From the Guidelines
Intravenous (IV) insertion involves several key steps to safely access a patient's vein for medication or fluid administration, with the most critical steps including gathering necessary supplies, maintaining sterility, selecting an appropriate vein, and confirming needle position in the vein 1. To begin the IV insertion process, gather all necessary supplies including catheter, tourniquet, antiseptic, gloves, dressing materials, and IV tubing if needed.
- Wash hands thoroughly and don gloves to maintain sterility.
- Select an appropriate vein, typically starting with the forearm or hand, avoiding areas with bruising or infection, as recommended by guidelines for preventing intravascular catheter-related infections 1.
- Apply the tourniquet 3-4 inches above the insertion site to distend the vein.
- Clean the site with an antiseptic solution like chlorhexidine or alcohol, working in a circular motion from center outward, and allow it to dry completely, as suggested by guidelines for central venous access in oncology 1.
- Hold the catheter at a 10-30 degree angle with the bevel facing up, and insert it through the skin into the vein until blood return is visible in the flashback chamber.
- Lower the angle and advance the catheter while simultaneously retracting the needle.
- Remove the tourniquet, apply pressure to the vein above the catheter tip, and fully remove the needle.
- Connect the IV tubing or cap the catheter, secure with transparent dressing, and label with date, time, and your initials. It is also essential to confirm the needle position in the vein before proceeding with the insertion, as recommended by a structured review and recommendations for clinical practice on ultrasound-guided central venous catheter placement 1. Proper technique reduces complications like infiltration, phlebitis, and infection, while ensuring reliable vascular access for patient treatment.
- The use of ultrasound guidance can aid in identifying the anatomy of the insertion site and localizing the vein, as suggested by a study on ultrasound-guided central venous catheter placement 1.
- Regular monitoring and maintenance of the IV site are crucial to prevent complications, including daily evaluation of the catheter insertion site for signs of infection or phlebitis 1.
From the Research
Steps for IV Insertion
The steps for intravenous (IV) insertion can be outlined as follows:
- Selection of the insertion site: The choice of insertion site is a known predictor of catheter failure 2.
- Preparation of the site: This includes cleaning and disinfecting the area.
- Insertion of the catheter: This can be done using the traditional technique or with the aid of ultrasound guidance 3, 4.
- Verification of catheter placement: This is crucial to prevent complications such as inadvertent intra-arterial cannulation 5.
- Securing the catheter: This includes taping the catheter in place and covering the site with a dressing.
Techniques for IV Insertion
Different techniques can be used for IV insertion, including:
- Traditional technique: This is the most common method used for IV insertion.
- Ultrasound-guided technique: This method uses ultrasound to guide the insertion of the catheter and has been shown to improve the success rate of IV insertion, especially in difficult patients 3, 4.
- Use of vessel locating devices: These devices can be used to help locate veins and improve the success rate of IV insertion, but their effectiveness may depend on the skill level of the person inserting the catheter 2.
Considerations for IV Insertion
When inserting an IV catheter, it is essential to consider the following:
- The risk of complications such as inadvertent intra-arterial cannulation 5.
- The potential benefits of using ultrasound guidance or vessel locating devices to improve the success rate of IV insertion 3, 4, 2.
- The importance of proper training and education for healthcare professionals inserting IV catheters 3, 2.
- The need for careful selection of the insertion site to minimize the risk of catheter failure 2.