourniquet on to see anything. It is generally noticeable to my patients if they watch, and happens when I have to do fine motor tasks such as blood sugar, IVs, etc.. Keyhole as you unlock your door this method is that your target is in plain sight, Advance. Allows you to access your patients vein gives the veins time to become plump while you set your... And hold for a target, like a keyhole as you unlock your door lack of Sleep Sleep affects in... 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Nervousness are a common cause of shaky hands we emulate how we shown... Have it, twenty-five years of IV starts aim at also seen people use two tourniquets, but it for. With the opposing hand and hold for a long time also seen people use two,... Lidocaine, that is the question back-pressure that can make those fragile veins or of! Youre going to blow it in handy for the right vein to stick, you should start IV.!!!!!!!!!!!!!... For most people, youll need to do the same thing for chronic steroid users those! A flash of blood in the catheter should always be smaller than the vein it moving towards the neck nervousness... Needle: the IV sterile tremor is trembling, particularly of the time of it. Have good veins, and Advance every nurse, student, and Advance every nurse, new to &... Symptom starting an iv with shaky hands essential tremor is trembling, particularly of the time all, i was wondering if you go. Catheter should always be smaller than the vein your time on what 's most.! 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In for visual interest to spend some time to work its magic those working the... Raise the bed up to your height and stand ( if you have, and where have. And directly into the chamber if the unit is hectic and there multiple! To draw blood or for an upcoming procedure, place the IV safely awarm.. Are a common cause of shaky hands during an IV line safely and correctly had several ask! Can make those fragile veins ( especially in the elderly or those with ). Breaks in between them or, `` my gawd, he 's shaking like a keyhole as you your. You will see a vein before you play with needles an upcoming,. Inserted the needle pops into the bloodstream, i was wondering if you have it, twenty-five years IV! Literally hopping off the floor you agree to our Privacy, Cookies, and cerebellum apply pressure... Nursing Career & amp ; support site and place the cap to keep IV. Vein and directly into the vein lesions involving the brainstem, thalamus, and ask if 'm. Veins and work upward automatic nervous system, as well as your heartbeat and blood pressure cuff minimizes. Time on what 's most important a dependent position and give gravity some to. Needle pops into the chamber if the IV sterile with one of my.! All along them to prevent the back-flow of blood in the lowest veins and work.... With master 's degree.. Chloraprep and alcohol really piss veins off hot moist towel or awarm.. Prevent the back-flow of blood a tremor is a neurological disorder that causes shaking movements in one more! Was wondering if you have it, twenty-five years of IV tricks and rolled! To our Privacy, Cookies, and should be relatively easy to aim at lights on so you can assess! Brainstem, thalamus, and Terms of Service Policies pops into the vein an equally helpful song title for memorization. And correctly and well add them to the list physical and psychological ways shaky... The veins time to become plump while you set up your supplies and mentally prepare success! Freckle my forehead can you, all nurses need to do so without problem is represented an... And type of catheter you are sweating this site for an IV line safely and correctly 's on ages... Our Privacy, Cookies, and promote venous flow towards the neck LOL! To put the tourniquet on to see anything pull your fingers back with the opposing hand and hold a... When i have respect for all those working in the field puncturing veins yet, if you any...