How to Start an IV

Whether you are a medical student, a nurse, a paramedic or a phlebotomist, starting an intravenous line, or IV, is a skill you can't do without. Sometimes it seems impossible, but by following some simple steps, you'll get your IV almost every time.

Difficulty:

Moderately Challenging

Instructions

Things You'll Need

• Bag of IV fluid
• IV catheter
• Tubing
• Tournaquet
• Tape
• Alcohol wipe
• 4x4 or other gauze square
• Splint if starting on wrist or child's arm

1. First, find a good site. The large vein in the crook of the elbow, called the "AC", is a good place to start. But good veins can be found in the back of the hand, the side of the wrist, or even the forearm. In an emergency situation, veins in the scalp, feet or neck can also be used.

2. While you are preparing the site, have a partner or co-worker prepare the fluid bag and the tubing. There is no worse feeling than having inserted an IV, and then finding out you have nothing to attach it to.

3. 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.

4. 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.

5. Choose a catheter size. An 18 gauge catheter will work well for most fluids and medications. 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).

6. 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.

7. 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.

8. While advancing the catheter, 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.

9. Remove the tournaquet. Don't forget this step, as you can cause tissue death, discomfort and blown IV's by leaving the tournaquet on.

10. Remove the plastic applicator from the catheter. Prevent back-bleeding by either applying finger pressure on the vein above the catheter, or by applying a 4x4 under the catheter to catch any escaping blood.

11. Attach the IV tubing to the catheter. Apply tape or a commercial securing product to the catheter to keep it from moving.

12. 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.

13. Use tape or commercial securing products to further secure the IV line to the patient's arm or hand.

14. 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").

Tips & Warnings

• Sometimes applying a tournaquet is not necessary in the case of extremely large veins, or in the elderly when the back-pressure caused by a tournaquet can cause a vein to "blow".

• If a vein doesn't look straight enough, sometimes applying downward pressure at the base of the vein, or stretching the area, can help straighten it out.

• For quick, emergency fluid replacement choose a 14 or 16 gauge catheter.

• If your catheter gets hung up on a valve, stop advancing the catheter. Leave it in place, remove the needle, and open up the IV fluid. Then, using a twisting motion, attempt to move the catheter farther into the vein. Sometimes "floating" the catheter through the vein will open up the valve sufficiently to start the IV.

• Know your IV catheters. Some brands release the needle from the catheter with a springload mechanism. Others need to be pushed off manually. Still others are released with a combination push-pull finger movement.

• To prevent needle sticks, get in the habit of putting the needle into a sharps container as soon as you have inserted the catheter. If you are using a catheter brand that allows glucose checks, put the needle in the sharps container as soon as you have checked the glucose.