Does these steps of an IV start sound okay?

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I wrote out my own steps for my IV validation. Does this sound okay or should I add or change something?? Thanks!!

IV insertion

  1. Walk into patient's room
  2. Hand sanitize
  3. Introduce yourself
  4. Identify patient
  5. Describe procedure to patient, tell patient that patient needs to help hold extremity still
  6. Ask for any allergies and avoid veins injured by infiltration or phlebitis, side of a mastectomy, dialysis shunt or affected by a CVA, used for lab testing, or near area of flexion such as antecubital fossa
  7. Raise patient's bed
  8. Prep short extension tube with saline:

    1. Short extension tube package, attach end cap if not in place
    2. Clean vial of normal saline w/alcohol swap
    3. Get 3 ml of air into syringe and inject air into vial
    4. Turn needle into injection
    5. Retrieve 3 ml of normal saline
    6. Clean short extension end cap with alcohol swap
    7. Prime the short extension tube then apply side clamp

      8. [*]Prep dressing with initials, date, site, and gauge of needle

      1. 10. Prep IV catheter by opening the package

      [*]Prep some tape

      [*]Put chucks under patient

      [*]Put tourniquet on patient 3-4 inches above the venipuncture site to obstruct venous blood flow and distend the vein

      [*]Feel for patient's radial pulse

      [*]Find your vein, ask patient to open and close hand

      1. Use distal vein first
      2. Non-dominant hand if possible
      3. Choose a vein above areas of flexion
      4. Vein should feel soft, full, and unobstructed

      [*]Take off tourniquet and PUT ON GLOVES!

      [*]Cleanse site w/antiseptic solution such as chorhexidine using a back and forth friction scrub for at least 30 seconds, allow to dry

      [*]Use non-dominant hand and place about 1-2 inches below the entry site to hold the skin taut against vein

      1. Avoid touching prepared site
      2. Helps prevent movement of the vein as the needle or catheter is being inserted

      [*]Enter needle, bevel side up with dominant hand at a 10-15 degree angle

      [*]When blood returns, lower the needle and enter another ¼ to ½ inch

      [*]Push catheter in and needle out until you hear a click

      1. Catheter should go in smoothly and easily

      [*]Release tourniquet

      [*]Remove needle while holding light pressure over the vein above insertion

      [*]Attach IV tubing and aspirate to see if blood return, if yes, flush normal saline and remove syringe

      [*]Put tape and dressing over insertion site but not over the connection of the catheter and tubing

      [*]Loop tubing close to the cannula and secure with tape to prevent kinking or pulling

      [*]Clean short extension tube end cap and attach administration end

      [*]Set up machine, unclamp, take off gloves, clean up and dispose sharps in sharps container

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I think it looks good but unsure about why the comment "Push catheter in and needle out until you hear a click".

You should advance the catheter while needle remains still. Then when catheter is pushed in you release tourniquet and then remove needle.

Good job on laying out all the steps!!

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Specializes in Emergency Department.

The first place where you stated you take the tourniquet off and put on gloves, just palpate for the vein, once located, put gloves on and begin prep as you stated. The whole IV start process can be completed in less time than it takes to read the steps... except for just waiting for the site to dry. Also, you should simply write something to the effect of "advance catheter hub, remove needle, safe the needle (may be done in one step), and secure the extension set to the hub of the catheter."

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I agree there are too many steps, but this poster is a student and I'm sure is being taught the extra steps as the "correct" way to start an IV. Practicing nurses are likely to have fewer steps. I generally don't need to use the tourniquet twice, paplate for a radial pulse, nor do I place chux underneath the patient. If I were to follow the above steps, my IV start would be a disaster, and I have placed many peripheral IVs. I think the OP needs to get feedback on her/his steps from clinical instructors or fellow students, not from practicing nurses. I see the poster also posted in the student section, which is good. Hopefully they will get some assistance there.

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Specializes in Infusion Nursing, Home Health Infusion.

This look like it cam out of a nursing procedure book which is OK b/c when you are learning you need all the steps until it get easier.

I would change the following things :

1. what is the purpose of the IV therapy....Is pt going to surgery...getting a CT scan or just needs a loc for abx..You need to know what the planned IV therapies are so you can select a good location and an appropriate size. Part of that is a quick review of pt hx if it not an emergency.

2 It is safer to use a NS pre-fill for an IV start

3 When you take the needleless connector (NC) from the package.... open it in such a manner that you do not touch it to anything and you then do not need to prep it..it is sterile at that point so just attach your NS pre fill and then your extension set if needed and then prime.

4 If you never want to leave a tourniquet on a pt's arm after the start ALWAYS unsnap the gown all the way to the shoulder so the tourniquet is not left in place under the gown...I see that happen a lot

5 (Push catheter in and needle out until you hear a click) That does not make any sense...after you have threaded or advanced a bit more you need to pull the needle back a very small amt about an 1/8 of an inch (can vary) and thread the remainder of the catheter into the vein as a unit...... It sounds like you are using the insyte autoguard so after the catheter has been threaded you can push the button to retract the needle into the protective housing. This step can vary slightly based on the product you are using. I prefer to do as described above and keep the catheter and needle as a unit until I am done threading as this keeps the blood exposure low and makes for a clean start. But you can also pull the needle back and then stabilize the needle so it does not move with the catheter as a unit and then slide the catheter in over the needle either be holding on to the hub edges or using the push tab on the catheter. That may be confusing until you see it done both ways. Most of the IV nurses I know use the first method so they have a one handed technique and that frees up the other hand fro traction.

6 Another pet peeve of mine is when nurses prepare tape and leave tape on bed and table surfaces...best to use a start kit with clean tape and once IV is in..tear it and put it directly on the pt..NEVER EVER use tape that has been hanging on your stethoscope or is in your pockets with lint and stuff. An IV is a wound..a direct route into someone vascular system and nothing like that should ever be used to secure the site.

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Specializes in Infusion Nursing, Home Health Infusion.

This look like it came out of a nursing procedure book which is OK b/c when you are learning you need all the steps until it get easier.I would change the following things what is the purpose of the IV therapy....Is pt going to surgery...getting a CT scan or just needs a loc for abx..You need to know what the planned IV therapies are so you can select a good location and an appropriate size. Part of that is a quick review of pt hx if it not an emergency.

2 It is safer to use a NS pre-fill for an IV start

3 When you take the needleless connector (NC) from the package.... open it in such a manner that you do not touch it to anything and you then do not need to prep it..it is sterile at that point so just attach your NS pre fill and then your extension set if needed and then prime.

4 If you never want to leave a tourniquet on a pt's arm after the start ALWAYS unsnap the gown all the way to the shoulder so the tourniquet is not left in place under the gown...I see that happen a lot

5 (Push catheter in and needle out until you hear a click) That does not make any sense...after you have threaded or advanced a bit more you need to pull the needle back a very small amt about an 1/8 of an inch (can vary) and thread the remainder of the catheter into the vein.....you can use the push tab on the catheter to do this. It sounds like you are using the insyte autoguard so after the catheter has been threaded you can push the button to retract the needle into the protective housing. This step can vary slightly based on the product you are using. I prefer to do as described above and keep the catheter and needle as a unit until I am done threading as this keep the blood exposure low and makes for a clean start. But you can also pull the needle back and then stabilize the needle so it does not move with the catheter as a unit and then slide the catheter in over the needle. That may be confusing until you see it done both ways. Most of the IV nurses I know use the first method so they have a one handed technique and that frees up the other hand fro traction.

6 Another pet peeve of mine is when nurses prepare tape and leave tape on bed and table surfaces...best to use a start kit with clean tape and once IV is in..tear it and put it directly on the pt..NEVER EVER use tape that has been hanging on your stethoscope or is in your pockets with lint and stuff. An IV is a wound..a direct route into someone vascular system and nothing like that should ever be used to secure the site.

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Specializes in Trauma Surgical ICU.

From your instructions you placed the tourniquet to find a vein then removed it and put on clean gloves but never "wrote" to reapply the tourniquet before starting the IV..

  1. Take off tourniquet and PUT ON GLOVES!
  2. Cleanse site w/antiseptic solution such as chorhexidine using a back and forth friction scrub for at least 30 seconds, allow to dry
  3. Use non-dominant hand and place about 1-2 inches below the entry site to hold the skin taut against vein

    1. Avoid touching prepared site
    2. Helps prevent movement of the vein as the needle or catheter is being inserted

      3. [*]Enter needle, bevel side up with dominant hand at a 10-15 degree angle

      [*]When blood returns, lower the needle and enter another ¼ to ½ inch

      [*]Push catheter in and needle out until you hear a click

      1. Catheter should go in smoothly and easily

      [*]Release tourniquet

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Specializes in Trauma Surgical ICU.

I avoid placing the tourniquet and then removing it then replace it again.. I have everything set up, look for a good site without the tourniquet first.. Once I find something, I cleanse, apply tourniquet, cleanse, then place IV, release tourniquet, tape down, clean up etc....

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Specializes in IV Team, ED, Med/Surg, Ortho.

I think this poster must be using the Protective Plus IV Catheters which would possibly explain the clicking sound they would hear at the time of threading and pull back possibly???

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Specializes in ER, progressive care.
I think this poster must be using the Protective Plus IV Catheters which would possibly explain the clicking sound they would hear at the time of threading and pull back possibly???

That's what I'm thinking. We have these at work. The click locks the needle in place as a safety feature.

protectivefamily.png

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