How to start an IV for Nursing | Intravenous Insertion 2021

IV insertion analysis and explanation

Hi everyone,

In this video I am going to take my IV insertion short video, which you can see here      and slow it down a little bit and explain the process a bit more.

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Before you insert an IV you want to think about where you want to place the IV. If you are trying to get an IV in for someone that is going for CT, there may be hospital policies that you want to follow regarding the size and location of the catheter you NEED to place for contrast dye. In general, our hospital policy suggests inserting an IV in the forearm as the ideal place as it the most safe place and less likely for the line to get kinked and not run your medication, have the IV pump yell at you etc… Depending on the patient, you want to choose a catheter that is appropriate, if the person looks very muscular they will probably have good veins, but if they are elderly and are small, veins will most likely be small. So always look at the patient and identify an appropriate size. Typically the IV size of choice is either a 22 gauge or sometimes 20 gauge.

So the torniquette is tied around the patients arm above the area where you want to insert. The tourniquette is important to be tied down quite tightly as it will allow you to see the vein easier and have it tied in a way that you are able to quick release it once you are finished. Pay attention to the technique that is used here. You can see it is tied where there is a loop here and there is a quick release here. So if we pull on the quick release it will untie very quickly. It is also important to not tie the tourniquette down so tightly that you will prevent arterial blood flow. You want to tie it enough to slow venous blood flow so that the veins are more plump and easier to puncture.

After tying the tourniquet make sure you place the hand in a way that allows you to visualize the vein properly. That may require you to set up or to turn on extra lighting. Also, while the tourniquette is tied in place allowing few seconds to pass is ideal for allow the venous blood flow to slow down.

After some time has passed and you feel you have a good visualization of the vein, clean the vein with whatever your hospital policy recommends to clean with. Cleaning over the site like so will allow the vein to pop more as well. Some people will also use a few a fingers and tap the vein to make it pop more.

So now let’s talk about the vein a bit more. As you can see this the ideal one to choose from due to few reasons. The first being is that it is very straight. It looks  big in size and the 22 gauge that was chosen here seems like it will be an easy insertion. The insertion site as you will see will be somewhere on this line here. This is because the vein is straight here, allowing for the plastic filament that is going to be inside the vein to easily go inside the vein. The areas we would avoid inserting the IV would be these ones. The reason being that these are likely to have valves in the junctions and also the plastic filament may push the fluids in the wrong direction if it is not properly situated. So the ideal location is where you have a straight vein like this and you can see that it is straight. After the green line the area underneath is ideal as vein will likely be occluded if the person bends their wrist.

Alright so now that we have decided what vein to use, we want to ensure that everything is prepared before we insert. So we flush the syringe hub so that once the IV is in we can flush it and make sure it is patent really quick, you can also place the syringe hub in the end before but I prefer to do it this way. Next we want to open the back of the needle portion to make sure that it is super stiff when we want to insert and pull back. Once that is all done, now its time to puncture. Before puncturing you can see that I hold the hand firmly tight and pull on the vein to make sure the vein doesn’t roll when inserting.

Alright so you go ahead with the puncture site and you can see that the needle goes in a few millimeters before we see flash back. As soon as we get that flash back we know we are in the vein. Once you are in the vein you have to be careful with movements and try to insert the catheter a little bit further in and then you can start pulling back on the needle catheter at the back. This is important because you do not want to have the plastic filament be kinked before inserting. However this does not mean you have to start over the whole process. If you have the plastic filament kink you do not need to take out the catheter you can try repositioning it and trying to fix it and push it forward. If there is a lot of resistance then that means you have either hit a valve in the vein or you are just not in the right place.

Okay so once the needle at the back is completely out you should see the line being flushed with blood, this is a good sign meaning that you are in the vein. Try and hold the hub like so and ideally you would have hand the dressing ready to put on, in this case we did not do that cause I was A+OX4 and did not move my arm. As many of you know, that is not always the case.

Moving onto the dressing site, you want to ideally be able to visualize the insertion site to see if you see any redness around the area. If it is red, that could be indicative of phlebitis and you may want to consider taking it out. Remember that potassium solutions are hard on the veins and so you have to administer these at a slower rate. We also want to flush with some normal saline to ensure that the catheter is patent.

Next, we want to make sure we secure that syringe hub with extra tape so it IV site doesn’t get dislodged easily and doesn’t kink the line. Then you are done! The IV is in, it is secured with a dressing and tape and the line is patent ready for use!

I also think it is worth mentioning to know the patients history before insertion. Things like chemotherapy can make veins more sensitive and lead to difficult IV starts. Also be careful with patients on blood thinners because the line might seem to have gotten flash back but in reality you are actually not in the right place. To combat this you want to pick a healthy vein to catheter size ratio. Look at a vein that may be an easy insert for a 20 gauge but place a 22 gauge in it.

Alright so that is the end of this video, I hope that it was helpful. If you learned something please consider giving it a thumbs up and let me know in the comments below any other suggestions you may have for me or others. Thanks for watching and I will see you in the next video.