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In a recent thread at EMT Life a paramedic student wrote:

Just entering my 2nd semester of paramedic school. So far I’ve found the coursework to be the easiest part. Instead of being stressed over tests I’m stressed over IV’s. 170 sticks in overall my % sucks. Granted most of those were just “oh I wonder if that vein could be hit with this gauge” attempts to find what could and couldn’t be done. Now that I’m on the truck I know what veins are my go to. Still struggling mentally with it but over the last 45 sticks my % is approx. 75% first attempt success. I have no clue what is going on, it seems so easy but I wind up screwing it up somehow. From my standpoint I’m getting flash but I’m blowing it on insertion still. I know to still go that little bit more but I’m wondering if I’m pulling the needle back while inserting the cath. Anyone else struggle like this this late in medic school? Really tired of getting made fun of when I can’t secure access first attempt.

It seems to me that a 75% success rate on the first attempt (for a paramedic student in his second semester) is actually not too bad.

Here is the advice I offered.

The habits you develop right now will last your entire career (good or bad). Lay out your equipment and spike your IV bag using the proper aseptic technique. Shut down the roller clamp prior to squeezing the drip chamber. It helps prevent air bubbles in the IV line. There is no need to remove the cap when you charge the line. Lower the side rail on the gurney and take a knee alongside the patient. Place the arm in a dependent position (below the patient’s heart). Apply the tourniquet in such a way that the tails are pointing superiorly (not toward your work space). Cleanse the area with alcohol. Once that is done don’t palpate again without re-cleansing. Hold the skin taught with the thumb of your left hand below the target vein. Make your first “stick” count (you should strive to get a flash with the initial stick). Then give a “bump” to ensure that the bevel clears the lumen (omitting this step is a very common error). As you advance the catheter look for the secondary flash. If you always do it this way you will become highly skilled at IV therapy. Conversely, I have seen paramedics with poor technique after 5, 10, 15 years in the field.

I’d love to hear your tips in the comments section!