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Administering an intravenous (IV) line is a critical skill in modern healthcare. IVs provide a direct route for healthcare professionals to deliver fluids, blood products, and medications into a patient's bloodstream via a small tube. This method ensures rapid absorption and precise dosage control, which is crucial for various medical interventions such as fluid replacement, blood transfusion, and antibiotic therapy. To perform IV insertion correctly, one must undergo proper medical training and adhere to established protocols.
Procedures
Preparing to Initiate an IV
- Sterile disposable gloves
- Appropriate size IV catheter (typically 14 - 25 gauge)
- IV fluid bag
- Non-latex tourniquet
- Sterile bandage or dressing
- Gauze pads
- Alcohol wipes
- Medical tape
- Sharps container
- Sterile pad or paper (to organize small tools)
Initiating an IV involves first introducing yourself to the patient and explaining the procedure. This helps ease the patient's nerves and ensures their consent. Once done, have the patient lay or recline comfortably.
- If the patient is nervous, their veins may contract, making IV insertion more challenging. Ensure the patient is relaxed.
- Ask if the patient has had previous IV difficulties, as they may know the easiest access sites.
Prime the IV tubing by suspending the IV bag, filling the tubing with saline solution, and removing any bubbles. Clamp the tubing to prevent solution dripping. Ensure no bubbles are left in the tubing and label both the tubing and bag.
- Injecting air bubbles can cause embolisms, a serious condition.
- Uncoiling the tubing and running the roller valve can help remove bubbles effectively.
Select a suitable-gauge catheter for the situation. Catheters come in various sizes (gauges), affecting the rate of fluid delivery and pain during insertion. Use thinner catheters for children and thicker ones for rapid transfusions.
- For IVs, opt for catheters around 14-25 gauge. Thinner catheters are preferable for children and the elderly, while thicker ones are suitable for rapid transfusions.
Wash and dry your hands before donning clean gloves to prevent infections. Change gloves if their sterility is compromised during the procedure. Change gloves before and after touching the patient, and before moving to another patient.
- Change gloves before touching the patient or engaging in clean/aseptic procedures.
- Replace gloves after procedures involving body fluid exposure or contact with the patient or their surroundings.
Locate accessible veins on the patient's body for IV administration. Prefer long, straight veins in adults' upper extremities and avoid veins in the dominant hand. For children, consider the scalp, hand, or foot. Avoid inserting IVs in specific locations to prevent complications.
- Avoid sites that interfere with surgery, recent IV locations, or infected areas.
- Avoid limbs on the same side as a mastectomy or vascular graft.
To engorge the chosen veins for easier insertion, secure a tourniquet behind the intended IV site. Adjust the tourniquet's tightness appropriately without causing excessive pressure, especially in older patients. Allowing the limb to hang down aids in vein prominence by increasing blood flow.
- Ensure the tourniquet is snug but not overly tight, as tightness can lead to bruising.
- Letting the limb hang down encourages blood flow, aiding vein engorgement.
If locating suitable veins proves challenging, palpate the patient's skin near the IV site. Apply pressure in the direction of the vein, feeling for its resilience. Consistent, gentle pressure for 20-30 seconds should enlarge the vein visibly.
Vein Access
Using a fresh alcohol wipe or another sterilizing agent like chlorhexidine, cleanse the skin where the IV will be inserted. Thoroughly wipe the area to eliminate bacteria, reducing the risk of infection during needle insertion.
Extract the catheter from its sterile packaging and inspect it for integrity. Confirm the tightness of the flashback chamber and the loose positioning of the catheter hub on the needle. After removing the protective cap, verify the needle's cleanliness before proceeding with insertion.
- Avoid contaminating the catheter or needle to maintain sterility and minimize infection risks.
Stabilize the patient's limb with your non-dominant hand, avoiding direct contact with the IV site. With your dominant hand, insert the needle (bevel up) into the skin, angling it shallowly as you advance.
- Watch for a flash of blood in the catheter hub, indicating successful vein entry. Advance the needle slightly further upon seeing the flash.
Missing the vein during IV insertion is common, especially with difficult veins. If no blood flash appears, inform the patient and try again, maintaining a reassuring demeanor throughout.
- Apologize if multiple attempts are needed, opting for a different limb each time to minimize patient discomfort and bruising.
- Offer reassurance, emphasizing that missed attempts are normal and not the patient's fault.
Withdraw the needle (not the catheter) about 1 centimeter while maintaining pressure. Advance the catheter into the vein, then remove the tourniquet. Secure the catheter with a sterile dressing, avoiding blocking the IV tubing connection.
- Ensure the dressing doesn't obstruct the IV tubing connection.
Hold the catheter hub securely as you remove the needle. Dispose of the needle properly, then insert the primed IV tubing into the catheter hub, securing it in place.
Tape the catheter hub and loop the tubing securely against the patient's skin. Apply a clear dressing over the IV site, leaving the catheter hub exposed. Ensure the tubing loop is free of kinks and label the dressing with insertion details.
- Check for tubing kinks, which can impede fluid flow.
- Label the dressing with insertion time and date.
IV Maintenance
Open the IV roller clamp and observe drips forming in the drip chamber. To confirm proper infusion, occlude the vein distal to the IV site and check for drips cessation, restarting upon release.
To minimize infection risk, regularly replace IV dressings. Transparent dressings should be changed weekly, while gauze dressings require more frequent changes. Maintain strict hygiene protocols during dressing changes to reduce infection risk.
- Ensure hand washing and glove changes before handling IV sites, particularly during dressing changes, which are linked to increased infection rates.
Resolve IV Insertion Challenges'As a novice nurse, I struggled with IV insertions. This guide transformed my approach. Now, I assist colleagues with IV insertion techniques confidently, thanks to the clarity provided by these steps and visuals.' - Breeaunna W.
Proper IV Maintenance is Key'Last year, my father was diagnosed with heart failure, requiring home IV medications. I was anxious about managing his IVs, but this resource emphasized the importance of sterile procedures and dressing changes. Thanks to this guidance, my father hasn't faced any complications from his home IV treatment in a year.' - Shivanand R.
Prepare Loved Ones for Weekly Infusions'As the primary caregiver for my grandfather, I had to take over his weekly treatments when insurance no longer covered home nurses. Initially nervous about administering IV injections to my 80-year-old grandpa, this guide provided clear step-by-step instructions and images that boosted my confidence in mastering the proper technique. Now, giving the infusions feels natural. My grandpa actually prefers having me, his granddaughter, handle everything instead of rotating nurses. This guide made a daunting situation much smoother for both of us.' - Lexi B.
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- Secure the gauze over the puncture site with tape or a bandage, such as Coban.
- Infiltration: Occurs when fluid escapes the vein and enters surrounding tissue, resulting in swelling and smooth, pale skin in the affected area. Severity varies depending on the medication administered.
- Hematoma: Results from blood leaking into surrounding tissue, often due to accidental puncture of multiple vein walls. Symptoms include pain, bruising, and irritation, usually resolving within weeks with light pressure.
- Embolism: Caused by injecting air into the vein, typically from air bubbles in the IV tubing. Children are particularly vulnerable. Severe cases may lead to breathing difficulties, chest pain, blue skin, low blood pressure, and even stroke or heart attack.
- Thrombosis and Endarteritis: Life-threatening conditions arising from injection into an artery instead of a vein. Symptoms include severe pain, compartment syndrome (excessive pressure on a muscle resulting in a painful, tight sensation), gangrene, motor dysfunction, and potential limb loss.
Helpful Tips
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Keep thorough records of IV insertion procedures to avoid unnecessary complaints and legal issues.
Important Warnings
- Limit vein-finding attempts to two. Seek assistance from another technician if unsuccessful after the second attempt.
- Always review patient records for specific instructions before performing IV insertions.
- Insert IVs only if you're a trained medical professional.
Essential Equipment
- Patient's medical chart
- IV stand
- IV solution bag
- Tourniquet
- IV clamp
- Adhesive tape
- Medical gloves
- Needle
- Syringe
- Cannula
- Betadine solution (Alternatively, use a chlorhexidine swab stick like ChloraPrep®)
- Cotton swab
- Tap water (for hand hygiene)
- Antiseptic soap
- Medical waste bin
- Sharps disposal bin
