How to Start an Intravenous Site

These steps do not delve into who is licensed to insert IVs--such as nurses, doctors, paramedics and lab personnel--but rather on how to start one. Knowing the basic techniques required may come in handy in times of grave emergencies.

Things You'll Need

• Tourniquet
• Alcohol pads
• Betadine pads
• Intravenous needles
• Medical tape
• 2-by-2 inch gauze pads
• Exam gloves

Instructions

1. Know that the majority of IVs are started in peripheral veins--not deep veins, arteries or major blood vessels. The site of choice is the arm. There are various sites on the arm that work better than others. If you miss a start in the middle of the arm, you cannot try on that same arm below that site. Therefore, it is taught to start on the most distal part of the arm, beginning at the hand and working your way up to the proximal part of the arm. First attempt to insert the IV in the hand or wrist, and if unsuccessful work your way up the arm.

2. Study the venous system of the arm to familiarize yourself with the location of suitable veins, such as the brachial-cephalic or the radial or antecubital vein. Of course, the body build or the emergency of the situation will dictate where you attempt to start the IV site. On elderly or obese people, the best place to start is the antecubital. On young, thin people, the lateral wrist or back of the hand is a good place to try. In an emergency situation, any vein possible is your target. The feet have great veins, but they should be used after the arms have been tried.

3. Don your gloves. Tie the tourniquet as tight as possible and what is bearable for the patient. Choose the best vein. Look closely for the straightest, largest, healthiest-looking vein. Rub the area in a circular motion from the center out for about an inch with the betadine. Repeat with the alcohol wipe. Position the IV needle parallel to the vein in the direction of the head. Never start an IV with the needle pointing toward the feet. Hold the arm with your off hand and slowly, steadily insert the needle into the vein. There is usually a slight pop as the needle penetrates the vein. Advance the catheter forward while at the same time retracting the metal needle insert. As soon as you see blood return in the chamber of the catheter, you know you have successfully started the IV.

4. Choose the size of the IV needle at your discretion. Generally, the largest bore that can be successfully started should be used because they are more effective when giving IV fluids, medications or emergency medications. The site of a large-bore IV will usually last longer than a smaller one. Use good judgment. It would not be smart to start a pediatric needle in an adult or an adult needle in a newborn.

5. Know the signs and symptoms of extravasation. This is when the IV site has gone bad, and the fluid or medication meant for intravenous administration is not going into the vein but into the tissue surrounding the IV. A good IV site will flow freely with no swelling, redness or pain at or near the insertion site.

Tips & Warnings

• Study different methods for starting IVs in different parts of the body. Ask someone with experience to walk you through the procedure. Have all your equipment ready before you begin.

• Make sure you are licensed to begin IVs. Never never attempt to start an IV unless you are positive it is within your scope of practice. Remember to first do no harm.