Hi, welcome to the skill Intravenous Catheter Insertion and Removal.
Now, this is a pretty complex skill, so please pay attention and follow along with me.
So, let's start with what you're gonna need.
There's actually a good amount of equipment that we need to consider when we start an IV.
So, first and foremost is the peripheral IV catheter.
Now, know with IV catheters, it's gonna vary in sizes,
so, you will have to make a decision about which one is most appropriate.
So, don't forget, peripheral IV catheters is going to vary in sizes.
Also know that each facility has a little bit different equipment
so you're gonna want to get familiar with what your facility has.
Alright. Next, we need to look at the extension tubing.
Sometimes, you're gonna hear a nurse call this a pigtail.
It's a funny name, but a lot of the time if someone says,
"Hey, go get a pigtail." This is what they're talking about.
Then we're gonna need the luer lock hub.
So, this is what's gonna connect to your pigtail or your extension tubing,
then you're gonna need saline flushes.
So, again, more equipment, we've got an IV start kit.
So, the nice thing, all of these pieces are usually bundled together.
However, I'm gonna talk about those components of that start kit.
So, first, you need an alcohol pad. This is gonna help clean the site.
You're going to need a tourniquet to hold pressure and also to help visualize veins for you.
You also will need a gauze dressing, this may help you there to clean up any mess that you made.
And also, a transparent dressing, this is gonna cover the IV insertion site, to keep out those microbes.
Alright, the last thing that you see is a stabilization device.
Now, this is gonna vary from facility to facility.
So, in this, just know that that's a possibility that your facility may use.
But lots of facilities do not use this due to cost and extra supplies.
So, when we start an IV, in any procedure with the patient,
don't forget hand hygiene when you come into the room.
We definitely wanna provide patient privacy cuz we are doing a procedure with our patient
and make sure that you guys are explaining this in detail to your patient.
Now, keep in mind, when we are poking or inserting an IV, if you will, anything sharp,
any procedure with a patient, there may be some apprehension there,
some anxiousness, so we wanna be reassuring in this step.
And also, don't forget to raise the bed to appropriate working height for you.
Luckily, I'm not very tall, but if you were, we don't wanna be crouching down or leaning over.
We wanna get in a position and do a procedure that is most comfortable for you so you can be successful.
So, once we've done that, we've provided privacy, done hand hygiene,
we've explained the procedure to the patient, we wanna position our patient
and it's good to place the patient and put their arm in a dependent, comfortable position.
Sometimes, we may wanna support their arm with the pillow if that's also comfortable for a patient.
Then you wanna prepare your supplies.
So, you have the option to use a tray table, you could also even put it on your patient,
to where it's very easy access when you're starting the IV.
You'll see that in a few in the demo.
Also, before we start the procedure, let's do everything we can
so we don't have to basically stop in the middle of what we're doing
and we've got our hands tied up so we're going to attach that luer lock to the extension tubing
and then, we're also going to attach our flush here and you'll see why later.
So, we're gonna attach the flush, we're gonna push the plunger,
in what we call prime the extension tubing.
All we really mean here is we're going to push the saline through the pigtail or extension tubing here.
So, now, pro-tip, if you will leave the flush attached to your pigtail or extension tubing,
this will make it much easier for you later when you have to attach it to the IV.
So now let's take a live look at how we prepare our equipment.
I'm gonna get some hand hygiene started.
Alright, so first I've got all my equipment here and of course, my patient.
So, I wanna make sure my patient is nice and comfortable.
This could be a bit of an anxious procedure for them,
so I want their comfort to be really important.
Alright, so then we're gonna take the arm that we decide to select our vein
and make sure that arm is in a nice, relaxed dependent position.
So, now I can open and prepare my supplies.
So, if you remember here, when we talked about supplies,
we've got an IV start kit that contains most of what we need.
We've also got our IV catheter, we've also got our extension set,
we also have our hub on top of our extension set so we can attach our flush later.
Alright. So, any time you start an IV, you wanna try to make sure all of your equipment is nice and ready,
because once you get in there, it's very hard to try to manage equipment and then IV insert.
So, let's open our equipment first.
Alright. So, most facilities have something looking like an IV start kit.
The nice thing in here when we open, it's got a nice tab for you,
you can open this up and this is gonna include things such as your alcohol pad, your tourniquet,
it's gonna have your extra gauze for you.
So, when we've opened this up, we've got our tape, we've got our ChloraPrep, or alcohol pad.
Now, each IV start kit is gonna vary a little bit
so just know that you will have something to clean the insertion site with.
We've got our tourniquet and this is gonna be applied to the patient.
Always comes with a nice little rubber band, let's get this off.
We're gonna unroll this so this is our tourniquet for our patient.
Then inside, we've got our transparent dressing as well, so we wanna get that out and ready.
We've got a gauze pad also inside the insertion kit in case you need to clean up a little extra body fluid or blood.
This is also a nice little thing that comes with the insertion kit.
This will help go underneath the patient's arm if you choose to use that.
Alright, so now that all of our equipment is open, I'm also gonna prepare my IV catheter.
As you can imagine, if I'm trying to insert an IV,
trying to open all of this while doing the IV is not gonna be very easy,
so let's get all of this prepped first. So, I've opened my IV start kit.
I've got my tourniquet and my catheter ready.
Now, we're going to prime and attach our extension tubing.
So, you noticed when I'm opening everything, I'm leaving everything in the package.
This is gonna keep everything as clean and sterile as possible before we apply it to our patient.
Now, anytime that you use equipment on your patient, don't forget,
you wanna make sure it's all in date as well, and make sure your equipment's not expired.
So, I'm gonna open this up and this is our luer lock or our cap
and this is going to go on one side of the extension tubing.
So, we can unscrew this, I'm being very careful not to touch the connecting points with my fingers
and attach this on top of my extension tubing
and I'm gonna leave this in the package again so it's not dragging on the table.
Next, we're going to attach our flush.
So, I'm going to open up my package, I'm going to take off the cap.
Now, these things are a little bit tricky.
There a lot -- a lot of the times, excuse me, under pressure so here's a little pro-tip,
on a saline flush, if you will pull down a little bit,
it will break that pressure, and you want to pull this all the way up
and prime this all the way to the top, okay, that way, when you inject,
it's not pushing air into your patient.
Alright, so here's our saline flush.
Now, we're going to attach it onto and this is the luer lock part where we screw this on.
Now that we've attached the hub to the extension tubing,
I've got my saline flush attached and now we need to prime it.
What I mean by this is I've got my saline flush and I'm gonna push the saline through the tubing
and you will be able to see how it's slowly dripping at the end.
That means the saline's made it all the way to the end,
so it's nice and prime for when we attach it to our patient.
Now, this is important to prime this so when we attach this to our patient, it's already all ready to go.
Now, one little thing that you've noticed, I have left the flush on the extension set.
The reason why I do this, once I insert the catheter, it's already ready to go,
I can screw it on, hold pressure, and inject.
So, this will save me a step later and it saves me from having to manage the flush, attach that
when I'm holding onto the catheter for my patient. Hope that was helpful for you.