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Intravenous Therapy: IV Insertion Sites, Equipment and Safety Guidelines

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Initiating IV therapy through IV insertion is a specialized and complex technique. Nurses are required to have basic knowledge of the anatomy and physiology of the different venipuncture sites to ensure client’s safety.

What are the different IV insertion sites?

The most accessible routes for IV insertion are the veins of the forearm because of its location and number.

    • Metacarpal Veins. Formed by the union of the digital veins on the back of the hand. They are ideal for IV insertion because they are easily visible and they lie flat.
    • Cephalic Vein. Located along the radial border of the forearm, the cephalic vein is ideal when using large bore cannulas or catheters. WARNING: When using this vein, avoid inserting IV near the watch-strap area because of the risk of radial nerve injury.
    • Basilic Vein. Runs along the ulnar border of the forearm and is prominent among male clients.

What materials must be prepared to initiate IV therapy?

Drip intravenous system
Adapted from DepositPhotos.com
  • Peripheral IV catheter. Use the smallest gauge and length possible to administer prescribed therapy but a large bore catheter for emergency therapy like blood transfusion.
  • IV start kit. Many healthcare institutions have these. It contains: 1) sterile drape, 2) tourniquet, 3) tape, 4) transparent dressing, 5) cleansing solution (70% alcohol or povidone-iodine), 6) 2×2 inch gauze pads 7) scissors
  • Clean gloves
  • Extension set. This can either be a saline lock, heparin lock, IV plug or adapter.
  • Prefilled 5-mL syringe with flush agent. The flush agent is a 0.9% saline solution.
  • Alcohol pads
  • Stabilizing device. This is optional but necessary for pediatric and geriatric clients.
  • Intravenous solution as prescribed by physician
  • Administration set. Choose between macrodrip or microdrip depending on prescribed rate.
  • Protective equipment. Involves the use of mask and goggles as per agency policy.
  • IV hanger. It can either be a pole or a mount on the wall or ceiling.
  • Watch. Use a watch with a second hand to accurately calculate drip rate.
  • Special patient gown. If available, have the client wear a gown with snaps at shoulder seam to make IV tubing removal  much easier.
  • Biohazard disposal container. To safely dispose sharps.

Nursing Safety Guidelines

Patient Education

  1. Educate client about the procedure in clear and concise terms. Allow client to ask questions and answer them to clarify any doubts and fears about the procedure.
  2. Instruct the client about the rationale for initiating IV therapy as well as the medications and solutions that will be used.
  3. Tell client what signs to report: inflammation, clotting, leaking or breaking.
  4. Give client instructions on how to bathe without getting the dressing wet.
  5. Discuss client’s activities and find out which activities can be continued to ensure safety during IV therapy.

Nurse Preparation

  1. Before starting IV therapy, check if you have all the needed information, physician’s order and equipment.
  2. Identify client properly using any two identifiers per agency policy: name and birthday OR name and account number
  3. Review and report any incompatibilities between prescribed medications and infusion solutions.
  4. Assess the appropriate route and rate of infusion. Ideally, use the client’s non-dominant hand if possible. NOTE: Never shave the chosen venipuncture site to avoid cuts and nicks.
  5. Assess for client’s allergies to latex or povidone-iodine.
  6. Do a mental review of the entire procedure from start to end and consider modifications, if needed.
  7. Maintain strict sterile techniques when required to prevent infections.
  8. If an equipment gets contaminated during the procedure, change it with a new one.
  9. Use standard precautions when dealing with body fluids and sharp items.

Key Points:

  • When choosing venipuncture sites, prioritize the veins on the non-dominant hand, if possible.
  • Give client as much as instruction needed about the procedure to prevent anxiety, clarify doubts and reduce fears.