Most patients who are in the hospital are going to have an IV for one reason or another. Which is why understanding the need, procedure, and complications of intravenous therapy are so important. Let’s dive in!
What does IV stand for?
IV stands for intravenous and can be used for a variety of reasons in the clinical setting. Primarily, IVs are placed for fluid replacement as well as a direct route for medications to be administered. Medications that are given intravenously will have a faster onset due to its direct access into the circulatory system.
What is an IV exactly?
An IV is inserted by the nurse after there is an order placed by the provider. The IV itself is stored in a catheter and is found in the supply room. When ready to insert, the nurse must gather all the supplies and verify the order with the patient.
IV Supplies
At some hospitals, there will be IV start kits that have pretty much everything you need for insertion. If your facility doesn’t have this, then you’re going to need the correct gauge catheter for your patient. Often times, a 16 or 18 gauge is used. Remember, the smaller the gauge number, the bigger the needle and vice versa.
In addition to the catheter, you will also need alcohol wipes, a flush to prime the tubing, the tubing, a tourniquet, transparent dressing, tape, gauze, gloves, and an IV pump and solution if the patient is getting fluids.
Pre-Insertion
Before you can insert the IV, be sure to verify the order and discuss it with your patient. Obtain verbal consent from the patient and gather your supplies. Perform hand hygiene and don clean gloves. Use your alcohol wipes to find a good vein that will hold the appropriate sized gauge catheter. Once you’ve found the vein you’re going to use, set your supplies up.
Different types of catheters will work in different ways and it’s important to know this prior to insertion. For example, some catheters will prevent backflow, meaning that when you get blood return, it will stay in the catheter chamber and will not come out. Whereas other catheters don’t have this feature, and the blood will flow out freely past the catheter. If you aren’t prepared for this, it might cause the patient concern.
When setting up your supplies, be sure to prime the tubing ahead of time with the flush so that it’s ready to be connected the second you get the IV in. At this time, go ahead and apply the tourniquet to get the vein nice and juicy.
Insertion
Now that you have your supplies, chosen the vein, become familiar with the catheter, have your tubing primed and your tourniquet on, you’re ready to insert! Re-clean your patients arm with the alcohol swap and uncap your catheter. With your non-dominate hand, hold the patients’ skin taut above and below the insertion site. With your dominate hand, insert the needle into the patients’ vein at about a 30 degree angle with the bevel up. Continue to advance the needle into the vein until you see the ‘flash’ in the catheter. The flash, aka the blood in the chamber of the catheter, will indicate the correct position of the catheter in the vein.
After the catheter is fully advanced, untie the tourniquet and advance the plastic catheter part of the IV into the patients’ vein. Remove the needle and activate the safety device that covers the needle. Then connect your primed tubing and flush. Flushing the IV should not hurt the patient or cause any swelling around the IV site. If it does, the catheter is not correctly placed, and you’ll likely have to try again.
Post-Insertion
If you can flush the IV without any problems, you know that it’s patent and placed appropriately. You can now secure the IV with transparent dressing. Be sure to add the date, time, and your initials to the tape before securing it to the IV for everyone to see. Place the needle in the sharps bin and dispose of the trash accordingly.
Chart the time, location, and gauge catheter after insertion. You can now use the IV for whatever the order was for. If it’s for IV fluids, get an IV pump and connect the proper fluids and tubing to the IV. If it’s for medications, you can now safely administer them.
Be sure to visit A Guide to Intravenous Fluids for more info.
Patient Education
After the insertion, it is important to educate your patients on IV complications. Inform them that if the IV site becomes swollen, painful, red, or hot to call you right away. As this could be signs of infiltration or infection. Other complications include extravasation, phlebitis, thrombophlebitis, hematoma, fluid overload, and cellulitis.
Be sure to check the patients’ IV site at least once a shift if not connected to fluids. If the patient is receiving medication or fluids, then check patency before every new bag of fluids or medication is given. If there are signs of complication, be sure to stop the IV from running more fluid and seek help from your charge nurse.
Infection Prevention
Always ‘scrub the hub’ before flushing or giving any IV mediations. Properly cap off the end of the IV tubing if it is locked and always preform proper hand hygiene before handling. Educate the patient on proper infection prevention and continue to monitor the site.
And that’s it! Now you know how to insert an IV!
Be sure to check out…
- Start of Shift Plan for New Nurses
- How to do a Quick yet Effective Head-to-Toe Assessment
- How To Don and Doff PPE for Medical Professionals
And see the rest of the Nursing Fundamentals Series:
- A Guide to Pain
- Delegation and the Nursing Process
- The 10 Rights of Medication Administration
- And more!