What is the proper protocol for administering an intravenous (IV) injection to a healthy adult patient?

How to Give an IV Injection

For intravenous injections in healthy adults, use proper hand hygiene and aseptic technique, select an upper extremity peripheral vein (preferably antecubital or forearm), cleanse the injection port with 70% alcohol, insert the catheter at a 10-30 degree angle, confirm blood return, secure the catheter, and administer medications slowly while monitoring for adverse reactions. 1

Site Selection and Preparation

Vein Selection

• Always choose upper extremity sites over lower extremity sites in adults to reduce the risk of thrombophlebitis and other complications 1
• Preferred peripheral IV sites include:
  • Antecubital fossa (inner elbow)
  • Forearm veins (cephalic and basilic veins)
  • Hand veins (as a last resort due to higher discomfort and phlebitis risk) 1, 2
• Avoid steel needles for medications that could cause tissue necrosis if extravasation occurs 1
• Consider a midline catheter or PICC when IV therapy duration will likely exceed 6 days 1

Skin Preparation

• Clean the injection site or port with 70% alcohol or iodophor before accessing the system 1
• Allow the antiseptic to dry completely before needle insertion to maximize antimicrobial effect 1
• Use aseptic technique throughout the procedure to prevent catheter-related infections 1

Insertion Technique

Equipment Assembly

• Gather all necessary supplies: appropriate gauge catheter (typically 18-22 gauge for adults), tourniquet, antiseptic, transparent dressing, normal saline flush, and prescribed medication 3, 4
• Ensure all components are compatible to minimize leaks and breaks in the system 1

Catheter Insertion

• Apply tourniquet 4-6 inches above the intended insertion site 2
• Insert the catheter at a 10-30 degree angle with the bevel up 2, 3
• Advance until blood return is visualized in the flashback chamber 2
• Lower the angle and advance the catheter off the needle into the vein 2
• Release the tourniquet and apply pressure above the catheter tip before removing the needle 2
• Secure the catheter immediately to prevent dislodgement 2

Medication Administration

Pre-Administration Checks

• Verify the "five rights": right patient, right medication, right dose, right route, right time 3, 5
• Check for medication compatibility if multiple drugs will be administered 1
• Assess baseline vital signs before administering medications that may cause reactions 1

Administration Protocol

• Flush the IV line with normal saline before and after medication administration to confirm patency and prevent drug interactions 1
• Administer medications at the prescribed rate—rapid injection can increase the risk of adverse reactions 1
• For the first 10 minutes of any new medication infusion, observe closely for immediate reactions including flushing, pruritus, chest tightness, or respiratory symptoms 1
• Monitor vital signs during administration, particularly for medications known to cause hypotension or allergic reactions 1

Specific Medication Considerations

• Central venous access is preferred for vesicant medications, vasopressors, and irritating drugs (calcium, amiodarone, procainamide) that can cause tissue damage if extravasated 1
• Medications like adenosine are more effective when administered closer to the heart via central access 1
• For emergency medications during cardiac arrest, the IV/IO route is strongly preferred over endotracheal administration 1

Monitoring and Complication Management

During Infusion

• Stop the infusion immediately if the patient develops pain, swelling, redness at the site, or systemic symptoms (headache, dyspnea, chest pain, hypotension) 1, 6, 7
• Switch to normal saline at keep-vein-open (KVO) rate to maintain access while assessing the situation 1, 6
• Perform a complete physical assessment including vital signs if any adverse symptoms occur 1, 6

Infiltration/Extravasation

• If infiltration is suspected, stop the infusion immediately and do not flush the line 7, 2
• Elevate the affected extremity and apply warm or cold compresses as appropriate for the specific medication 7, 2
• Document the medication infiltrated, estimated volume, location, and clinical findings 7
• For vesicant extravasation, notify the physician immediately as antidotes may be required 2, 8

Hypersensitivity Reactions

• For mild reactions (pruritus, flushing, urticaria): stop the infusion, monitor for 15 minutes, consider antihistamines 1
• For moderate reactions (dyspnea, hypotension, tachycardia): stop the infusion, administer hydrocortisone 100-500 mg IV, famotidine 20 mg IV, maintain IV access with normal saline 1
• For severe reactions/anaphylaxis: immediately administer epinephrine 0.3 mg IM into the anterolateral thigh, call emergency services, prepare for resuscitation 1

Equipment Maintenance

Administration Set Changes

• Replace primary administration sets no more frequently than every 72 hours unless catheter-related infection is suspected 1
• Replace tubing used for blood products within 24 hours of initiating the infusion 1
• Replace tubing for lipid emulsions within 24 hours 1
• Change needleless components at least as frequently as the administration set 1

Injection Port Care

• Wipe injection ports with 70% alcohol before each access 1
• Cap all stopcocks when not in use to prevent contamination 1
• Access ports only with sterile devices to minimize infection risk 1

Critical Pitfalls to Avoid

• Never restart an infusion after a reaction without laboratory clearance and physician approval, even if symptoms resolve, as serious reactions can progress with continued exposure 6
• Never assume "just a headache" during infusion is benign—it may signal acute hemolytic reaction, bacterial contamination, or TRALI 6
• Never use lower extremity sites in adults due to significantly increased thrombosis and infection risk 1
• Never administer IV medications during active bacteremia when avoidable, as this increases the risk of seeding infection 9
• Never combine leftover contents of single-use vials for later use due to contamination risk 1
• Avoid unintentional intra-arterial injection by carefully identifying anatomical landmarks and confirming venous (not pulsatile) blood return—arterial injection can cause severe pain, paresthesias, gangrene, and limb loss 8

Documentation Requirements

• Document the insertion site, catheter gauge, number of attempts, medications administered, patient response, and any complications 6, 7
• Maintain 100% traceability for all IV medications and blood products as a legal requirement 6
• Report all transfusion reactions and serious medication reactions to the appropriate institutional authorities 6