How to start an IV is a fundamental skill that every nurse must master.
This procedure is essential for providing patients with critical access to their bloodstream for the delivery of medications, fluids, nutrients, and other treatments. Honing this skill not only enhances a nurse's competence and confidence but also significantly impacts patient outcomes and satisfaction.
About 80% of hospital patients, according to the Journal of Infusion Nursing, receive peripheral IV fluid administration, and nurses are vital in preventing complications during this procedure.
This guide provides a step-by-step guide to starting an IV, discusses the benefits of mastering this skill, and offers tips for improving technique.
The importance of IV skills
For nurses, proficiency in how to start an IV is a key aspect of clinical practice. This skill is indispensable in various healthcare settings, including hospitals, outpatient clinics, emergency departments, and home care. Mastering IV insertion enhances a nurse's versatility and value within the healthcare team, allowing them to provide timely and efficient care in a range of situations.
Beyond the practical benefits, being adept at IV insertion also boosts a nurse’s confidence and reduces anxiety associated with difficult procedures. Confidence in IV skills can translate into a more relaxed and efficient approach, which can positively affect the patient’s experience.
Skilled IV placement also can reduce potential complications.
How patients benefit
When nurses are adept at starting IVs, patients benefit significantly from a seamless insertion process.
Minimizing discomfort and anxiety during the procedure can greatly enhance the overall patient experience. A successful first attempt at IV placement reduces the need for multiple needle sticks, which can be painful and distressing. Additionally, efficient IV insertion ensures that patients receive their medications and fluids promptly, which is crucial in emergency situations and for those requiring continuous treatment.
A smooth IV process also minimizes the risk of complications. Proper technique helps prevent issues such as infiltration, where the IV fluid leaks into surrounding tissues, or phlebitis, which is the inflammation of the vein. Reducing these risks leads to fewer interruptions in therapy, less discomfort for the patient, and a lower likelihood of additional medical interventions.
Preparing for insertion
Preparation is key to success when learning how to start an IV.
Begin by gathering all necessary equipment, including gloves, an IV catheter, tourniquet, antiseptic swabs, adhesive tape, gauze, a transparent dressing, and an IV start kit. Ensure that you have checked the patient’s medical history for any contraindications to IV therapy, such as allergies to specific materials or previous IV complications.
Create a comfortable and calm environment for the patient. Explain the procedure clearly, addressing any questions or concerns they may have. This helps to alleviate anxiety and ensures patient cooperation. Position the patient comfortably, with their arm supported and extended. Apply a tourniquet about 4 to 6 inches above the intended insertion site to distend the veins, making them more visible and palpable.
Selecting the insertion site
Choosing the right vein is an important step in successful IV insertion. The most common sites are the veins in the forearm and the back of the hand. These veins are typically more accessible and less prone to complications.
When selecting a vein, consider factors such as the size, condition, and mobility of the vein, as well as the type of therapy and duration of treatment.
Palpate the veins to assess their size and condition. Look for veins that are straight, firm, and well-filled. Avoid areas with visible signs of infection, scarring, or recent IV sites. In patients with difficult venous access, consider using a vein finder or ultrasound to locate suitable veins.
Performing the insertion
Once you have selected an appropriate vein, prepare the insertion site by cleaning it with an antiseptic swab, moving in a circular motion from the center outward.
Allow the antiseptic to dry completely to ensure effective disinfection. Don clean gloves to maintain aseptic technique throughout the procedure.
Stabilize the vein by gently pulling the skin taut below the insertion site. This helps to prevent the vein from rolling and provides a stable target for insertion. Hold the IV catheter with your dominant hand, bevel up, at a 15- to 30-degree angle to the skin.
Insert the catheter into the vein using a smooth, controlled motion. You should feel a slight "pop" as the needle enters the vein, followed by a flashback of blood in the catheter chamber, indicating successful venous entry. Once you see the flashback, advance the catheter slightly to ensure it is well within the vein.
Next, hold the catheter hub in place with your non-dominant hand while releasing the tourniquet. Continue to advance the catheter over the needle into the vein. Once the catheter is fully advanced, retract the needle while applying pressure above the insertion site to prevent blood from leaking out.
Secure the catheter by applying adhesive tape and a transparent dressing over the insertion site.
Ensure that the dressing is applied smoothly without wrinkles to maintain visibility of the site and reduce the risk of infection. Attach the IV tubing to the catheter hub and secure it with additional tape, if needed. Flush the catheter with saline to ensure patency and check for any signs of infiltration or phlebitis.
Monitoring and troubleshooting
After successfully starting the IV, monitor the site regularly for signs of complications. Look for any redness, swelling, or pain that could indicate infection, infiltration, or phlebitis. Ensure the IV is flowing smoothly and that the patient is comfortable.
If you encounter difficulty during the insertion, such as missing the vein or encountering resistance, do not attempt to force the catheter. Instead, withdraw the needle slightly and reassess the situation. It may be necessary to select a different vein or reposition the patient’s arm to achieve successful insertion.
Improving IV insertion technique
Improving IV insertion technique requires practice, continuous learning, and feedback. Here are some strategies to help nurses refine their skills and become proficient in how to start an IV:
- Practice regularly: The more you practice, the more comfortable and skilled you will become. Take every opportunity to start IVs under supervision and seek feedback from experienced colleagues.
- Use visualization and palpation techniques: Develop your ability to visualize and palpate veins accurately. This skill is particularly important in patients with difficult venous access. Practice identifying veins using both sight and touch to improve your confidence and accuracy.
- Stay calm and confident: Anxiety can affect your performance. Stay calm and confident during the procedure. Deep breathing and positive visualization can help reduce stress and improve focus.
- Attend workshops and training events: Participate in IV insertion workshops and training sessions offered by your employer. These programs provide valuable hands-on experience and tips from experts in the field.
- Learn from mistakes: Reflect on any challenges or difficulties you encounter during IV insertion. Use these experiences as learning opportunities to improve technique and advance problem-solving skills.
- Stay updated on best practices: Keep abreast of the latest best practices and guidelines for how to start an IV. Advances in technology and techniques can enhance your skills and improve patient outcomes.
By following a systematic approach to IV insertion, from preparation and site selection to insertion and monitoring, nurses can improve their technique and provide high-quality care. Continuous practice, feedback, and ongoing education are key to mastering this vital skill. As nurses become more proficient in IV insertion, they contribute to better outcomes and overall healthcare quality.