IV Insertion

Question 1

What are the goals of IV insertion?

Answer 1

Use standard precautions to insert a peripheral intravenous (IV) catheter following guidelines that minimize risk or injury to the patient and increase the likelihood of success

Question 2

What are the indications for IV access?

Answer 2

1. Fluid administration by IV access in various clinical settings including…
2. Infusion of IV meds
3. Infusion of blood or blood products
4. IV contrast or dyes
5. IV nutrition

Question 3

What are the contra-indications for IV access?

Answer 3

1. Extremities w/ cellulitis/infection
2. Extremities w/ sign. burns, edema or injury
3. Extremities w/ impaired circulation such as mastectomy, axillary node dissection, clot, PVD, venous insuff.
4. Extr w/ AV fistula

Question 4

What are general guidelines about IV location placement?

Answer 4

DO NOT use site distal to prior failed IV
catheter insertion attempt or site distal to
preexisting phlebitis

Question 5

What are the potential complications due to technique?

Answer 5

no flash of blood, catheter cannot be threaded, catheter threaded but fluid does not flow freely

Question 6

What are the potential local complications?

Answer 6

1. Thrombophlebitis

2. Site infection or cellulitis

Question 7

What are the potential systemic complications?

Answer 7

1. Septicemia
2. PE (w/ centrally placed peripheral lines)
3. Air embolism ( when lines not properly flushed )

Question 8

What equipment is needed for IV access?

Answer 8

1. Gloves
2. Tape
3. Antiseptic solution
4. Dressing
5. Tourniquet
6. Pen
7. IV catheter
8. IV tubing
9. IV fluid

Question 9

What is the procedure for gaining IV access with a straight needle ?

Answer 9

1. Wash your hands
2. Choose appropriate vein for access (palpate vein and choose area 1 in. free of valves ideally)
3. Put on gloves (standard precautions)
4. Apply tourniquet above site of access
   5, Cleanse area with antiseptic solution w/ back and forth motion for 30 sec. then allow to dry
5. Anchor vein by applying light pressure a few cm below access site with nondominant thumb
6. Hold IV catheter at flash chamber, using thumb and middle fingers of dominant hand
7. With bevel facing up, insert needle into vein at 15-20 degrees
8. Observe for entry of blood into flash chamber of IV catheter
9. Once blood flow is apparent, advance IV catheter slowly, using index finger of nondominant hand
10. Release tourniquet
11. Once catheter is fully inserted, remove needle and attach IV tubing [After you have flushed the IV line/tubing and it is free of air bubbles!]
12. Tape tubing securely

Question 10

How does the procedure change for a butterfly needle?

Answer 10

1. Once flashback noted thread the needle in
2. Hold plastic butterfly portion of IV line in place against the skin
3. Release tourniquet
4. Begin infusion and check for swelling
5. Secure butterfly

Question 11

What special considerations need to be observed for pediatric and geriatric populations?

Answer 11

1. Smaller more fragile veins
2. Fewer venous options present
3. Avoid lower extremity in elderly and w/ vascular insufficiency
4. Securing line is essential, as child are more active
5. In elderly, sclerotic vessels can be present
6. 24-g preferred catheter size in children