Sterile disposable gloves Appropriate size “over-the-needle” IV catheter (typically 14 - 25 gauge) Bag of IV fluid Non-latex tourniquet Sterile bandage or dressing Gauze Alcohol wipes Medical tape Sharps container Sterile pad or paper (set small tools out on this to keep them close at hand)
When patients are nervous, their veins may contract somewhat in a process called vasoconstriction. This makes it harder to start an IV, so make sure your patient is as relaxed and comfortable as possible before proceeding. You may want to ask whether the patient has had any trouble with IVs in the past. If so, the patient may be able to tell you which sites are easiest to access.
Injecting air bubbles into a patient’s bloodstream can cause a serious condition called an embolism. One easy technique for removing bubbles from the IV tubing is to uncoil the tubing to its full length and run the roller valve all the way up to the drip chamber. Next, puncture the IV bag with the tubing spike and pinch the drip chamber. Open the roller valve and release the line — fluid should flow down the length of the tubing without producing any bubbles.
In general, for IVs, you’ll need a catheter that’s about 14-25 gauge. Tend towards higher-gauge (thinner) catheters for children and the elderly, but tend towards lower-gauge (thicker) catheters when rapid transfusion is needed.
Before touching the patient Before clean/aseptic procedures (like administering IV medications) After procedures with a risk of body fluid exposure After touching the patient After touching the patient’s surroundings Before moving to a different patient
Places where the IV will interfere with surgery In the same location as another recent IV In a site that shows signs of infection (redness, swelling, irritation, etc. ) In a limb on the same side of the body as a mastectomy or vascular graft (this can lead to complications)
Don’t tie the tourniquet too tight — this can cause bruising, especially in the elderly. It should be tight, but not so tight that you can’t slip a finger underneath. Letting the limb hang limp towards the floor while a tourniquet is in place can help the veins become more prominent by increasing the blood flow to the limb.
Don’t allow the catheter or needle to come into contact with anything other than the patient’s skin in the IV site. This can compromise their sterility and increase the risk of infection.
Look for a flashback of blood at the catheter hub. This is a sign that you’ve successfully hit the vein. Once you see the flashback, advance the needle one more centimeter (cm) into the vein.
If you repeatedly miss the vein, apologize to the patient, remove the needle and catheter, and try again on a different limb with a fresh needle and catheter. Attempting numerous inserts on the same vein can be very painful for the patient and leave lasting bruising. You might comfort the patient by explaining why it didn’t work and also saying something like, “Sometimes these things just happen. It’s no one’s fault. We should get it right next time. ”[5] X Research source
Be sure not to block the the IV tubing connection with your dressing.
Make sure there are no kinks in the loop — this can interfere with the flow of fluids into the bloodstream. [7] X Research source Don’t forget to place a label with the date and time of insertion on the IV dressing.
Don’t forget to wash your hands and wear a fresh pair of gloves every time you touch a patient’s IV site. This is especially important for when you’re changing dressings, as the use of long-term IV connections is associated with an increased rate of infection. [9] X Trustworthy Source PubMed Central Journal archive from the U. S. National Institutes of Health Go to source
Secure the gauze over the puncture site with tape or a bandage, such as Coban.
Infiltration: Occurs when fluid is injected outside of the vein into surrounding soft tissue. Will cause swelling and smooth, pale skin in the affected area. Can be a minor or serious issue depending on the medicine being administered. Hematoma: Occurs when blood leaks from the vein into the surrounding tissue, usually after more than one vein wall is accidentally punctured. Often accompanied by pain, bruising, and irritation. Will usually resolve within several weeks light pressure. Embolism: Occurs after injecting air into the vein. Often caused by air bubbles in the IV tubing. Children are especially at risk. In serious cases, causes trouble breathing, chest pain, blue skin, low blood pressure, and even stroke and heart attack. Thrombosis and endarteritis: Life-threatening conditions that can result from injecting into an artery, rather than a vein. Can lead to severe pain, compartment syndrome (high pressure on a muscle leading to a very painful “tight” or “full” feeling) gangrene, motor dysfunction, and even the eventual loss of the limb.
