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Intravenous Therapy: IV Insertion

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What is intravenous insertion?

Intravenous (IV) insertion is a procedure wherein a vein is punctured through the skin by a cannula to provide venous access.

IV insertion site using a Gauge 20 IV Catheter
IV insertion site using a Gauge 20 IV Catheter

To whom is IV insertion done?

IV Insertion is done to clients:

  • with fluid and electrolyte disturbances
  • who are critically ill
  • who have nothing per orem (NPO) after surgery or for any other reason

Initiating IV Therapy through IV Insertion

Steps

Rationale

1. Check doctor’s order, identify client and secure consent.

IV insertion can’t be performed without doctor’s order.

Proper identification ensures that procedure is done to the right client.

Initiating IV therapy through IV insertion is an invasive procedure that needs client’s consent.

2. Wash hands and prepare all equipment at bedside. Ensures asepsis and a smooth flow of procedure.
3. Explain procedure and answer client’s questions and worries. Decreases fears and anxiety.
4. Select IV site.

Choose distal veins so that once damaged, the proximal part of the vein can still be used.

Avoid areas that bends (hands and wrist) to prevent infiltration.

Use non-dominant hand for freedom of movement.

Avoid extremity with low sensation or poor integrity.

5. Ask client to rest arm of selected vein. Makes the veins more visible.
6. Put on gloves. Maintains asepsis.
7. Cleanse insertion site from starting in the middle of the site going outward.

Reduces transmission of microorganism.

Be sure to leave the area dry before insertion.

8. Apply tourniquet 5-6 inches above selected site. Engorges the vein for easier IV insertion.
9. Anchor vein by placing thumb over vein and stretching the skin against the direction of insertion. Stabilizes the vein and aids in IV insertion.
10. Insert the stylet-catheter, with bevel up, at a 20 to 30 degree angle. Prevent damage to the posterior wall of the vein.
11. Check for blood backflow. Pressure from tourniquet causes quick backflow of blood into the catheter.
12. Loosen stylet and advance catheter into the vein until hub rests on the IV site.

Ensures proper placement of catheter.

Note: Do not reinsert stylet after loosening to prevent puncture to the catheter.

13. Hold thumb over the vein above the catheter tip and release tourniquet. Prevents blood leaking and reestablishes venous blood flow.
14. Quickly release pressure over the vein and connect needle adapter of the IV set to the hub of the catheter. Prompt connection reduces blood loss.
15. Begin infusion at a slow rate (per institution policy). Keeps vein open and ensures patency of IV.
16. Tape over the hub of the catheter. Place transparent dressing over the site. Secure catheter in place and controls bleeding and infection.
17. Secure tubing in loop fashion. Prevents tubing dislodgment.
18. Remove gloves and do aftercare. Prevents transmission of microorganisms.
19. Label the site with date and time of insertion and the size and gauge of catheter. Serves as guide for next dressing change.

What to document?

Make sure to document the following after procedure:

  • date and time of IV insertion
  • size and gauge of catheter
  • client’s untoward reaction to the procedure
  • type of fluid infused and prescribed rate
  • additives, i.e. contrast amount and type

Key Considerations:

  • During IV insertion on elderly clients, use a 5 to 15 degree angle because their veins are more superficial.
  • It is recommended to change IV site every 3 days to avoid infection and other IV complications. Refer to the institution’s policy.
  • Always insert IV in the direction of venous return (toward the heart) to prevent venous valve damage.