RUNNING HEAD: Inserting an IV

Inserting an IV

Julia Durso
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TABLE OF CONTENTS

Preface

Introduction
These guidelines have been written as a training manual for which will be the main source of

learning how to do an intravenous line on a patient. This manual should be used to study and self

teach. This was written for nurses and other healthcare professionals with the appropriate

credentials to be able to carry out this procedure.

Objectives
At the end of this lesson, you will be able to:

Assemble an IV bag with tubing

Prepare veins for an IV
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Insert an IV
Remove the Needle

Contact
For questions about this manual contact the writer, Julia Durso, by email.

Julia.durso@uky.edu

Practice Exercises
1. What materials are needed to start an intravenous line?
2. What should you say to the patient when first meeting them?
3. What do you do if there are bubbles in your IV tubing?
4. On which patients should you use smaller catheters?
5. How do you palpate a vein?
6. When inserting the needle, should the bevel face up or down?
7. How far do you move the needle into the vein?
8. How do you reduce the strain on the catheter and tubing?

Answers
1. Gloves, 14-25 gauge catheter, tourniquet, bag of IV fluid, gauze, sterile dressing, medical

tape, alcohol wipes, sharps container, and sterile pad.

2. Introduce yourself and explain what you will be doing.
3. Gently squeeze or tap the tubing.
4. Children and elderly people.
5. Push down on it from the side closest to the tourniquet.
6. The bevel should face up.
7. One centimeter.
8. Loop it and secure it with medical tape.

Preparation
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Step 1: Acquire All Materials

To begin, you will need to gather all the materials necessary to start an IV. You will need

two sterile gloves, a 14-25 gauge IV catheter, a tourniquet, a bag of IV fluid, gauze, a sterile

dressing, medical tape, alcohol wipes, have a sharps container near by for disposal, and a sterile

pad to set everything on.

Step 2: Make Sure the Patient is Comfortable with You

When you first walk into the room, make sure that you introduce yourself to the patient.

Be kind, polite, and make it evident that you care about the level of care that the patient is

receiving. In a calm manner, let them know that you are going to start an IV, where you will be

placing it, and that they might experience a pinch or some pain while you are doing it. Be kind

and calm so your patient does not get scared or nervous.

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Make sure that no part of the process is a surprise to your patient, so walk them through

what you will be doing. You can say something like, I will insert a small needle for just a

second and you might feel a pinch. This will prepare your patient for any pain and keep them

from being surprised during the process.

Step 3: Assemble the IV Liquid and Tubing

First, take the bag of IV liquid and suspend it from an elevated stand. Then attach the

tubing to the attachment site of the IV liquid bag by inserting the pointy end of the tubing into

the whole in the bottom of the IV bag. After that, fill the attached tubing with IV liquid wherever

you need to by adjusting the valves on the tubing. To adjust the valves, just push the adjuster to

the opposite side.

Next, it is extremely important that you check for bubbles in the tubing. If you fail to get

rid of any bubbles in the tubing, they can go into the patients blood stream and cause an

embolism. An embolism can block blood flow and be very serious, so it is critical that you avoid

this. If you see any bubbles in the tubing, you can remove them by gently squeezing or tapping

on the tube at the site of the bubble. If the bubble will not seem to go away after squeezing or

tapping the tubing, you can disconnect the tube and let it flow into a garbage can. After this, just

reconnect the line.

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Step 4: Pick the Right Size Catheter

To start, you need to know that catheters get larger as their number decreases. This would

mean that a 14 gauge catheter would be larger than a 25 gauge catheter. Although a larger

catheter administers the medicine quicker, they are also more painful for the patient. For this

reason, you should use smaller catheters on children and older patients.

For patients that need their medication administered quickly, use a larger catheter. The

catheters are over the needle, so after the vein is punctured, remove the needle and leave the

catheter in place. Mount the catheter that you have chosen for your patient over the needle before

beginning to insert it.

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Step 5: Put on Gloves

To prevent infection, wash your hands with an antibacterial soap and dry them with a

clean paper towel before putting on gloves. Before ever puncturing the patients skin and

exposing you both to disease, make sure to put on sterile gloves. Although this step seems

obvious, it is critical that it is not skipped or forgotten. If your gloves ever come in contact with

something that could compromise their cleanliness, you should immediately remove them and

put on a clean pair.

Step 6: Find a Good Vein

As you are preparing to start the IV on your patient, first find a vein that is prominent

enough to put the needle into. Look for these veins either on the back of the patients hand or the

inside of their forearm or elbow. Start the IV in whichever of the two locations that you can find

an accessible vein. Avoid any areas that look red or irritated or that have recently had another IV

in them or another type of procedure.

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Action
Step 7: Apply Tourniquet and Palpate Vein

A tourniquet is a band that is tied around the patients arm to constrict blood flow. Let the

patient know that you will be tying a tourniquet around their arm to get better access to their

vein. When applying the tourniquet, place it on the side of the body closest to the chest. This is

because it will stop the blood from flowing into and out of the area you are trying to access.

Make sure it is not too tight, especially on older patients because it could tear their skin.

It should be tight, but you should also be able to slip a finger underneath it. When tying the

tourniquet, wrap it around the patients arm, then tie as if you are tying a single knot. However,

do not pull the end all the way through. Instead, pull it only half way through. This should leave

a small loop on one side and the rest of the band on the other side. This is so you can easily

remove it by pulling on the rest of the band when you are finished inserting the catheter. Then tilt

the patients arm downward to make the veins swell even more.

If the vein is still not prominent enough for you to confidently insert the needle, palpate

it. To palpate the skin, press down on the patients vein from the side closest to the tourniquet.

When pushing down on the vein, you should feel a little bit of a force come from it. Push up and

down on the vein for about 20 seconds. This should make the vein visibly larger.
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Step 8: Disinfect

To kill the bacteria around the site of the vein, disinfect the skin. To do this, rip open the

alcohol wipe. Then rub it gently and thoroughly all over the patients skin close to the site of the

vein. Apply an even coat to prevent infection.

Step 9: Prepare Needle

Remove the catheter and needle from their packaging. Then remove the protective cap

that is over the needle. After it is removed, push the catheter onto the needle until it is secure.

Make sure you do not touch the needle to anything before inserting it into the patients skin. This

could cause infection.

Step 10: Insert Needle

Use your non-dominant hand to hold the patients arm while you insert the needle with

your dominant hand. Take the needle in your dominant hand and insert it with the bevel facing

up. This will ensure that the needle goes in smoothly and easily because the sharper portion is
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being inserted. Make sure to insert the needle at a shallow angle so that it does not go too deep.

When you successfully get the needle into the vein, blood will move into the catheter. Once this

happens, move the needle one centimeter into the vein.

Step 11: Remove the Needle

Leaving the catheter in the skin, carefully pull the needle back one centimeter out of the

vein. Slowly push the catheter into the vein while putting pressure on the skin and vein with your

non dominant hand. When the catheter is in the vein, secure it with the sterile dressing. Place this

on the lower half of the catheter. Then remove the tourniquet by pulling on the band connected to

the loop. Next, remove the needle completely from the catheter, but only the needle.

After the needle is removed, place it into the sharps container. Next take the IV tubing

and remove the protective cover. Then screw it onto the catheter until it is locked into place.

Secure the catheter and tubing with the medical tape. First tape the end of the catheter, and then

make a loop with the IV tubing. Make sure it does not have any kinks in it that would prevent the

IV from flowing. Then secure the loop with another piece of medical tape. The loop will reduce

the strain on the catheter so that it does not pull on the skin or come out.
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