How to Start an IV
Table of Contents
One of the most important skills a nurse needs to know is how to start an IV. Starting an IV can be intimidating, but with the right techniques, you can learn to perform the procedure properly and consistently on the first attempt.
Starting an IV
Starting an IV is a multistep process that begins with preparation and staying calm. When it is time to start an IV on a patient, gathering and preparing your materials first will allow you to focus and proceed with confidence.
Equipment Necessary to Start an IV
You’ll need the following supplies:
- An IV starter kit
- Extension tubing or cap
- Normal saline flush
- IV needle
Perform proper hand hygiene and put on gloves before opening any packages. Lay out your materials, label the IV, flush the extension tubing, and prep the needle/catheter packaging before approaching the patient.
Prepare Your Patient
Select the correct needle gauge: 20-gauge for most adults, and 22-gauge for older adults, pediatric patients, or those with fragile veins. Set the patient at ease with a confident, relaxed demeanor.
Apply the tourniquet and locate a vein by looking for a "bounce"—a collapse and rebound when tapped. Note the vein’s direction, depth, and thickness. Clean the insertion site with the ChloraPrep kit, moving in a circular motion outward for 30 seconds, and allow it to dry completely.
Insert the IV
Pull the skin taut with your nondominant hand to stabilize the vein. With your dominant hand, hold the IV catheter at its base, bevel up. Prepare the patient for a pinch, then insert the needle at a 20-degree angle. Once you see a "flash" of blood in the cannula, advance the needle 2–6 mm more, then slide the cannula off the needle into the vein. Apply pressure above the site with your index finger, release the tourniquet, and retract the needle.
IV Therapy Tips
- Create a Connection: Ask about needle phobias before starting. Even without fears, patients often prefer not to watch the insertion.
- Relax in Your Process: Follow a specific, repeatable order for setup and infection control to ensure no steps are missed and to project a calming, controlled environment.
Vein Selection
If standard tourniquets don't reveal veins, especially in patients with low blood pressure, consider using a blood pressure cuff flipped upside down to dilate veins more comfortably. Always evaluate distal veins first, working your way proximally, and prioritize a nondominant hand unless otherwise requested. Consider the purpose of the IV: avoid joint areas for standard fluids to prevent obstruction, or use the antecubital (AC) vein if a larger needle is required for rapid infusion.
Make the Vein More Visible
Use these techniques to help veins stand out:
- Use gravity by letting the arm hang.
- Apply warm compresses.
- Flick or tap the vein gently (avoid slapping).
- Ask the patient to clench and release their fist.
- Rub the area with an alcohol pad in the direction of blood flow to support vein filling.
Securing the IV Line
Properly taping the IV ensures patient comfort and procedure success:
- Placement: Tape tubing laterally in the direction of natural motion to prevent tangling.
- Stress Loops: Add one or two loops of tubing attached to the skin with tape; this ensures that if the line is pulled, the loop dislodges rather than the entire IV.
- Leaking: If an IV leaks at the insertion site, you may still be able to use it if you can advance the catheter tip past the leak point. Test with a nonirritating fluid first.
Special Considerations
- Fragile Veins: Use the smallest gauge possible for older or pediatric patients and ensure extra stabilization.
- Darker Skin Tones: Visualization techniques like the BP cuff tourniquet and disinfecting in the direction of blood flow are especially helpful.
- Prominent Valves: Use the "floating method"—attach extension tubing and flush with saline while advancing the catheter to help open valves.
Additional Tips
- Practice: Use a banana to practice insertion resistance; friends or family may be willing to let you practice tourniquet/palpation techniques.
- Hold Firm: Keep the skin taut to prevent veins from rolling.
- Select the Right Gauge: Smallest is best for comfort and easier insertion.
- Move On: If an insertion is unsuccessful, don't let it shake your confidence. Keep practicing.
In-Home IV Therapy
If you are looking for an in-home IV therapy team that are experts in IV placement, Reset IV is here to help. We serve many locations, including:
Las Vegas | Miami | Fort Lauderdale | Los Angeles | Palm Beach | Orlando | Dallas | Virginia | Maryland | Tampa | Orange County | Washington D.C. | Park City | Salt Lake City
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