10 Essential IV Start Tips for Insertion

Are you an aspiring medical professional struggling to master the art of intravenous (IV) insertion? IV insertion is a crucial skill for medical professionals, and with these 10 essential tips, you’ll be well on your way to becoming an IV ace. This blog post will give you everything you need to ensure successful IV insertions, from assembling the right equipment to assessing flow rate velocities. Keep reading if you want to learn more.

The 10 IV Start Tips For Safety and Success

Here are some essential tips on starting IVs:

1. ANTCUBITAL FOSSA (AC) IV Site Selection

Medical procedures can be daunting, especially when inserting intravenous (IV) lines. However, with the development of specialized AC sites for IV insertion, patients can now experience a more comfortable and hassle-free process.

The AC site, or the antecubital fossa, is the bend of the elbow where the veins are easily accessible and visible. Using this area as the insertion point makes the process quicker and more reliable, reducing the risk of complications and discomfort.

2. The Angle Matters 

Due to their technique, I have often seen nurses and nursing students need to catch up while inserting an IV. They correctly pull the skin taut, secure the vein and insert – but end up piercing through it, making it impossible to thread a catheter.

Generally speaking, one should strive to create a 10-30 degree angle about the skin for insertion; this ensures that when you get a flash of blood, your needle is still likely inside the vein allowing you to advance with the catheter.

However, aiming for a deeper vein may require adjusting this angle accordingly. If you cannot float the catheter despite having a visible “flash” of blood, try withdrawing both needle and catheter by millimeters or two before attempting to re-advance with the catheter alone. This should help you yield better results.

3. Understand Gauge Size

Regarding medical procedures involving needles and cannulas, the gauge size is significant. This measurement refers to the diameter of the needle or cannula – the larger the gauge number, the smaller the diameter.

Therefore, choosing the appropriate gauge size for the task is crucial. While more giant gauge needles are typically used for functions such as fluid resuscitation and blood transfusions, it’s essential to consider the size of the targeted vein.

Using a larger gauge needle in a smaller vein can cause significant irritation and discomfort for the patient.

Medical professionals can minimize discomfort and ensure a more successful procedure by selecting the smallest gauge size for the vein. It’s essential to properly assess each unique situation and make informed decisions for the best possible outcome.

Some Most Common needles are: 

• 16 gauge (green)
• 18 gauge (blue)
• 20 gauge (pink)

4. Select the Right Equipment 

Selecting the right equipment is essential. The size and type of needle will depend on the patient’s age, weight, veins, etc. Practice makes perfect—the more practice you get inserting various needles and catheters, the easier insertion will become.

Make sure that you have all of your equipment ready as follows:

• An alcohol wipe.
• A disposable tourniquet.
• An IV cannula.
• Alcohol cleanser.
• Gloves.
• A suitable plaster.
• A syringe.
• Saline.
• A clinical waste bin.

5. Prepare the Area 

Before you begin, cleaning and preparing the area thoroughly is essential. Make sure that the patient’s arm or leg is appropriately positioned and secure, and use an alcohol wipe to clean the area around where the needle will be inserted. Taking your time to prepare appropriately before insertion will help ensure the best results.

6. Identify the Vein 

Identifying a suitable vein is essential for successful IV insertion. To determine the best possible veins, looking for thick and round veins with little or no visible valves is necessary. The size and location of the vein may vary depending on the patient’s age, weight, and other factors.

Pro Tip: SMALL VEINS? MAKE THEM LARGER

• HEAT: Heat can be great for inducing vasodilation, which causes veins to become more prominent. Applying a warm compress or hot pack can help you gain visual access to the vein and make threading an IV easier. Just make sure it’s not too hot to cause any harm.
• GRAVITY: The arm can be put in a dependent position, which helps pool blood into distal veins, making them easier to see and palpate. This increases the chance of successful IV insertions.
• NITROGLYCERIN OINTMENT 2%: A small amount of 2% Nitroglycerin ointment applied topically over a small area can help dilate peripheral veins. In one study, those with the ointment applied to their hands required fewer needle sticks than the control group. Of course, this is a medication, and so requires an order from a doctor.

7. Insertion 

Some people detest having to dig when they’re starting an IV. That’s understandable. Still, it doesn’t always have to be a painful task and can often be accomplished in just a few seconds of digging around.

The trick is not randomly attempting to find the vein but carefully using your fingertips to discern its direction. If there’s no flash of blood after inserting the needle and catheter, pull them back out slightly and reassess the vein before aiming again.

I can’t tell you how many times I stumbled on my first attempt but managed to thread the IV on my second or third try.

Additionally, the patient’s pain receptors will become desensitized, making it usually less painful than getting poked again.

That said, some patients won’t take kindly to this procedure, and make that clear to you. In such cases, respect their wishes.

8. Alert From ARTERIAL STICK

You can accidentally puncture an artery instead of a vein when inserting an IV. If this occurs, the catheter will begin to pulsate, meaning it should be removed immediately. The vein may be located close to the artery, but more often than not, it is the latter that has been hit. This is usually noticeable when the catheter fills up with bright red arterial blood much quicker than darker venous blood would.

Though access is accessible in this situation, there are complications associated with peripheral IVs inserted into an arterial line. The most dangerous of these is thrombophlebitis—the formation of a blood clot in the patient’s arm. If medications are infused through this line, the risk is even greater.

To avoid these risks, it is best to remove the catheter and attempt insertion again in an actual vein.

9. Assess the Flow Rate 

Once you have inserted the IV correctly and it is secure, monitoring the flow rate closely is essential. If there is too much pressure in the line, the flow rate may be too high and may cause damage to the patient’s veins or surrounding tissue.

To monitor this, you can use a syringe pump to measure the amount of fluids being infused over time. This helps to ensure that all medications and fluids are delivered safely and effectively.

10. Tape and Secure the IV 

Once the flow rate is assessed, tape or secure the IV to ensure it remains in place. This will help prevent accidental needle removal and keep it from kinking or twisting. A secure yet non-constrictive technique is essential so patients can still move their arms or leg without discomfort.

11. Maintain a Sterile Environment

Finally, it’s essential to maintain a clean and sterile environment during the IV insertions. Ensure that all instruments are sterilized before use and that any surfaces where the procedure is performed have been adequately cleaned. Additionally, all sharps should be discarded in a clinical waste bin, and hands should be washed thoroughly after every procedure.

How To Be a Vein-finding Master?

• Place the arm in a dependent position and give gravity some time to work its wonders. 
• Encourage the patient to clench and unclench their fists; this will help bring out the veins.
• Gently palpate along each vein with your finger to identify a suitable one for insertion.
• Use an ultrasound machine if you are having difficulty locating a suitable vein. This can provide a clear image of the veins in the arm.
• Try using a warm compress to help relax the veins and make them easier to locate.
• An inflated blood pressure cuff is an effective tourniquet that won’t pinch hairs or skin like rubber straps often included in IV start kits. 
• When searching for a vein, it’s best to go by feel rather than sight – this will open up more possibilities since many good veins are just below the surface. 
• Train your sense of touch by feeling for veins on yourself, friends, family, and compliant patients. The index finger is most sensitive to this purpose – a vein should feel bouncy when palpated, while tendons will be stiff and move if asked to clench a fist or roll the wrist.
• A hot compress or towel can aid in dilating a vein to make it more visible.
• Flicking at the vein may help it “pop up,” so try this if you know it’s there but cannot feel it.
• Ask the patient to pump their fist – this will cause veins to become more prominent and easier to find.
• Avoid the antecubital vein if possible – IVs here often don’t last long due to the patient’s arm bending and creating a kinked catheter that impedes flow. However, if a lot of fluids or blood need to be infused quickly, the AC should be utilized due to its large size, though remember to change to another vein as soon as possible.
• Listen to the patient’s experience – if they tell you a particular vein is better or consistently “rolls,” consider that!

Be Confident and Insert the Catheter like a Pro

• To prevent the vein from “rolling,” it is essential to secure the arm firmly. The photo demonstrates a technique that involves using your non-dominant hand to create traction on the skin while inserting the catheter with your dominant hand. This will ensure successful access to the vein.
• Once the arm is secured, insert the needle at a 15-degree angle sweepingly toward the vein. It is essential to keep your wrist straight and not bend it, as this can cause trauma to the vessel wall.
• Use your thumb to advance the catheter slowly and gently into the vein. Advance the catheter until you can no longer move it, and then back off a little and attach your IV tubing.
• Once attached, use your dominant hand to advance the catheter while applying gentle traction with your non-dominant hand. Ensure not to pull too hard on the vein, which can cause trauma or an arterial puncture.
• Once the catheter is in place, assess for blood return. If you see a flashback of blood, your needle is likely in an artery, so take care not to advance any further or remove the hand too quickly, as this can cause bleeding and hematoma formation.
• Finally, after confirming the correct placement, secure the catheter with a dressing and tape.

Following these steps and practicing regularly will make you a vein-finding master in no time.

References

https://healthandwillness.org/10-iv-insertion-tips-for-nurses/#:~:text=Cubital%20Fossa%20(AC)&text=AC%20lines%20are%20when%20IVs,the%20elbow%20pit%20triangular%20area.