Initiating a Peripheral IV Infusion

Initiating a Peripheral IV Infusion

Equipment
■ IV solution.
■ Administration set or IV lock and injection caps.
■ IV catheter.
■ If using extension tubing, a saline-filled syringe to prime it.
■ Procedure gloves.
■ Scissors.
■ Antiseptic swabs containing CHG or 70% alcohol wipes.
■ Tourniquet (nonlatex, if available).
■ Sterile catheter stabilization device or 1/2-in. tape; 2 in. 2 in. sterile gauze and/or transparent semipermeable occlusive dressing.
■ 1-in. hypoallergenic tape, preferably clear.
■ Labels, time tape.
■ Linen-saver pad.
■ Arm board, if necessary.
■ Be Smart! For a glass solution container, use vented tubing; for a plastic container, you may use either vented or nonvented tubing.

Assessment
■ Check VS, laboratory values, urine output, skin turgor, breath sounds, and the condition of mucous membranes to confirm the need for IV therapy.
■ Assess the veins on the arms and hands for a potential insertion site.
■ Assess for allergy to tape and check the medical record for complicating factors such as anticoagulant therapy, bleeding disorders, or low platelet count. Post-Procedure Reassessment
■ Monitor the IV site and flow rate (many agency standards require hourly), as well as signs of infiltration, inflammation, and phlebitis.
■ Monitor tolerance of IV therapy: auscultate lungs and monitor VS, I&O, laboratory values, and neck vein distention.
■ Be Safe! Report signs of fluid overload, such as:
■ Crackles.
■ Edema.
■ Shortness of breath.
■ Diminished urine output.
■ Increased BP.
■ Increased heart rate with bounding pulse.
■ Distended neck veins.

Key Points
■ Prepare the IV solution and administration set, including extension tubing and volume control device if used.
■ Apply the tourniquet.
■ Be Safe! Keep the catheter sterile throughout the procedure.
■ Be Smart! Locate a vein. As a rule, select the most distal vein in an upper extremity.
■ Don clean nonsterile gloves and cleanse the site. Allow the antiseptic to dry on the skin. Do not touch the site after cleansing.
■ Use your nondominant hand to apply gentle traction on skin at the insertion site to stabilize the vein.
■ Inform the patient that you are about to insert the catheter.
■ Hold the catheter, bevel up, at a 30° to 45° angle and pierce the skin.
■ Lower the catheter so it is parallel to the skin, and advance it.
■ Watch for a flashback of blood; continue inserting the catheter. Advance the catheter halfway, then remove (or retract) the needle as you insert the catheter the rest of the way—to the hub.
■ While holding the catheter in place with one hand, release the tourniquet with your other hand.
■ Connect the IV administration set or extension tubing to the IV catheter.
■ Adjust the flow rate according to the prescriber’s order.
■ Secure the connection, stabilize the catheter, and apply dressing to the IV insertion site.
■ Secure the tubing by looping and taping it to the skin.
■ Label the dressing, tubing, and IV solution. Apply a time tape.
■ Place an arm board as needed.

Documentation
■ Record the date and time of insertion, gauge and type of catheter, number of attempts, and location of the insertion site.
■ State whether you used a tourniquet, blood returned in the catheter, the IV was flushed, and the type and amount of flush solution used.
■ Describe the dressing and tape type used, the method of stabilizing the IV line, and the type and rate of the IV fluid infusing.
■ Describe patient’s tolerance of the procedure, any adverse reactions, teaching done, and any interventions that were required.
■ Often, IV care is documented on a flowsheet.
■ Document on the I&O sheet the amounts of fluids infused.

Pierce the skin at a 30o to 45o angle

Secure the IV catheter at the hub with transparent dressing

Smooth the transparent dressing to the skin