How to Start an IV: A 5-Step Guide
1. Choose the correct IV gauge
2. Prep the patient for IV insertion
3. Get the IV line ready and set up the IV bag
4. Insert the IV needle
5. Secure the IV line
What’s Needed to Start an IV?
To start an IV, you will need specific, sterile supplies at the ready. Let’s explore what each of these items is and what it is used for:
IV start kit: This kit contains the basic items you will need to insert the actual IV into your patient.
The kit contains:
A tourniquet to help you locate a vein.
Antiseptic wipes to clean the IV site before inserting the needle.
A needle gauge to pick the appropriate size, and an identification sticker to label the IV.
Gauzes
Tape
Tegaderm
Labeling the IV is critical so other members of your patient’s health care team know who placed the IV, when the IV was placed, and when or if a replacement IV should be administered.
IV needle: The IV needle allows you to access your patient’s vein. You use the needle to place the plastic cannula in the vein and then the needle is removed.
nurse starting iv
Extension tubing or cap: Once the IV is in place, you will need the tubing to connect the IV to whatever fluid you’re administering to the patient. If you’re placing the IV to draw blood or for an upcoming procedure, place the cap to keep the IV sterile.
Normal saline flush: Finally, you will need a saline flush that generally comes in a pre-filled syringe. The flush is used to ensure the line is clear and in working order before administering fluids.
How to Set Up an IV
This is a great time to prepare your patient for insertion (mentally and emotionally). With your IV kit materials ready:
Open up the IV start kit and place materials within arm’s reach.
Draw up saline flush out after opening (unless using a prefilled syringe).
With the IV catheter connector, flush the extension tubing or cap.
Open up the catheter package.
Now you’re ready for proper IV insertion.
How to Start an IV Step by Step
Once you have prepared for what you need to insert an IV successfully, you’ll need to figure out where you’d like to insert the IV.
Areas with problems like edema or burns will not work. Look for clear skin, preferably where veins are visible and the IV cannula will fit well.
You can complete the process of starting the IV line after you’ve identified the IV site.
1. Choose the correct IV gauge.
You will need to determine the proper IV gauge first, which will determine how big of a needle and IV catheter you’ll use.
There are benefits and drawbacks to each size – larger IV options can administer the medicine faster but tend to be more challenging to insert, cause more pain for the patient, and increase vein irritation.
There are five main types of gauge sizes you need to know, listed from largest to smallest:
14g-16g IV: These are the largest options; you will not typically need an IV this size. You may need to use one of these in rare circumstances, such as needing to deliver fluid in a critical situation quickly. These should not be used on anyone with smaller veins, though.
18g IV: The next step down is still fairly large. This size generally only sees usage in emergency situations, as well. Once again, those with small or otherwise fragile veins should not be given these IVs.
20g IV: This size can generally be used on most adults. It works in various situations, including blood return and lab work. While this option does not deliver medicines or fluids as fast as the larger gauges, it will suffice in most typical situations.
22g IV: This size is significantly smaller, making it a good fit for most pediatric patients and adults with fragile veins. This gauge generally does not suffice in situations where the patient needs a lot of fluids quickly.
24g IV: This size is mainly designed for infants. This gauge size is extremely small and can be flimsy, therefore would not be usable on any large child or adult.
2. Prep the patient for IV insertion.
Once you have determined the proper IV size you’ll need, you can prepare your patient:
Start by washing your hands and putting on a pair of clean gloves. Remember that you have a high risk of interacting with the patient’s blood, so this is critical.
Use the tourniquet on your patient’s arm (or above the area of IV insertion) to help make the veins more visible. Look for a vein that is straight and large. You can also palpate to feel around (sometimes you can’t see the veins, but you can feel them).
Use your antiseptic swab, often either chlorhexidine (CHG) or alcohol, to clean the area thoroughly and then allow it to dry.
After preparing your patient, you can begin to prepare the IV.
3. Get the IV line ready and set up the IV bag.
Prepare your IV while your patient’s arm (or other area of IV insertion) dries from the disinfectant wipe.
Begin by preparing your IV tubing. Hang the IV bag from something elevated and fill the tubing with saline solution.
Watch for any signs of bubbles in the IV line. Remove any bubbles to prevent an embolism in the patient. You can do this by gently tapping or squeezing the line.
Open the IV and remove the needle cap. Twist the catheter hub to make sure it is loose and ready.
Ensure the IV does not touch anything other than the patient’s skin at the insertion site. You do not want to compromise the sterility of your instruments.
nursing student inserting IV needle
4. Insert the IV needle.
Once you have fully prepared your IV and have prepared your patient, the time has come to insert the IV.
Hold the needle in your dominant hand at about a 10- to 30-degree angle. This should be from the arm (or area of insertion), and you should have the bevel up.
With your non-dominant hand, hold the skin taught over the vein so it doesn’t move as you try to insert the needle.
When you have inserted the needle correctly, you will see a flashback of blood in the flash chamber. You might also see this flashback in the catheter, depending on the size and type of catheter you are using.
Once you see this flashback, decrease the angle of the needle until you are nearly parallel with the skin. Then, advance a few (2-6) millimeters.
After you’ve advanced the entire unit, advance only the IV catheter and slide it off the needle. It should slip in easily. If you see dimpling on the skin, you may have accidentally placed it in extravascular space instead of intravenous. Carefully attempt the venipuncture again.
Next, take off the tourniquet and use your index finger to put pressure beyond the catheter tip. Removing the tourniquet helps ensure proper blood flow.
Finally, press the activation button to retract the needle fully.
With this, you have completed the IV insertion. Now it’s time for the IV line.
5. Secure the IV line.
Now that you have the IV in place, secure it with the materials you had in your IV kit.
You might use a dressing like Tegaderm or gauze and tape to hold the IV in place. If you have an extension loop, ensure the securement of this, as well. Ensure nothing can easily get caught and pull the IV out.
If the patient does not understand the importance of not pulling out the IV, such as a young child or a confused patient, you can wrap the IV area with Coban. It’s important to leave the cap accessible if you do this.
How to Remove an IV
Knowing how to remove an IV is just as important as starting one – and of course, remember best hygiene practices.
Beginning with gloves on, carefully loosen the dressing around the insertion area. Then place gauze over the insertion site.
Pull out the IV cannula in one quick, smooth motion.
Apply firm pressure for at least two minutes on the gauze over the insertion site. Without that firm pressure, blood seepage can occur.
nursing student applying pressure to IV insertion site
After those two minutes, check to see if the bleeding has stopped from the insertion area.
Secure the insertion site with gauze and tape.
Dispose of the cannula and other materials properly.
With this knowledge of placing and removing an IV, you’re ready to take on real-life IV insertion.
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