How to Start Intravenous Therapy

Intravenous therapy is used to treat a variety of health conditions and to stabilize vital signs. Intravenous therapy works by delivering liquid medication through a catheter inserted into an open vein. Most commonly referred to as I.V. lines, these lines deliver medication to the body faster than the oral route. Since starting an I.V. line can be a source of frustration, it's important to become familiar with the process.

Instructions

1. Read the doctor's orders. Ensure that the order is complete and legible before gathering supplies. This is especially important because some I.V. solutions have similar dosage concentrations, names and packaging. Mixing medications with the wrong I.V. solution could result in harm to the recipient. Ask for verbal orders to be repeated to ensure accuracy.

2. Gather the supplies. Retrieve the I.V. solution and the ordered medication from the medicine room. Double-check the order for accuracy. Collect I.V. tubing, cleaning supplies, gloves, needles, and a tourniquet from the supply closet. Choose a large bore needle so the medication flows more easily through the body. Bring a few smaller needles in case the patient has thin or rolling veins. Place the supplies into a transport bucket to avoid losing small pieces.

3. Assemble the equipment. Lay the equipment on a clean flat surface. Open the I.V. tubing and clamp the slider closed. This prevents the solution from leaking while being setup. Hang the solution bag from an I.V. pole to promote flow. Leave the port end of the tubing inside the tubing tray to help prevent infection. Connect the catheter end of the tubing into the open port on the I.V. solution bag. Close the tubing and open the catheter on the medication bag. Insert the catheter into an open port on the tubing. Open the slider on the primary tubing and let a small amount of solution flow into the tray before clamping it closed. This ensures that the tubing is connected properly and doesn't contain leaks.

4. Choose an IV site. Assess the nondominant arm of the patient to find a suitable insertion site. This helps reduce the likelihood of I.V. infiltration due to movement. With a gloved hand, gently feel the veins starting at the wrist and working up to the elbow. Select a vein that is large enough to support the needle and that hasn't been recently injured. Always choose the vein that's farthest from the elbow in case you miss the vein and need to retry the insertion. It may be necessary to apply the tourniquet to aid in finding a suitable site.

5. Insert the IV. Tie the tourniquet around the patient's arm slightly above the intended insertion site. Although the tourniquet should be tight, it shouldn't make the patient's arm or fingers numb. Using a circular motion, clean the insertion site with an alcohol pad to help prevent infection. Open the needle and place it in your dominant hand with the bevel side up. Use your nondominant hand to locate and pull the skin under the insertion site tight. Insert the needle into the vein using firm pressure. Look for a "flash" of blood in the catheter chamber before advancing the catheter. Push the catheter and listen for it to lock into place. Twist the needle away from the catheter and place it in an approved disposal container. Release the tourniquet and tape the I.V. into place.

6. Connect the tubing. Wipe the patient's I.V. port with an alcohol pad. Uncap the I.V. tubing and twist it into the I.V. port. Unclamp the slider and watch the drip chamber underneath the solution bag. The solution should drip steadily from the bag into the I.V. site. The catheter at the insertion site should clear of blood and be the same color as the I.V. solution. There should be signs of redness or swelling at the insertion site. Calculate the drip rate by using manual methods or by placing the I.V. bag into a calibration monitor.

Tips & Warnings

• Some facilities have prepackaged I.V. trays for quick retrieval. Asking a co-worker for assistance can speed up the process and make you feel more comfortable with the procedure.

• Never force a needle or catheter into a vein. Doing so can cause damage.

Resources

• Learn about phlebotomy technicians