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IV InsertionThis section covers the proper way to prepare and complete an IV insertion on a client in the clinical field. Having the ability to insert IVs correctly and efficiently is a essential skill for a nurse, especially one in an acute care setting such as the emergency room. However, even if you are not in a more acute care setting, you should still know how to use the correct technique to insert a peripheral IV line.
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Equipment
- Non-latex exam gloves, chose ones that are a proper fit to your hand.
- Tourniquet
- 2 to 4 2x2 gauze pads
- Cholra-prep device or Alcohol prep pad
- Medical tape, tear 3 to 4 pieces prior to procedure for efficiency
- Tegaderm dressing
- 7 inch saline lock IV line
- 10 ml syringe
- 10 ml 0.9% Normal saline flush
- IV catheter, size depending on what the site is to be used for. 18 gauge to 24 gauge is the usual span for acute care settings
Assessing for a Good Vein
When assessing the client for a good vein to start an IV in you can use these simple guidelines:
- Ask the patient if they have ever had an IV before. If they have, ask where it was inserted because chances are that you will be able to hit that same vein.
- Ask the patient if they have good veins. Generally when patients who have had IVs before know that they are having another, they will let you know voluntarily if their veins are difficult to hit or if they roll easily. This is common in many elderly clients.
- Ask the patient if they are right or left handed. This can eliminate any problems the patient may have when it comes to signing forms for instance. Also the catheter when inserted into spaces such as the hand and antecubital area can be uncomfortable when moving the extremity.
- After applying the tourniquet to an area above the desired entry site, ask the client to make a fist and release it about 5 to 10 times. This will help to pump up the veins making them easier to see.
- If the client's veins are not easily visible, palpate for them. Start in the antecubital area because often times most patients have a very large antecubital vein, which is easy to hit. If you think that you have found a vein but aren't sure, you can use an alcohol prep pad and rub over the vein. The alcohol can make the vein easier to see and makes your job a lot easier.
- Choose a vein that is as straight as possible to allow you to achieve the easiest insertion. Try not to insert near any bifurcations.
- Some clients, especially ones who are older, tend to have more valves in their veins. This can pose as a problem because although you might get a flash in the chamber, when you attempt to advance the catheter, you will hit resistance and chances are that you will not be able to save the IV. If you look closely at a client's vein, valves look like little balloons along the vein.
Choosing The Right Catheter Size
Choosing the right catheter size may seem like a difficult task, but in all reality it is not if you know the uses for the many different sizes. Most agencies will have protocols that will tell you if they need a certain size for diagnostic testing, and this will be ordered by the physician for a specific size if they anticipate a certain procedure for the patient.
Here are some quick tips for selecting the right catheter size:
Here are some quick tips for selecting the right catheter size:
- 18 or 20 gauge is usually the gold standard because they allow most anything to be infused through them.
- If you are going for a vein in the hand or wrist a 20 gauge or above needs to be used because larger catheters can be very irritating in these areas.
- Some clients have very tiny veins, so using a large catheter is not an option, so choosing a 22 or 24 gauge is appropriate to ensure you get a patent line.
- If a patient is anticipated to go for a radiological study such as a CT scan, an 18 gauge needs to be inserted above the wrist. The reason for this is due to the injection of contrast dye for the procedure. It doesn't have to do with the concentration of the dye, but rather the speed at which they inject it, which is rapidly, so they need a larger bore to facilitate this.
- Generally 14 and 16 gauge catheters are not needed in most settings, but if they are they generally go in larger veins.
- Agencies have the same brand of catheters, just in different sizes. So you don't need to worry about one catheter being different from another.
Tips for Inserting the IV
All hospitals have different procedures when it comes to how you are supposed to start an IV, however the underlying concept is still the same no matter where you go. Knowing how your hospital wants things done is a good thing to learn to facilitate a better work environment. Getting an IV can be a new event for some clients and it is a unknown territory, so make sure to educate your client on why the IV is being inserted and the procedure along with it. Building a trusting relationship with a patient is key because if they see that you are confident in your ability and know why they need this procedure, it makes inserting the IV a much easier experience This can be a very traumatic time for a client because it is painful, and the ability of the client to manage their pain can make your job easier or harder, depending on their pain tolerance. Make sure to tell the patient when the poke is coming and ask them to hold still and be as relaxed as possible. After you have hit the vein and retracted the needle, let the client know because a common misconception among many clients is that the needle stays in, when in fact the catheter is plastic. When flushing the line, make sure that the site flushes easily and there is no swelling above the catheter, which could suggest an infiltration. After the procedure is complete, thank the patient for their cooperation and ask if there is anything that you can do for them.
Documentation
- Insertion of an IV requires specific documentation.
- Document the size of the catheter that was inserted
- Document the location of the catheter
- Document who inserted the catheter, whether it was yourself, or if EMS personnel inserted it en-route.
- Document that a Tegaderm dressing was applied and labeled with the date and time of the initiation and your initials.
- Document how the line flushed and if it is good to use.
- Document how the patient reacted to the procedure