IV Insertion

IV insertion Common insertion sites Most common sites are veins of the hand and arm including basilic, cephalic, and metacarpal veins. Try to avoid antecubital fossa area for long term IV use as there is a risk of dislodgement due to frequent flexion and extension of the arm PEARLS of wisdom: Always start distally and move proximal as needed. Once a proximal area of a vein is used do not use the area distal to it as there is a risk of leakage from the initial IV insertion area. An IV site will last longer if you avoid placing it in an area where it will affect the patient doing their activities of daily living. Don’t “flick” the vein to get it to dilate. You risk causing a hematoma to the area and damage to the vein. It really serves no purpose. Use your hands as a guide. Even though a vein may look good on the outside it may not be healthy on the inside. A good vein should be soft, bouncy and dilated. It should have good recoil when you press on it. Using a “two step technique” (separate puncture of the skin and vein can help prove success rates and cause less risk of going right through the vein. Use a warm towel or a warm blanket to the limb that you will be starting the IV in prior to initiation. It can help dilate the vessels so you can see them better. Promote venous filling by using gravity as your friend. Have the patient hang their hand over the bed or below their heart to promote vein filling. Never use extremities that have compromised circulation. Damage to the vessel can occur. Its always best to have extra hands to help if you can find them. Ask a friend to be your helper and hand you needed supplies during insertion. Watch out for bifurcations, sclerosed veins, blown vessels, bruised areas, areas with skin breakdown, lots of hair present, or areas of redness or warmth on the skin……. these are all areas to avoid in order to be successful in starting an IV. Making small talk with the patient can help them to relax and it can also help you relax and focus on the task at hand. RELAX and Breathe----the calmer you are during the procedure the more chance of success you will have. . Choosing the right catheter/cannula size    Ideally, use large bore 18g needle for patients who have the slightest chance of being a surgical patient (i.e. patients with abdominal pain or trauma). The same goes with patients who might need blood transfusion or emergency medications later on. It will be hard to provide emergency fluid replacement or bolus lifesaving medications through a 22g needle. Remember, the size of the catheter to be used is determined by the type of care the patient needs. For example, you can use 22g in a bag of blood that needs to run over a period of less than 4 hours. A bigger catheter size, on the other hand, is ideal if you’re going to pressure a bag in. Smaller gauge catheters are appropriate when dealing with patients in nonemergent settings or if the patient’s condition has been better defined. Medication and IV solution prep 1. Hand hygiene first 2. Confirm order 3. Prepare IV bags per order using your medication rights 4. Look for color, clarity and clarify expiration date of medications and solutions you are using. Make sure bag is intact. 5. Roller clamp tubing to off position 6. Compare solution and order again. 7. Spike bag after cleaning hub of bag and don’t contaminate spike of tubing. 8. Squeeze drip tubing chamber to fill it half way 9. Hold the end of the tubing over the sink and prime the tubing by slowly opening the roller clamp. Make sure to invert the tubing when fluids reach the ports and hubs and tap to get the fluid out of the area. Place the protective cap on when primed and clamp roller. Date, time your tubing and bag. Perform hand hygiene. IV insertion technique 1. Hand hygiene. Introduce self, verify orders, gather supplies and Place tourniquet 4-6 inches above insertion site. Start distal and move proximally. Look for bifurcations, sclerosis of veins and previous sites. Don’t insert below a previous site in the same vein. With index finger palpate veins finding the most appropriate vein. Remember don’t depend that a visible vein is always the best vein. Always use your finger to palpate and verify vein patency. Release tourniquet. 2. Clean with appropriate cleaning solution and let area dry. When cleaning start with a side to side motion, then a up and down motion, then in a circular motion from the inside out on the area you are going to insert your IV. Chlorhexidine needs to dry at least 30 seconds, alcohol at least 60 seconds, and betadine 2-3 minutes. Chlorhexidine is the most common and best cleaner to use when inserting an IV. 3. Place tourniquet appropriately again. 4. Anchor vein taught above insertion site 5. Insert bevel up at a 10-30% angle quickly piercing the skin and then gently advancing into the vein. Look for flash, lower the catheter to the level of the skin and advance catheter into the vein. While advancing the catheter pull back on the needle – when the catheter is in place, remove the needle while applying pressure at least 3cm above the insertion site as to not displace the catheter. Place on IV tubing. 6. Stabilize the catheter with appropriate tape or catheter and securement device. 7. Check patency by flushing and then clamp. 8. Date/time insertion site. Dispose of needle and supplies appropriately and perform hand hygiene BEVEL UP INSERTION!!!!! Site Management YOU ARE RESPONSIBLE FOR THE IV EVEN IF YOU DIDN’T INSERT IT!!!!!! Monitor for infection, phlebitis, infiltration, extravasation, circulatory overload, pain, decreased skin temperature around insertion site, edema, pallor to area