Iv procedure

Verify provider's order to start and maintain a peripheral IV.

Identify the patient. Review patient’s history for:

Explain procedure to patient.

Place the patient in a comfortable sitting or reclining position and place the arm in a dependent position to increase venous fill.

Assess the patient’s veins to determine start location.

Prepare supplies.

Apply a tourniquet 2-6 inches above site.

Assess the patient's veins in the upper extremity and identify potential sites that are easily seen or palpated. Lightly palpate the vein with the index and middle fingers of your nondominant hand. Stretch the skin to anchor the vein. If it feels hard or ropelike, select another. If the vein is easily palpable but not sufficiently dilated, place the extremity in a dependent position for several seconds or lightly stroke the vessel. Apply dry heat if necessary.

Release the tourniquet for site preparation.

Clean the intended insertion site and surrounding skin with alcohol prep pad using a back-and-forth scrubbing motion for at least 15 seconds to remove flora that would otherwise be introduced into the vascular system with the venipuncture. If the intended insertion site is visibly soiled, clean it with soap and water before applying the antiseptic solution. Allow the antiseptic to dry completely for 30 seconds. Multiple preps can be used if skin cleaning is not achieved with just one. Clip hair around the insertion site, if needed, with single-patient-use scissors or disposable-head clippers to facilitate dressing application after catheter insertion.

If you must palpate the intended insertion site after cleaning, remove and discard your gloves, perform hand hygiene, and put on sterile gloves to avoid contaminating the insertion site.

Tell the patient that you're about to insert the device

Re-apply tourniquet

Immobilize the vein by pressing 1" to 2" below the site with your thumb and drawing the skin taut.

Place the bevel up of the needle at a 10- to 15-degree angle 

Puncture the skin and anterior vein wall, watching for blood to appear in the flashback chamber. Advance the catheter/cannula into the vein. It should thread in easily without resistance. 

Release the tourniquet 

Place 2x2 under the catheter hub, and occlude the vein. Pull the needle out and quickly attach the luer lock cap/tubing connection. Make sure the connection is tight. If there is any blood that spilled, clean it off the skin with antiseptic before taping.

Apply tegaderm or tape at the top of the IV at the insertion site to immobilize as best as possible. Put a piece of tape across the luer lock cap/tubing as well. If the catheter isn't in the vein, remove and discard it, apply pressure with a cotton ball to the puncture site and wrap the patient with coband. Select a new venipuncture site and, using fresh equipment, restart the procedure.

If using a cap, use antiseptic to clean the insertion site of the luer lock cap. Push all of the air bubbles out of the saline solution syringe. Insert the needle into the luer lock cap. Pull back to aspirate and see blood flow easily into the syringe. Gently and slowly push saline fluid in. Do the same if using any tubing connection. Aspirating will assure the catheter is set correctly in the vein. When pushing fluids, always check for signs for infiltration. 

Discard used supplies in appropriate receptacles. Remove and discard your gloves. Perform hand hygiene.