How to start an IV

Esme12, ASN, BSN, RN · Sep 6, 2011

first, find a good site. then assamble everything you will need, flush your tubing or pig-tail/heploc/extension. cut your tape. now....

apply a tournaquet a few inches above your site. tie or secure the tournaquet in such a way that it can easily be removed after the catheter is inserted.

wipe the site with the alcohol pad. this is a good time to make sure the vein is relatively straight, doesn't split off into two or more veins where you want to insert the cathetor (bifurcate), or has large valves that may impede catheter movement.

choose a catheter size. in the case of the elderly or very young, a smaller catheter (indicated by a larger number) may be the better choice. in the case of emergency fluid replacement, choose a larger catheter (indicated by a smaller number).

remove the cap from the catheter. pulling the skin on the iv site taut with one hand, insert the needle catheter at the site you've chosen. keep the catheter as closely parallel to the skin as possible. imagine an airplane landing on a runway; that's the angle you are looking for.

you will know you have "hit" the vein if you see blood in the catheter's plastic applicator. once you see this "flash" of blood, began advancing the catheter.

while advancing the catheter, keep skin pulled taut, remove the needle in whatever way is indicated by the brand you are using. once the needle is removed, secure it so that no one can be poked or injured by it.

remove the tournaquet. don't forget this step, as you can cause tissue death, discomfort and blown iv's by leaving the tournaquet on.

remove the plastic applicator from the catheter. prevent back-bleeding by either applying finger pressure (firmly)on the vein above the catheter, or by applying a 4x4 under the catheter to catch any escaping blood.

attach the iv tubing/pig-tail/heploc/extension tubing to the catheter. apply tape or a commercial securing product to the catheter to keep it from moving.

open up the iv line. if you were successful, you will see fluid dripping in the drip-chamber of the tubing, as well as no swelling or leaking at the iv site. if the iv site swells, or there is no fluid dripping in the drip-chamber, you were unsuccessful.

use tape or commercial securing products to further secure the iv line to the patient's arm or hand. adjust the drip rate to whatever is appropriate for your patient. turn the drip rate down to just a few drops a minute to keep the line "tko" or "kvo" ("to keep open" or "keep vein open").

http://youtu.be/2-jdbffjx1e

i hope this helped......but in this case it's true. practice makes perfect.:heartbeat

merlee · Sep 6, 2011

Please check the archives, and other recent posts.

This is a frequently asked question!

nowim clean · Sep 6, 2011

Play with the IV get comfortable with it. Make sure you know how it works as far advancing the cath, and removing the needle. Take a touraquet home and practice feeling viens once you have the feel then close your eyes and feel for viens you will get to where you hit by feel instead of sight. once youre comfortable feeling the viens then start drawing blood use a butterfly as it will give you the flashback like a IV would. After a few of those move onto IVs we all have days when we miss sticks it comes with the job just dont pysch yourself out about.

prmenrs, RN · Sep 6, 2011

If you have a "rolley" vein--a big fat one that looks way too easy--secure it on both ends. Your thumb below the site and forefinger above it, and keep it taut. Otherwise, you can chase it all over the place, and wind up w/a big bruise. Those veins don't always cooperate.

A few prayers to the IV gods of your choice won't hurt.

Isabelle49 · Sep 6, 2011

Remember that starting IV's is 95% luck and 5% skill!

LisaRN1105 · Sep 6, 2011

Thank you and I will definitely archive this question.

spudster · Sep 6, 2011

Shop around before sticking the vein.....one of the biggest mistakes I see with new nurses is that they try to spot a vein immediately and go after it. Sometimes, waiting a moment or two and looking will reveal a better vein than the first one spotted. So....happy hunting! I couldn't hit the broad side of a barn when I started 9 1/2 years ago and now I am actually a "go to" person for tough sticks. So, hang in there and keep sticking!

haji · Sep 6, 2011

one thing i think is important that is not usually mentioned: after you get a flashback, you actually need to advance a few more millimeters and then stop the needle and advance the catheter.

once i started doing this my % of good starts improved a lot.

most people will tell you to advance the catheter as soon as you see a flash, but in my experience it doesn't work.

also its easier if you lower the arm off the side of the bed (gravity helps fill the veins), and if the patient is on propofol.

ProgressiveActivist, BSN, RN · Sep 6, 2011

Take your time. Raise the bed so that you're not bent over and put the bedrail down. The first vein I see is the one that I know I am going to get an angiocath in.

Two tourniquets, one above and one below the vein works for obese or third spacing patients.

That Guy, BSN, RN, EMT-B · Sep 6, 2011

FEEL the vein, dont just look for them.

AgentBeast, BSN, RN · Sep 7, 2011

Remember that starting IV's is 95% luck and 5% skill!

My friends at Fort Minor say it's more like

10% luck,

20% skill,

15% concentrated power of will,

5% pleasure,

50% pain,

And 100% reason to remember the name!