Tips and Tricks – IV starts part duex

So now that we’ve put it all down in writing on HOW to start an IV, for you visual learners out there I’m going to SHOW you how to do it. I was detailed to another station so I have some different help in getting this produced. Your equipment should already be assembled (IV catheter, tape or dressing, tourniquet, sharps container, prep pads, fluids if you intend to use them and associated drip set, and a saline or heparin lock) before you attempt an IV. You should also not attempt this procedure unless you are qualified and allowed to do so. You’ll also notice I’m not using BSI precautions. This is because I’m not actually starting an IV on my subject AND I’m showing you detail for hand position.

Step 1: Select a site. Remember that your best start may not always be the obvious one, and sometimes you are selecting a site based on patient condition and complaint. If you are in doubt, palpate. A vein will not contract when you bend the arm, and it will be a little mushy when you push on it then return to it’s normal position.

Step 2: Place the tourniquet. I like mine high on the arm and very tight. Having the patient pump their hand is pointless, engorgement of the veins is best accomplished by gravity.

Step 3: CLEANSE! Using a prep pad of some sort and scrub away from the site in a circular motion. DO NOT TOUCH the area that you just cleansed with your gloves.

Step 4: Pull traction on the skin towards you and insert the catheter. This should be at flat angle and a quick motion, the faster you get the needle and catheter in the less of a pain response the patient will have. I like to start insertion a few millimeters below where I would like the hub to end up, this does two things. It ensures that if I miss immediately and get no flash I can advance the needle a bit more til I find the vein and it gives me a point of reference if the catheter gets pulled on. If I know that it took less than 1/3 of the catheter to get a flash, then I know that the catheter can be pulled at least 1/2 the remaining length and still be in the vein. This is useful if you are working with a combative patient or if you hit a wall or a valve and have to back the catheter out to flush it in. You should insert the lock/line into the hub and screw it down tight at this point.

Step 5: Flush the lock/line. This is simply to push open any valves in the venous system and to ensure you have proper flow. This is the time you should be looking for infiltration and swelling around the distal end of the catheter. It is not uncommon to have swelling around the hub itself. Sometimes if you poke a larger enough hole in the vein and the pressure is high enough it will bleed around where the catheter inserted. This is normal. What you are looking for is around the distal end.

Step 6: Secure the line/hub. You can use tape and do a cross most commonly taught in text book or use a commercial dressing. Here we used a standard commercial dressing.

This article was written by rstine