› Start a Peripheral IV

Peripheral IV Tips and Techniques

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While many facilities have special IV teams that start all the peripheral intravenous lines on patients, it is still a skill you need to have just in case it is up to you to get one inserted.

If you are in home care, on occasion, a physician may order a short term IV therapy that would require you to start an IV. While PICC lines are much more common, it is still a possibility.

Since the IV is going to be remaining in the vein for a long period of time, unlike venipuncture (phlebotomy) in which you enter the vein, get blood and remove the needle, there are a few other considerations you must be mindful of.

Places to Avoid Inserting a Peripheral IV

Putting a peripheral IV in a vein in a joint can mean the catheter can be bent and possibly kinked. So while the AC (Antecubital) area is great for veins, you may want to avoid it if possible. Obviously in an emergency, any vein is a good vein. 

Or, if you can immobilize the joint with an IV board taped to the arm, then the AC area would be feasible. The same goes for veins right at the wrist.

  • Avoid the Lower extremities when possible
  • Avoid the affected side for patients with mastectomy
  • Avoid the affected side for patients with a stroke
  • Avoid the side with an AV fistula for dialysis
  • It is preferable to use the non-dominant side for a patient that is alert and oriented.
  • Avoid veins at bifurcations (“Y” intersections)

Look for larger veins when starting the peripheral IV for administration of blood as a larger bore needle will be needed (18 G)

When setting up, I like to loosen the cap to the extension tube so it isn't tough to get off while I have my hand on the inserted peripheral IV.

Make sure when you apply the tourniquet that it is tied so that one hand can release it. Remember to release the tourniqet once the catheter is in, before trying to attach the tubing to the catheter.

Notice the flashback of blood in the catheter that tells the nurse she is in the vein.

Once the saline lock is attached, I like to draw back on the syringe to make sure I see blood to be certain I'm still in the vein before flushing with the syringe.

Label with time, date, type and size of angiocath and your initials.

Getting the Vein to Stand Up at Attention

You want the vein to fill with blood and to expand as much as possible to make it easier to see, feel and insert that catheter. The first and most obvious way is using the tourniquet. Other ways to bring a vein up are to: 

  • gently slap the vein
  • dangle the arm so more blood will stay in the extremity
  • apply warm compresses for about 5 minutes
  • clenching and unclenching the fist

When you feel a vein, the bigger ones have a bouncy feel to it, the smaller ones have less rebound to them. 

You can apply the tourniquet to dilate the veins and find one but then if you are going to get supplies ready, please, release the tourniquet until you are ready to actually stick the patient. Keeping a tourniquet on for a long period of time can be uncomfortable.

Cleaning the Area

Each facility has their own procedure on how they want their staff to clean the site.

Some use betadine, cleaning in an outward circular pattern, let the betadine dry then repeat with alcohol to wipe the betadine off.

Some places use chloraprep which according to manufacturers instructions should be scrubbed in a back and forth pattern for 30 seconds then left to dry. (And, NO, do not blow on it or wave your hand over it to dry it faster!)

Reasons for IVs

The three main reasons are to administer

  • Blood
  • Medications
  • Fluids to rehydrate a patient

Which brings me to the point that if a patient is dehydrated that means his blood volume is down from normal and it may make it tougher to find a vein. 

The Angiocatheter

Angio catheter simply means a catheter (tube) that is going into a blood vessel (angio). Rather than just a hollow metal needle similar to what you put on the end of a syringe to give medication, this is a needle that is covered by a flexible plastic tube (beige color).

The needle protrudes just at the pointed end to allow sticking through the skin into the vein. Once it is in the vein, the soft vinyl or plastic tube is pushed off the needle and advanced into the arm and the stiff sharp needle is removed. This means less chance of accidently puncturing the vein while it remains inserted for days at a time.

The Actual Insertion

Insert the needle at 15 degree angle then drop even further when you get the flashback of blood. Advance maybe another 1/8” to make sure you are in then push soft catheter off the needle and up to the hub, leaving the sharp stiff needle as is. 

Once the catheter is situated press the needle safety release and it will snap the needle out of the catheter and into a safety sheath.  

Watch how the people hold the catheter in the videos while they start their peripheral IV. They hold the barrel with their thumb and third finger. The index finger is left free to push the tab that advances the soft catheter into the vein while holding the needle steady.

Intermittent Peripheral Iv

While many IVs have a bag of fluid or meds hanging and running continuously, there is also what is called a "saline lock". They used to be called "heparin lock" because we used to fill the tubing and the catheter with a low dose of heparin to prevent the end of the angiocatheter from clotting. It was found that saline did just as good a job and so heparin is rarely used. 

The catheter is inserted into the vein and the short tubing is filled with saline and has a cap at the end to prevent blood from leaking out. 

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