Starting an IV

When faced with starting an IV, most nursing students and even many professional nurses dread the thought. However, venipuncture is an essential part of patient care and all nurses must master the skill.

You may already know the basics of how to insert a peripheral IV catheter, but many times you will have a patient with “difficult” veins, making the task even more challenging. Our goal is to reduce the number of venipuncture attempts made on patients and have one successful IV start!

Here are 7 simple tips to help you start that difficult IV:

1.ASSESS THE VEINS with a properly applied tourniquet – a tourniquet that is too loose or too tight does not allow the veins to dilate. Lower the patient’s arm below heart level and have them open & close their fist. Alternatively, for a patient with really poor access, a blood pressure cuff can be inflated to a low setting (a few points higher than their diastolic), instead of using a tourniquet.

2. WARM THE IV SITE AREA to promote vasodilation. Applying instant warm packs or a warm blanket for 5 to 10 minutes will help bring the veins to the surface.

3. If you find the patient has flat dehydrated veins, HYDRATE THE PATIENT if possible by having them drink 3 cups of water before the IV start.

4. DISINFECT THE INSERTION SITE, using an alcohol wipe by stroking in the direction of venous flow (towards the heart) to improve vein filling. Rubbing the area vigorously causes the veins to become much more visible and prepares other possible nearby veins which may be suitable. Remember to let the alcohol dry to prevent painful stinging for the patient.

5. For the patient that is obese or has generalized edema, an ACE wrap can be used to WRAP their forearm, THEN ELEVATE the arm for about 15 minutes while the swelling temporarily decreases. When inserting the IV, leave a small portion of the cannula out so the tissue has enough room to expand when the edema returns.

6. USE A VEIN FINDER VISUALIZATION DEVICE if available for a patient with poor venous access. However, remember to palpate the vein also, as those that are deeper and larger are usually a better site than superficial veins that are thin and smaller.

7. PREVENT VEIN “ROLLING” by holding traction on the vein and skin just below the venipuncture site, using the thumb of your non-dominant hand.