One of the most important skills a nurse needs to know is how to start an IV.
Starting an IV can be intimidating. However, by the time you finish reading this article, you’ll know all the essential tricks and tips to start an IV properly the first time consistently.
Starting an IV
Starting an IV is a multistep process that begins with feeling calm and prepared. Ready yourself with plenty of practice and patience, and try not to rush your learning process.
When it is time to start an IV on a patient, gathering and preparing the needed materials can give you a moment to take a deep breath and prepare. So here are the basic steps.
Equipment Necessary to Start an IV
You’ll want to start with:
- An IV starter kit
- Extension tubing or cap
- Normal saline flush
- IV needle
Before you open any packages, perform proper hand hygiene and put on your gloves. Then you can open your IV starter kit and lay out all of the materials for easy access.
Label your IV with the identification sticker included in your kit. Next, open your saline, flush the extension tubing or cap, and open up the IV needle and catheter packaging before moving to your patient.
Prepare Your Patient
Evaluate your patient to decide which needle gauge is best for your IV. Most adults in a typical situation can use a 20-gauge IV, though older adults, pediatric patients, or those with fragile veins may require a 22-gauge IV.
Once you determine the appropriate needle gauge, you can prepare your patient for their IV. It is essential to set your patient at ease by being confident and relaxed.
Place the tourniquet on the patient’s arm, and locate the vein you plan to use for your IV. When choosing a vein, most nurses and phlebotomists look for a “bounce” — a collapse and rebound of the tissue when you tap the vein with your finger.
You’ll also want to look at the direction a chosen vein is running and take note of the depth and thickness of your chosen vein.
Clean the IV insertion site with the ChloraPrep included in the IV starter kit. Starting at the location where you plan to insert the needle, apply ChloraPrep, working outward in a circular motion for 30 seconds.
Allow the site to dry completely before beginning your insertion.
Insert the IV
Using your nondominant hand, pull the skin below the insertion site taut to stabilize the vein. Avoid touching the area you just cleaned.
With your dominant hand, hold the IV catheter with your thumb and index finger at its base, pointing the needle’s bevel upward. Prepare your patient to feel a pinch, then insert the needle into the vein at a 20-degree angle.
You’ll know you’re in the vein when you see a flash of blood in the cannula. Advance the needle into the vein about 2–6 millimeters more, then slide the cannula off the needle, threading it into the vein.
Using your nondominant index finger, apply pressure above the insertion site to keep blood from leaking out of the IV. Now you can release the tourniquet and press the activation button to retract the needle fully.
IV Therapy Tips
Regardless of how many IVs you’ve inserted, some tips and techniques make the process easier for all involved.
Create a Connection
Starting your IV insertion by connecting with your patient can set the stage for a simple, straightforward procedure. Check in with your patient before gathering up your IV supplies.
Make sure they understand the process and ask them if they have any needle phobias. Even those without fears about needles often do better when they don’t watch your insertion.
Relax in Your Process
Create a process for setting up your IV supplies and performing proper infection control measures in a specific order. Then always follow that order so that you don’t forget a step.
Routines can be calming, and when you exude calm and control, your patient can relax too.
Selecting the best vein for your IV is critical for a one-and-done insertion. Unfortunately, the patients needing an IV don’t always display plump, bouncy, well-hydrated veins.
Try a BP Cuff Tourniquet
A properly applied tourniquet can help reveal hidden veins. However, for patients with lower blood pressure, swap the tourniquet for a blood pressure cuff flipped upside down.
The BP cuff allows you to inflate the cuff appropriately to see veins dilate and apply more comfortable compression.
Locate the Best Placement for You and Your Patient
To ensure you always select the best vein available, start your selection by evaluating all of the patient’s veins, beginning with the distal veins and working proximally.
Unless a patient expresses a preference, try to find an accessible vein on their nondominant hand, so they can still perform tasks with their dominant hand.
Purpose Dictates Placement
Yet another factor to consider in vein selection is the reason for the IV. For example, suppose the patient requires intravenous antibiotics or fluids.
In that case, inserting the IV away from the elbow or other areas where the joints bend will keep the IV from becoming obstructed every time they move. In contrast, the antecubital or AC vein may be best if the patient needs a larger IV for a rapid infusion.
Make the Vein More Visible
Once you’ve identified the best vein for your IV, there are ways to ensure the vein is visible. Some of these methods include:
- Employ gravity by letting the arm hang
- Use warm compresses to make the vein dilate
- Avoid slapping the vein, which can cause it to contract
- Instead, flick or tap the vein to enlarge it
- Ask the patient to clench and release their fist
You can also support the vein filling and becoming more visible while keeping the insertion site area disinfected. Using the alcohol pad, rub the area in the same direction as the blood flow, which will push the blood past the valves and support vein filling.
Insertion of the IV
Once you’ve prepared the site and located and dilated the best vein for your IV, it’s time to insert it. Ideally, you’ll insert the IV in a swift movement.
Stabilize the vein and insert the catheter directly atop the vein instead of from the side. Even an anchored vein can push sideways if the puncture comes from the side instead of above.
Some patients have hardened or scarred veins, causing kinking of the cannula. You can twirl the catheter and overcome resistance by inserting the IV with a slightly rotating motion.
If you feel resistance, stop the insertion, as you don’t want to damage the vein further.
Securing the IV Line
Correctly inserting an IV is one of the best feelings in nursing. Make sure the feeling lasts by carefully securing the IV line.
Properly taping the IV tubing will ensure the IV stays in place and the patient doesn’t experience discomfort during their infusion.
Where to Secure an IV
If you secure your IV appropriately, it should stay in place even with a bit of tugging. Start by taping the tubing away from the cannula site, keeping the catheter accessible but secure.
When choosing where to secure the tubing, consider the body’s natural movements. If you run the tubing laterally in the direction of any motion, it won’t coil or tangle.
Secure Stress Loops
Adding one or two stress loops can ensure your patient stays comfortable, and you won’t need to reinsert the IV if they pull on the line.
By looping the tubing at least once and attaching the loops to the skin with your tape, you can protect your IV from any pulls, as a stress loop will pull out before the entire line dislodges.
What If the IV Leaks?
Even a well-placed IV can leak. However, if the leak occurs at the point and time of insertion, you may still be able to use the vein if you can advance the catheter tip above the leak.
If this works, test the IV with a nonirritating fluid for any leaks to ensure the line is now secure.
Patients of varying sizes, ages, and skin tones can make IV insertion more challenging. Veins vary widely in size, thickness, and visibility.
For example, older and pediatric patients have smaller, more fragile veins. Therefore, using the smallest gauge that can still allow for proper venous flow provides for easier insertion.
Additionally, these patients’ IVs will require extra stabilization, as children tend to move more than adult patients, and older adults may be prone to falls.
It may be harder to visualize veins in patients with darker skin tones. However, employing the visualization tricks above, including using a blood pressure cuff as a tourniquet and disinfecting in the vein’s direction, can make the patient’s veins stand out more.
Patients who have veins with prominent valves, like weight lifters, can make catheter insertion more difficult. The floating method may work for these patients.
Attach the extension tubing to the cannula and flush the tubing with saline using a syringe while advancing the catheter. This can help open the valves.
Sometimes, all it takes is a couple of pointers to begin building a perfect record of IV insertion. Here are some tips for ensuring your IV goes in smoothly.
Practice Makes Perfect
Practicing proper tourniquet techniques and locations and identifying the best veins can be just as helpful as practicing insertion. Additionally, your friends and family will be much more amenable to letting you tourniquet and palpate them than letting you stick them.
A banana offers a comparable resistance and insertion feeling if you need to practice insertion.
Look and Feel
Sometimes the best veins are not easily identified by looking. So get in the habit of feeling and looking for veins to always find the best ones.
Veins can roll or shift, especially in patients with thinner skin. Holding the skin above and below the vein taut with your nondominant hand can limit that movement.
Select the Right Gauge for the Job
As a rule of thumb, selecting the smallest catheter for the ordered therapy is best. Smaller needles typically lead to easier insertion.
Let Unsuccessful IVs Go
Everyone makes mistakes. It becomes more challenging when you begin doubting your ability to insert an IV. Move on from misses and keep practicing.
In-Home IV Therapy
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