Tips for Initiating a Peripheral IV
Initiating a peripheral IV is an essential skill for nurses that requires both technical competency and good patient communication. Here are some tips to help you successfully start a peripheral IV:
1. Prepare Your Equipment:
IV catheter (appropriate size, generally 18-24 gauge for adults)
Tourniquet
Antiseptic wipes (e.g., chlorhexidine or alcohol)
Sterile gauze
Adhesive bandage or transparent dressing
Saline flush
IV tubing and solution (if needed)
Gloves
Sharps container
2. Explain the Procedure:
Explain the procedure to the patient, including what they can expect and the purpose of the IV. This helps reduce anxiety and gain their cooperation.
3. Select the Vein:
Location: Choose a site on the non-dominant arm if possible. Common sites are the dorsal side of the hand, forearm, and antecubital area.
Vein Characteristics: Look for veins that are straight, soft, and well-dilated. Avoid veins that are overly tortuous, previously used, or near joints.
4. Apply the Tourniquet:
Placement: Tie the tourniquet around the upper arm, about 4-6 inches above the intended insertion site.
Tightening: It should be tight enough to restrict venous flow but not arterial flow. Check for a pulse below the tourniquet.
5. Vein Dilation Techniques:
Gravity: Have the patient lower their arm below heart level to promote vein filling.
Clenching Fist: Ask the patient to clench and unclench their fist to help dilate the veins.
Tapping: Gently tap or stroke the intended vein to encourage dilation.
Warm Compress: Apply a warm compress to the site for a few minutes if the veins are not prominent.
6. Antiseptic Technique:
Clean the insertion site with antiseptic wipes in a circular motion, starting at the center and moving outward. Allow the site to air dry completely to reduce the risk of infection.
7. Insert the IV Catheter:
Needle Angle: Hold the catheter bevel up and insert it at a 10-30 degree angle to the skin. This angle may be adjusted based on the vein depth.
Vein Entry: Once you see a flashback of blood in the catheter hub, lower the angle slightly and advance the catheter a little further into the vein.
Threading: Once inside the vein, advance the catheter over the needle into the vein. Hold the needle steady while advancing the catheter.
8. Secure the Catheter:
Release the tourniquet.
Apply gentle pressure above the insertion site to stabilize the catheter while you remove the needle.
Connect the IV tubing or saline lock and flush the catheter with saline to ensure patency.
Secure the catheter with adhesive bandage or transparent dressing to prevent movement or dislodgement.
9. Monitor and Document:
Observe the site for signs of infiltration, phlebitis, or infection.
Document the procedure, including the site, gauge of the catheter, number of attempts, and any patient reactions.
10. Patient Comfort and Communication:
Reassure the patient throughout the procedure, especially if they express pain or discomfort.
Educate the patient on signs of complications and inform them to notify you immediately if they experience any issues.
Troubleshooting Tips:
Difficult Veins: If veins are hard to find, have patients hydrate well if appropriate, as this can help plump up their veins.
Rolling Veins: Stabilize the vein with your thumb below the insertion site and use gentle pressure to keep it from rolling.
Slow Flashback: If blood flashback is slow, you might be on the vein wall; adjust by slightly pulling back the needle or catheter and then advancing gently.
By following these tips and maintaining a calm and confident demeanor, you can improve your success rate with peripheral IV insertions and ensure patient comfort and safety.
