Ok, so starting the 18g AC on a younger admit in the MICU is no problem, or getting the 22g on a random tiny forearm vein. These are the patients that usually come up somewhat stable and the team didn't feel the need to line them in the ER. So that is where my peripheral IV practice comes from.

Our unstable, elderly admits with nothing for veins almost always come up with a triple-lumen central line so the opportunity to practice starting a good peripheral on these patients is extremely limited.
The last several times I've tried they always blow and the doc usually comes in and places an EJ peripheral 18g (at least my experienced coworkers don't get them placed either, makes me feel a little better).

Any tips on getting successful peripherals started on this challenging patient population?
I really want to get successful starts going on them before I am an SRNA.