Procedural Demonstration of Inserting a Peripheral IV by Brienne Leary.
First you will need to find the vein. You should visualize for the vein, or you can palpate and feel a bouncy tube.
Sometimes you will need to place the tourniquet as your first step to help find the veins
and fill them with blood to make it easier to visualize.
Next, you’re going to apply the tourniquet. You’ll loop the tourniquet
under the patient’s extremity and then pull both tabs upwards, cross the ends over each other
and then pull one tab behind and under the other one. Pull it partially though to create
a small loop, but do not pull it all the way through; this will leave a tail for easy removal.
Next you'll want to prep the skin using your cleansing prep pad and gauze.
Let the area dry for approximately 30seconds.
Remove the plastic covering from the IV catheter, exposing the needle and cannula. Loosen the
catheter from the needle. Prepare to approach the vein with the IV catheter. Make sure you
hold the IV catheter with the bevel of the needle facing up. Next, you’ll want to puncture
the skin using a 25-30 degree angle initially to access the vein. Insert the IV slowly to
avoid going through the vessel. Look for a flashback of blood in the catheter as an indication
that the IV is in the vessel. Once flashback is visualized, advance the catheter slightly,
and then decrease the angle of the catheter to be more parallel with the skin. Carefully
advance the catheter off the introducing needle by simultaneously stabilizing the needle and
sliding the catheter completely under the skin. If advancement stops, the catheter may
be hitting up against a valve. You can remove the tourniquet, attach a saline flush directly
to the catheter, and then try to advance while flushing in saline.
After advancing the catheter, remove the tourniquet. If possible, apply pressure above the insertion site and remove
the needle. There should still be blood flowing back indicating that the catheter is in the vein.
Secure your sharps, attach the connector, and flush the catheter, looking for infiltration.
Infiltration is caused when the catheter is no longer in the vein and fluid is now infusing into the patient's soft tissue.
It can also occur when there is a hole in the vein that has gotten large enough to allow for extra fluid to leak out around the insertion site and into the tissue.
Next, we’ll talk about securing the IV.
If the connector has a metal or thick end, place a piece of gauze under the end
before putting the dressing on to protect the skin from breakdown.
You’ll want to dress the site with a transparent occlusive dressing.
Make effort not to cover the insertion site with anything opaque. This is important so that the site
can be monitored for signs and symptoms of infiltration or phlebitis. Assess, again,
for the patency by flushing, and clamp the connector. Secure the catheter with tape
using the chevron technique. This is shown here by taking a ½ inch piece of tape, adhesive
side up, sliding it under the hub of the catheter and cross the tabs over one another, adhering
them to the patient on opposite sides. When necessary, use a second piece of tape and
secure the attachment device.
When an IV is placed over a joint, use a supporting device, such as an arm board, to keep the
child from bending the extremity.
Point of Clarification. The chevron technique is only
one method that is used to secure an IV to a patient. Be sure to check with your institution's
policy as to how you should secure an IV to your patient.