PERIPHERAL IV PLACEMENT - Scott & White Memorial Hospital

Peripheral IV insertion
Scott and White
Indications for IV Therapy
 Establish or maintain a fluid or electrolyte
 Administer continuous or intermittent
 Administer bolus medication
 Administer fluid to keep vein open (KVO)
 Administer blood or blood components
Indications for IV Therapy
 Administer intravenous anesthetics
 Maintain or correct a patient's nutritional
 Administer diagnostic reagents
 Monitor hemodynamic functions
 Gather supplies
 IV cannula
 IV tubing
 IV fluid or
 Heparin lock
Steel Needles
 Butterfly catheter. They are named after the
wing-like plastic tabs at the base of the needle.
They are used to deliver small quantities of
medicines, to deliver fluids via the scalp veins
in infants, and sometimes to draw blood
samples (although not routinely, since the
small diameter may damage blood cells).
These are small gauge needles (i.e. 23
Steel Needles
Over the Needle Catheter
 Catheters (and needles) are sized by their diameter,
which is called the gauge. The smaller the diameter,
the larger the gauge. Therefore, a 22-gauge catheter
is smaller than a 14-gauge catheter.
 To deliver large amounts of fluid or viscous solutions
such as blood and blood components, you should
select a large vein and use a 20 gauge or less.
 To administer medications, an 20 –22 gauge or in a
smaller vein will do. The smaller the catheter, the less
the irritation to the vein.
Approach to Patient
 Introduce yourself to the patient
 Assess the patient identification
 Assess alertness and attitude of patient
 Explain to the patient and/or family the need
for the procedure
 Explain to the patient and/or family the steps
in the procedure
 Raise the bed/ gurney sufficiently high that
you can work in good light without hurting
your back.
 If the intended site is distal, kneel or seat
yourself so that you can work closely and
Vein Selection
Veins of the hand
1. Digital Dorsal Veins
2. Dorsal Metacarpal Veins
3. Dorsal Venous Network
4. Cephalic Vein
5. Basilic Veins
Vein Selection
Cephalic Vein
Median Cubital Vein
Accessory Cephalic Vein
Basilic Vein
Cephalic Vein
Median Antebrachial Vein
Vein Selection
 Try to cannulate the most distal veins first.
 If for example, the antecubital veins are ruined
as a result of failed cannulation attempts, this
can cause problems in the event of a
successful cannulation further down.
 Any drugs or fluids put through the cannula
may extravasate at the failed cannula site
Inappropriate sites
 Edematous areas
 Hematomas
 Scarred areas
 Arms with cannulas, fistulas or vascular
Universal Precautions
 If the IV cannot be started with gloves on, ---it
cannot and should not be started.
 Protect yourself with adequate body-substance
isolation at all times.
 Glasses, goggles, or splash shields, may also be worn.
 ALL patients must be considered infective at all
times. It is NOT ACCEPTABLE to compromise
precautions for any reason [this includes tearing off
a finger tip of one's glove to permit palpation].
 Occlude Venous Flow
 Apply tourniquet 4-6 inches above the
insertion site. Veins may also be distended by
placing the limb in a dependent position,
applying a warm pack in addition to the
tourniquet, or applying a blood pressure cuff.
The tourniquet or blood pressure cuff should
not obstruct arterial flow.
Apply Tourniquet
 Prep The Skin
Alcohol Scrub
 Use vigorous circular motion. Allow the
skin to dry. This procedure defats the
Clean with alcohol
 Povidone Iodine Scrub
 Using a circular motion, work from the
center of the insertion site outwards. Allow to
dry for two minutes.
If the patient is allergic to iodine preparations
use a vigorous two minute alcohol scrub.
 Hold the skin taut and anchor the vein with the
thumb of your free hand. Avoid recontamination of
the area.
 Lower the hub of the needle close to the skin and
align needle for insertion.
 Insert the needle, bevel up, into the skin and
subsequently into the vein. The free hand is used to
stabilize the vein while the needle is being
introduced. If the needle is in the vein, blood return
will be visible in the flashback chamber.
 Technique for skin puncture at the side of the
selected vein.
 The needle should puncture the skin to one side of
the vein about 1/2 to one inch below where the
needle will enter the vein. Pierce the skin at a 45
angle along side of the vein. Once through the skin,
insert the needle into the vein nearly parallel to the
vessel (10-20 angle).
 Technique for skin puncture directly over the
selected vein.
 The needle should puncture the skin at a 45
angle directly over the selected vein. Once
through the skin, decrease the angle to about
10-20 and enter the vein.
 After the needle has entered the vein,
proceed to slowly advance the needle
approximately 1/2 inch.
 Carefully withdraw the needle about 1/2 inch
while continuing to advance the catheter.
Inserting cannula
 Apply pressure to the vein just above the tip
of the catheter to obstruct blood flow.
 Remove the introducer needle. Connect the
catheter to IV tubing or to “heparin” lock.
 Release the tourniquet
 Cover the insertion site with a transparent
occlusive dressing, tape securely,label.
 Begin IV fluid or flush “Heparin” lock
 Remember that IV catheter site rotation is
recommended every 72 hours, unless you are
using extended dwell catheters.
Remove tourniquet
 If you are unsuccessful in entering the
vein and there is no flashback, then
slowly withdraw the catheter, without
pulling all the way out, and carefully
watch for the flashback to occur
If you are still not within the vein,
then advance it again in a 2nd attempt to
enter the vein. While withdrawing always
stop before pulling all the way out to
avoid repeating the painful initial skin
 If after several manipulations the vein is
not entered, then release the tourniquet,
place a gauze over the skin puncture
site, withdraw the catheter and tape
down the gauze. Try again at another

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