IV frustrations

Less than a year ago I was trained for the first time how to start ultrasound guided IVs for the department.  The superiors are trying to have more IV "experts"  so we don't become so dependent on a few people.

This was by far my favorite training.  I wasn't given a lot of details on how to do it properly, just showed the differences between a vein and an artery.

Veins and Arteries appear like black circles on the screen, when you push on it arteries pulse and veins collapse

I wasn't given a lot of information other than that. I was great at finding veins, it's not that difficult.  I didn't know how to access the vein, that information was briefly discussed but that's it.

After the training I would find the vein, set down the device and stab blindly for the vein I had just found.  Any seasoned nurse can tell you that going in blindly for a vein is horrible.  You end up digging and chances are you're just hurting the patient.  I was so bad at the ultrasound IVs I hated when people asked for my assistance with the ultrasound IVs.

Right before Christmas I was called and asked to do additional training after the holidays.  I jumped on the opportunity because, as described, I was horrible.  I needed additional training, I'm sure everyone knew.

The trainer taught me to find a vein, no problem here.  He then showed me, using the ultrasound guided device, what the needle looked like when inserted into the skin.  He then showed me what the vein looked like when the needle was inserted.  

The bright thing in the middle of the vein is the IV needle. When you see this image you're in and just need to advance the catheter.

He explained a couple of more things, and something clicked in my brain.  I don't miss frequently anymore.  I know I'm not the best but I can get an US guided IV quickly, with blood work, in less than 15 minutes (sometimes longer, depends on how much extra skin they have).  The most difficult part for me is finding the needle after it's inserted (again, sometimes takes a while but I'm pretty good at it). 

The other day I started an IV on a patient, it worked perfectly.  Several hours later I found out the IV had infiltrated and nobody was able to get another IV.  Even the doctor entered the room and wasn't able to get the IV.  He contemplated starting an IO on the patient.

Later that evening, before I learned of the first IV infiltration, I had been called in to start another IV.  The patient was extremely sick and required 2 IVs.  I got them without a problem, both of them were started quickly and without difficulty. Both in the antecubital just like before.  This patient, right after I let go of his arm, bent the arm to keep himself warm.  

I learned about 2 hours later that all the IVs had infiltrated on both patients.

I've had a lot of IVs lately infiltrate after I leave the room.  It's becoming frustrating to me because it appears as though I'm incompetent with my IVs.  I've done research as to why the IVs would infiltrate after the fact and it basically boils down to the patients are moving too much causing the catheter to dislodge from where I secured it.

Or they are bending their elbows too much causing the catheter to kink.  Those are the only two explanations I can come up with.

I think ultimately I need to start trying for other locations for the IVs.  I think that's my only solution.  Talking with other nurses they aren't blaming me.  Personally I don't know, but I got to try something else.  I'll try again tomorrow.