I want to provide for you a narrative to help you visualize and prepare yourself for the process of starting an IV. A lot of students and new nurses get intimidated by getting venous access. I want to help you. I want you to be good at this because the better skills you have, no more effectively you can save life and make a huge difference in this world! So here we go, follow along visually as you read.
Wash your hands as your come into the room and explain to the patient that you need to start an “IV”, or in plain terms: place a needle into the arm to access your veins. Turn ALL THE LIGHTS ON. The more light the better, so you can see the contrast of veins to tissues. Place the tourniquet above or below the elbow to start. I like to attempt veins below the elbow. The IVs in the AC don’t last very long, and if you have a continuous infusions, the pump will be alarming every time the patient bends their arm. It’s also very uncomfortable for the patient to have the IV catheter in the AC. So place that tourniquet below the elbow and put your gloves on if they already aren’t on. Take a couple seconds for the veins to fill – to hopefully see them better. I like to use this 5 seconds of waiting to prime the extension set tubing with normal saline, leaving the flush connected and open up the IV kit. As veins start to pop up to the surface, I start to look and feel around with my gloved hands. If you see great vein, feel it to determine how deep it feels beneath the skin. A vein with feel bouncy and will rebound like a balloons surface, It should feel like a soft hose filled with water. An area that does not contain a vein will just feel squishy like skin and tissue. Tissue with no veins will feel dull and not bouncy. This is hard to explain but once you feel it a couple times you will start to understand. Maybe practice by putting the tourniquet on yourself while looking and feeling for veins. Once you found an acceptable vein that you want to try to hit, open the alcohol or cloriprep. Scrub scrub scrub. There are so many germs on the skin, don’t be afraid to over scrub. Clean the area and the surrounding area that you are getting ready to attempt. If you are right handed, grab the IV needle and uncap it with your left hand. Then with your left hand pull the skin down, about 3-4 inches below the vein you want to “hit”. Stretching out the skin increases your chances of getting the catheter perfectly into the vein by securing those rolling veins. Go ahead and pierce the skin, don’t hesitate but don’t stab the person either. It’s a swift but gentle motion. If you go in too slow or too fast the chances of the vein blowing are super high. Once you get some blood return into the needle advance a centimeter more, push the plastic catheter with one finger, retract/pull the actual needle and quickly screw on the extension set. Remove the tourniquet. Some plastic catheters have a “stop-lock” technology that give you 4 seconds or so before the blood starts leaking. But if your catheter doesn’t have that technology, use one of your left fingers to put slight pressure over the insertion site – to stop the blood flow. Once you have connected the extension set to the plastic catheter, pull the syringe back to check for blood return. If you get blood right away, GREAT. Flush it all back and make sure it doesn’t infiltrate (form a little bubble of normal saline above the insertion site). If you don’t get blood return, flush it slightly. Sometimes an IV can be good without blood return – especially with the modern day kits. If you can flush it, and theres no sign of infiltration and the patient feels no discomfort – YOU DID IT! You successfully started an IV. Go ahead and secure it with a dressing and give yourself a pat on the back. FYI – even the most experienced nurses can miss a vein. Don’t be discouraged, ask for help, we were not meant to nurse alone.