TIPS FOR STARTING IVs & IV THERAPY

 
 

Learning IV skills is frightening to student nurses and even professionals. It is after all, an invasive procedure that takes a while to learn and can be a painful process for your patient. But you have to learn somehow, so let’s dive in to the nuts and bolts of this skill.  Remember, knowledge is power and practice really does make perfect! So, gaining as much clinical experience as possible and understanding the do’s and don’ts will help you master this skill

 

Before viewing all of our tips, please review your hospital or facilities policy to ensure you are working within their guidelines and remain compliant.  You can always visit the Infusion Nurses Society for standard practice on infusion therapy.

 

 Choose the right catheter/cannula size

 

Whenever possible use a large bore 18g needle for patients who are admitted for surgery, or any type of trauma patient, who may need a blood transfusion, emergency fluids or bolus meds.  22g needle are not ideal for these situations.

Always determine the size of the catheter by the care your patient needs. Also, if you are going to use a pressure bag, a larger catheter than a 22g would be ideal.

In non-emergencies or scenarios when you know exactly what type of care your patient may need, a smaller gauge catheter is acceptable.

Patient who require a CT scan with contrast will need a larger cannula size (18g or 20g) because the procedure involves injecting at a rate of 10-20 mls with pressures up to 300 p.s.i

Diabetic patients, chronic steroid users, IV drug abusers,  people with fragile veins or long term chemo patients may have disorders of the blood vessels 

(vasculopathy) and must be given a smaller cannulae to preserve the available veins. Ascertain the anticipated length of treatment before using the veins.  A PICC line or central line may be more appropriate in these cases, if the therapy is expected to be long-term. Again, check with your hospital policy before making these decisions.

 

Potassium, Phenytoin, or 50% Dextrose can be irritating to the patient and can cause tissue damage, so, use a smaller catheter in a large-bore vein when administering these drugs.

 

hypertonic or irritating drugs such as Phenytoin, Potassium, or 50% Dextrose.

In agitated or confused patients, use a needle-less system if possible.

Preparing the patient

Even if you don’t feel confident, act like you are and never show your fear to your patient.  Speak firmly and act professional.

Educate the patient about the procedure to lessen anxiety. Less anxiety equals easier access to their veins.  If it’s cold in the room, or the patient is cold, warm the room up. You can also cover the site with a moist, warm towel, to help bring veins to the surface.

 

Another method to dilate small veins in to apply nitroglycerin ointment to the insertion site. Leave it on for one to two minutes before disinfecting the site with alcohol.  A long as you remove it quickly, it will provide good vasodilation, without the systemic side effects.

 

Allow the patient hang his/her arm down as low as possible to promote gravity venous filling.

Patients who are hypovolemic or in state of shock must be placed in Trendelenburg  to minimize an air embolism, permit access and promote venous flow towards the neck.

Always try to start the IV in the non-dominant side for the convenience of the patient. When this is not possible use the veins in the dominant side. These veins are usually larger due to greater exercise.

A stable patient should only need one secure, peripheral access. Trauma patients may require more.

Shaving is NEVER a recommended practice in preparing a venipuncture site, as this causes damage to the skin integrity and can lead to infection.

Clean the insertion site with an alcohol wipe, in the direction of the venous flow to improve filling of the veins. Clean the area widely to prepare veins nearby which you can use if the initial insertion site fails. Allow the alcohol to dry before insertion of the needle. Needles coated in alcohol are more painful during insertion.

In patients with edema you may find  an ACE wrap to their forearm helpful. Elevate the affected part and wait for about 15  minutes until the swelling decreases temporarily. During IV insertion, leave a small amount of the cannula out and anchor it well so that the tissue can have enough room to expand once the edema reoccurs.

 

 

 

Finding the best vein

Preparing the patient

Even if you don’t feel confident, act like you are and never show your fear to your patient.  Speak firmly and act professional.

Educate the patient about the procedure to lessen anxiety. Less anxiety equals easier access to their veins.  If it’s cold in the room, or the patient is cold, warm the room up. You can also cover the site with a moist, warm towel, to help bring veins to the surface.

 

Another method to dilate small veins in to apply nitroglycerin ointment to the insertion site. Leave it on for one to two minutes before disinfecting the site with alcohol.  A long as you remove it quickly, it will provide good vasodilation, without the systemic side effects.

Allow the patient hang his/her arm down as low as possible to promote gravity venous filling.

Patients who are hypovolemic or in state of shock must be placed in Trendelenburg  to minimize an air embolism, permit access and promote venous flow towards the neck.

Always try to start the IV in the non-dominant side for the convenience of the patient. When this is not possible use the veins in the dominant side. These veins are usually larger due to greater exercise.

A stable patient should only need one secure, peripheral access. Trauma patients may require more.

Shaving is NEVER a recommended practice in preparing a venipuncture site, as this causes damage to the skin integrity and can lead to infection.

Clean the insertion site with an alcohol wipe, in the direction of the venous flow to improve filling of the veins. Clean the area widely to prepare veins nearby which you can use if the initial insertion site fails. Allow the alcohol to dry before insertion of the needle. Needles coated in alcohol are more painful during insertion.

In patients with edema you may find  an ACE wrap to their forearm helpful. Elevate the affected part and wait for about 15  minutes until the swelling decreases temporarily. During IV insertion, leave a small amount of the cannula out and anchor it well so that the tissue can have enough room to expand once the edema reoccurs.

 

 

Finding the best vein

If you have to try again, apologize to the patient. Tell them it’s not their fault or yours, but this sometimes happens.  Remain calm and remember that some patients will be a “hard stick”.  Just do the best you can. Most patients with “bad” veins have been through all this before and are well used to it.