Skills required for starting an IV

Lev, MSN, RN, NP · Aug 2, 2016

Blood can be given through a 22g IV catheter, even if given rapidly.

Rapid transfusion of packed red blood cells: effects of dilution, pressure, and catheter size. - PubMed - NCBI

poppycat, ADN, BSN · Aug 2, 2016

Blood can be given through a 22g IV catheter, even if given rapidly.
Rapid transfusion of packed red blood cells: effects of dilution, pressure, and catheter size. - PubMed - NCBI

I've given blood through a 24 g in the past.

Guest957596 · Aug 2, 2016

Blood can be given through a 22g IV catheter, even if given rapidly.
Rapid transfusion of packed red blood cells: effects of dilution, pressure, and catheter size. - PubMed - NCBI

A large gauge is better than a 22 as an RBC is approximately 22ga in diameter and can lyse the cell. But you go with what you've got. From what I've seen, a 20ga is the norm except in the ED.

FLO4Life · Aug 3, 2016

If I were Jane, I'd be more concerned about that continuous bladder irrigation set-up behind her more so than the IV she's about to get :cautious:

Lev, MSN, RN, NP · Aug 3, 2016

A large gauge is better than a 22 as an RBC is approximately 22ga in diameter and can lyse the cell. But you go with what you've got. From what I've seen, a 20ga is the norm except in the ED.

Did you look at my link?

IVRUS, BSN, RN · Aug 3, 2016

Although many places may video an educational offering, it does NOT mean that the video is thoroughly appropriate.

Students please note:

1. As others have posted, you do NOT need a 20 g, much less an 18 g to infuse blood. I always do it with a 22g.

2. If one were using the OSHA compliant IV catheter (like the Introcan Safety 3) you would NOT be exposed to your patient's blood as they are valved peripheral IV catheters.

3. Alway check your IV start and IV supplies package integrity/expiration date BEFORE you open the supply package.

4. She mentioned for "long term therapy" she'll use a large vessel.... NO, get an order for a PICC, please.

5. P.S. Betadine is a horrible antiseptic agent, imo.

6. She said she was placing a NON-OCCLUSIVE dressing...WHAT?

7. When she was cleansing the skin the second time becuase of questionable contamination, DO NOT have the tourniquet on, or one will surpass the time that it is allowed on the arm.

8. Do not tell the patient, "You're going to feel a stick." Instead, tell them that they will feel a PINCH.

9. Once you see blood in the flashback chamber, do NOT advance first, but rather DROP ones angle then advance a mm or so.

10. Your TSM (transparent Sterile Membrane) dressing needs to cover the junction of the catheter's hub and the extension set.

Hope this helps.

Asystole RN · Aug 3, 2016

A large gauge is better than a 22 as an RBC is approximately 22ga in diameter and can lyse the cell. But you go with what you've got. From what I've seen, a 20ga is the norm except in the ED.

2016 INS Standards

Select the smallest-gauge peripheral catheter that

will accommodate the prescribed therapy and patient

need 1,4 : (V)

1. Consider a 20- to 24-gauge catheter for most infusion

therapies. Peripheral catheters larger than 20

gauge are more likely to cause phlebitis. 1-4,9 (IV)

2. Consider a 22- to 24- gauge catheter for neonates,

pediatric patients, and older adults to

minimize insertion-related trauma. 1-4 (V)

3. Consider a larger-gauge catheter (16-20 gauge)

when rapid fluid replacement is required, such as

with trauma patients, or a fenestrated catheter

for a contrast-based radiographic study. 1-4,10 (IV)

4. Use a 20- to 24- gauge catheter based on vein

size for blood transfusion: when rapid transfusion

is required, a larger-size catheter gauge is recommended

(refer to Standard 62, Transfusion

Therapy )

Asystole RN · Aug 3, 2016

Ugh. Terrible video.

MaxAttack, BSN, RN · Aug 5, 2016

Palpating veins that I could hit by tossing the needle like a dart from across the room made me giggle a little.

Mhsrnbsn · Aug 5, 2016

Please don't take this video as gospel! I am the IV source for my floor when all else fails my phone jingles with the "please can you". For people first learning PLEASE PLEASE PLEASE do not approach a live human arm the way the practices arms are. While there are a decent amount of people in this world with wonderful veins... You'll find especially in the beginning "it ain't like the fake arm" stay calm and don't beat yourself up over it. Even people that seem to get them all have off days.

I always feel so discouraged when I see new nurses beat themselves up over missing an IV that I can get. Remember all skills take practice, just don't go into a real live persons room and expect it to be the same as that arm.

Palpate for the veins don't always trust what you can see. I always say mind your ABCs, aisles, bends, curves... We want to send the catheter down a straight aisle... try to avoid areas that bend (anticubital, wrists, hands), and mind the curves some veins that look curved especially in the elderly are actually straight veins. If you pull the skin taught most times the vein straightens out.

We we want to avoid areas that bend (unless of course this is an emergency situation, or the only decent veins you can find). I have found IVs placed in bending areas irritate the patients, and their veins and can cause pain, they usually don't last as long either because of the constant bending. The internal catheters sometimes kink off! So we end up needing to replace an IV because they can't keep their elbows straight or wrists straight. I know I will have a lot of nurses that may disagree with me, the AC is certainly a gold mine and easy shot...

But if you want one that'll last the recommended 2-3 days you may find you do great with the forearm. Added bonus? No downstream occlusion alarms! I work on a med surge floor, and I respect that some specialty areas need to take the quickest access possible. But if you want to learn how to start an IV you need to just get out there and do it, the fake arm helps you get the practice of the motions down but poking flesh does not feel the same, and not all veins will be readily palpable.

CardiacDork, MSN, RN · Aug 8, 2016

Ugh. Terrible video.

I know right? 17 minutes to cannulate? Ain't nobody got time for dat yo!