Have you ever stared longingly at a sweet pair of pipes rippling the surface of the forearms of gym-rat? I must confess that, as a nurse, I have practically salivated at the sight of bulging veins on some stranger in the hospital elevator. It’s second nature for nurses to have their radars attuned to a good intravenous puncture site. It’s also second nature for experienced nurses to perform the set of operations required to start an IV in under 10 seconds. Well, what about the rest of us that struggle with such seemingly mundane tasks? Don’t worry! I was once a new grad with shaky hands awkwardly approaching an equally nervous patient. I fumbled over my set-up, searched for supplies, and perspired over my field. So, if you were like me then this post is for you, my friend. Keep reading for a simplified, step-by-step guide to starting an IV.
Starting an IV
- Ask the patient to state their name & DOB.
- Tell the patient that, “There is an order from their doctor to start an IV”.
- Ask the patient, “Do you know what an IV is?”
- Explain to the patient that, “A catheter will be inserted into your vein to give you medications. This will avoid having to stick you repeatedly with needles later on when medications are needed for various reasons.”
- Ask the patient, “Do you have any allergies to medications, fluids, tapes, or cleansers?”
Gather appropriate equipment
- A pair of gloves
- An angiocatheter
- A tourniquet
- A Tegaderm
- An IV extension set, also known as a saline lock.
- Alcohol or antiseptic skin cleanser
- A 10 cc NS flush
- An IV label
- A TB syringe & Lidocaine.
- Keep in mind that the IV start kit may contain a bundle of supplies including the tegaderm, tourniquet, tape, label, and gauze.
Perform hand hygiene & observe any specific infection control precautions
- Unwrap the angiocatheter & test the independent movement of the plastic catheter away from the needle by disengaging and sliding it away from the base before returning it to its original position.
- Open the IV start kit.
- Prepare the tape used to secure the IV by splitting it and placing it within reach.
- Squeeze & fracture the dividing chamber of the topical antiseptic tincture, which saturates the sponge at the end of the unit.
- Unwrap and place the tourniquet within reach.
- Expose the tegaderm and place it within reach as well.
- Set aside the IV label.
- Expel the small amount of air from the NS flush syringe and instill NS into the saline lock. Leave the syringe attached.
- Withdrawal 0.5 cc of Lidocaine into a TB syringe and set it aside for later use (I prefer to use this technique. Although it may cause a small stinging sensation, if you were like me when you first started, you might find yourself digging around a bit. This will help.)
- Provide privacy for the patient by closing the door or pulling the curtain.
- Assist the patient to a comfortable position with their arm at a dependent angle below the level of the heart.
- Place a towel or chux under the extremity to protect the linens from blood.
- Dilate the vein with a tourniquet by placing it 6-8 inches above the anticipated venipuncture site.
- Explain to the patient that the tourniquet may feel tight.
- Encourage the patient to clench and unclench their fist to further dilate the vein, which helps with visualization.
- Lightly tap the vein with your fingertips if necessary.
- Use the patient’s non-dominant arm if possible.
- Look for veins that are relatively straight.
- Remove the tourniquet.
Clean & begin venipuncture approach
- Perform hand hygiene & apply gloves.
- Reapply the tourniquet 6-8 inches above the anticipated venipuncture site.
- Clean at the site of venipuncture insertion with topical antiseptic using circular motions moving from the center outward for several inches.
- Allow solution to dry on skin.
- Insert the Lidocaine anesthetic intradermally with the needle angle parallel to the skin. Inject 0.2 – 0.5 cc to lessen pain during IV insertion.
- Use the non-dominant hand to pull the skin taught below the entry site.
- Hold the angiocatheter at a 10-15 degree angle with the needle bevel facing up.
- Insert the needle-stylette & catheter through the skin & into the vein.
- Once blood flow is seen, lower the assembly angle, advance it slightly to ensure that both the needle-stylette & catheter are in the vein, & then stop.
- Advance only the “over-the-needle” catheter with the index finger until the hub is at the venipuncture site and in contact with the patient’s skin.
- Release the tourniquet.
- Carefully remove the needle stylette and engage the needle safety device while holding pressure on the vein with your non-dominant thumb 2-3 inches proximal to the insertion site to prevent blood back flow.
Secure intravenous equipment
- Attach the saline lock to the hub of the catheter and release thumb pressure.
- Flush the catheter with NS to ensure position, patency, and flow.
- Remove the NS flush syringe.
- Tape the catheter with tape strips, which forms a loop that travels underneath the hub and over the wing-tip flanges on either side of the hub. Also, place a strip of tape across the hub.
- Apply a tegaderm over the top of the insertion site.
- Loop the saline lock tubing and secure it with tape.
- Remember to label the date, time of insertion, type & gauge of catheter, and the nurse’s initials.
- Clamp the saline lock tubing.
- Discard the tourniquet & any sharps. Remove and discard the gloves. Perform hand hygiene.
And there you have it! For a video tutorial, you can visit the NurseMastery YouTube channel –@ https://www.youtube.com/channel/UCk83s6ertzScinZSIDXGswA.