Initiating a Peripheral Venous Access IV Infusion

Goal: The access device is inserted on the first attempt, using sterile technique.

1. Verify the IV solution order on the MAR/CMAR with the medical order. Clarify any inconsistencies. Check the patient’s chart for allergies. Check for color, leaking, and expiration date. Know techniques for IV insertion, precautions, purpose of the IV administration, and medications if ordered.

2. Gather all equipment and bring to the bedside.

3. Perform hand hygiene and put on PPE, if indicated.

4. Identify the patient.

5. Close curtains around bed and close the door to the room, if possible. Explain what you are going to do and why you are going to do it to the patient. Ask the patient about allergies to medications, tape, or skin antiseptics, as appropriate. If considering using a local anesthetic, inquire about allergies for these substances as well.

6. If using a local anesthetic, explain the rationale and procedure to the patient. Apply the anesthetic to a few potential insertion sites. Allow sufficient time for the anesthetic to take effect.

Prepare the IV Solution and Administration Set

7. Compare the IV container label with the MAR/CMAR. Remove IV bag from outer wrapper, if indicated. Check expiration dates. Scan bar code on container, if necessary.
Compare on patient identification band with the MAR/CMAR. Alternately, label the solution container with the patient’s name, solution type, additives, date, and time.
Complete a time strip for the infusion and apply to IV container.

8. Maintain aseptic technique when opening sterile packages and IV solution. Remove administration set from package. Apply label to tubing reflecting the day/date for next set change, per facility guidelines.

9. Close the roller clamp or slide clamp on the IV administration set. Invert the IV solution container and remove the cap on the entry site, taking care not to touch the exposed entry site. Remove the cap from the spike on the administration set. Using a twisting and pushing motion, insert the administration set spike into the entry site of the IV container. Alternately, follow the manufacturer’s directions for insertion.

10. Hang the IV container on the IV pole. Squeeze the drip chamber and fill at least halfway.

11. Open the IV tubing clamp, and allow fluid to move through tubing. Follow additional manufacturer’s instructions for specific electronic infusion pump, as indicated. Allow fluid to flow until all air bubbles have disappeared and the entire length of the tubing is primed (filled) with IV solution. Close the clamp. Alternately, some brands of tubing may require removal of the cap at the end of the IV tubing to allow fluid to flow. Maintain its sterility. After fluid has filled the tubing, recap the end of the tubing.

12. If an electronic device is to be used, follow manufacturer’s instructions for inserting tubing into the device.


Initiate Peripheral Venous Access
13. Place patient in low Fowler’s position in bed. Place protective towel or pad under patient’s arm.

14. Provide emotional support, as needed.

15. Open the short extension tubing package. Attach end cap, if not in place. Clean end cap with alcohol wipe. Insert syringe with normal saline into extension tubing. Fill extension tubing with normal saline and apply slide clamp. Remove the syringe and place extension tubing and syringe back on package, within easy reach.

16. Select and palpate for an appropriate vein. Refer to guidelines in previous Assessment section.

17. If the site is hairy and agency policy permits, clip a 2-inch area around the intended entry site.

18. Put on gloves.

19. Apply a tourniquet 3 to 4 inches above the venipuncture site to obstruct venous blood flow and distend the vein. Direct the ends of the tourniquet away from the entry site. Make sure the radial pulse is still present.

20. Instruct the patient to hold the arm lower than the heart.

21. Ask the patient to open and close the fist. Observe and palpate for a suitable vein. Try the following techniques if a vein cannot be felt:
a. Massage the patient’s arm from proximal to distal end and gently tap over intended vein.
b. Remove tourniquet and place warm, moist compresses over intended vein for 10 to 15 minutes.

22. Cleanse site with an antiseptic solution such as chlorhexidine or according to facility policy. Press applicator against the skin and apply chlorhexidine using a back and forth friction scrub for at least 30 seconds. Do not wipe or blot. Allow to dry completely.

23. Use the nondominant hand, placed about 1 or 2 inches below the entry site, to hold the skin taut against the vein. Avoid touching the prepared site. Ask the patient to remain still while performing the venipuncture.

24. Enter the skin gently, holding the catheter by the hub in your dominant hand, bevel side up, at a 10- to 15-degree angle. Insert the catheter from directly over the vein or from the side of the vein. While following the course of the vein, advance the needle or catheter into the vein. A sensation of “give” can be felt when the needle enters the vein.

25. When blood returns through the lumen of the needle or the flashback chamber of the catheter, advance either device into the vein until the hub is at the venipuncture site. The exact technique depends on the type of device used.

26. Release the tourniquet. Quickly remove the protective cap from the extension tubing and attach it to the catheter or needle. Stabilize the catheter or needle with your nondominant hand.

27. Continue to stabilize the catheter or needle and flush gently with the saline, observing the site for infiltration and leaking.

28. Open the skin protectant wipe. Apply the skin protectant to the site, making sure to apply at minimum the area to be covered with the dressing. Place sterile transparent dressing or catheter securing/stabilization device over venipuncture site. Loop the tubing near the site of entry, and anchor with tape (nonallergenic) close to the site.

29. Label the IV dressing with the date, time, site, and type and size of catheter or needle used for the infusion.

30. Using an antimicrobial swab, cleanse the access cap on the extension tubing. Remove the end cap from the administration set. Insert the end of the administration set into the end cap. Loop the administration set tubing near the site of entry, and anchor with tape (nonallergenic) close to the site. Remove gloves.

31. Open the clamp on the administration set. Set the flow rate and begin the fluid infusion. Alternately, start the flow of solution by releasing the clamp on the tubing and counting the drops. Adjust until the correct drop rate is achieved. Assess the flow of the solution and function of the infusion device. Inspect the insertion site for signs of infiltration.

32. Apply an IV securement/stabilization device if not already in place as part of dressing, as indicated, based on facility policy. Explain to patient the purpose of the device and the importance of safeguarding the site when using the extremity.

33. Remove equipment and return the patient to a position of comfort. Lower bed, if not in lowest position.

34. Remove additional PPE, if used. Perform hand hygiene.

35. Return to check flow rate and observe IV site for infiltration 30 minutes after starting infusion, and at least hourly thereafter. Ask the patient if he or she is experiencing any pain or discomfort related to the IV infusion.