IV Catheter Placement
Several skills are beneficial to the nurse and paramedic, but perhaps one of the most important skills is the ability to place an intravenous catheter into a vein. This procedure is most commonly referred to as “starting an IV”. In today’s medical community, intravenous cannulation is necessary for the administration of many antibiotics and other therapeutic drugs. Listed below are the procedures and guidelines for starting a successful IV. Following these instructions will provide a positive experience for the patient and clinician.
First, you must obtain all of the necessary supplies: gloves, alcohol or Betadine preps, a tourniquet, tape, an appropriately sized IV catheter, a bag of IV solution, the IV tubing, and gauze pads. While obtaining the supplies, you should inform the patient that IV catheter placement is necessary, and why. Do not lie to the patient and tell him or her that it is a painless procedure. Instead, be honest with them and explain that the initial puncture feels like a sharp pinch on the skin and that the pain and discomfort associated with the IV placement is only temporary. You may find it helpful to demonstrate to the patient the amount of pain to expect by pinching the skin on the back of their hand. This is especially helpful for younger patients or patients who are more concrete in their thinking.
Now, assemble and arrange all of the needed supplies so that they are easily accessible. Connect the IV tubing to the solution bag and allow the fluid in the bag to run through the entire length of the tubing, also known as priming the tubing. When this is done, clamp the tubing closed. You will then need to tear several pieces of tape, six to eight inches in length, to later secure the IV catheter and tubing to the patient’s skin. Keeping these items within close reach will help with the success of the IV catheter placement.
Before continuing any further, place protective gloves on your hands, as there will be direct contact with bodily fluids. Then, you will need to locate a suitable venipuncture site. Some common placement sites for IVs include the back of the hand, the forearm, the antecubital fossa (inside of the elbow), foot, or ankle. After choosing an appropriate site, place a tourniquet above the desired puncture area. Tie the tourniquet using a slip-knot, leaving one end of the knot exposed for rapid removal. The tourniquet slows the venous blood return and increases the vein’s size, thus increasing the ability to see and feel the vein. Now, choose a vein that is well fixed (not rolling) by palpating it with your fingers. The vein will feel spongy and spring back to the surface when you remove your finger. Be careful not to choose a vein with multiple valves near the cannulation site, as this will decrease your chances for a successful IV start.
Next, cleanse the chosen site with the alcohol or Betadine prep and allow it to fully dry. While the prepared area is drying, you should inspect the IV catheter for any manufacturer defects and ensure it functions properly before use. Once the prepped area is dry, place the catheter between your thumb and middle finger with your index finger resting on the top of the catheter. This is the preferred holding method of most nurses and paramedics. Now, it is important to inform your patient that you are about to begin with catheter placement and that his or her cooperation is essential for the best outcome. Holding the catheter at a thirty to forty-five degree angle, enter the skin with the needle’s bevel facing up. Continue to advance the catheter until you feel a pop and see the flashback of blood within the needle’s transparent chamber. Once you have done this, reduce the angle of the needle and advance it approximately five millimeters more.
After needle advancement, the next step is to slide the catheter off of the needle in a gentle twisting motion, while continuing to hold the catheter hub. You should continue advancing the catheter until it is approximately one to three millimeters from the puncture site in the skin. Now, remove the tourniquet by gently tugging on the shorter end. The needle needs to be immediately discarded in the sharp’s container to decrease the likelihood of an accidental needle stick to the practitioner or the patient.
Finally, while you continue to occlude the venous blood flow and hold the catheter hub with one hand, use your other hand to firmly attach the IV tubing set, which has already been primed. Remove the finger that has been occluding the blood flow and open all of the clamps on the tubing to allow the IV solution to run freely. Slowly, decrease the flow of the solution to the appropriate rate as ordered by the physician. Using a small gauze pad, wipe away any excess blood or fluid on the surface of the skin. Then, using the pre-torn pieces of tape, secure the catheter hub and the IV tubing to the patient’s skin. Take extra caution not to kink the tubing. Once everything is secured, recheck the IV solution’s flow and then attend to the rest of your patients needs.
Starting a successful IV takes practice, time, and patience. Once you have perfected this procedure, you will see that the above steps are simply guidelines to help beginners. As your experience grows, you will develop your own techniques and preferences. Remember these steps, and both you and your patient will have a successful IV catheter placement experience.
