IV Placement Start To Finish (How to Start an IV)

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All right guys. In this video we're going to talk about placing an IV from the start to the finish. The first thing that we have to look at is that we have to verify an actual need for an IV for the patient, and also see if there's an order. Some facilities have these standing orders that indicate how many IVs a patient needs or different types of patient conditions that will require an IV. Like for example, the ICU I used to work in required that every patient had two IVs. Regardless, we actually had to have a specific order that said it was okay to have only one IV on the unit. Now, that didn't include central lines and that kind of stuff, but these were strictly peripheral IVs. So we need to make sure that the patient has a need for it. So maybe specific types of patients, traumas, patients that have electrolyte imbalances, dehydrated patients, those are ideal patients and that are going to need that IV.

So make sure that the patient actually has a need for it. The next thing that you're going to do is identify a vein. The vein identification is so very important because you have to anticipate the needs for the patient and understand potential comorbidity in the patient. Also, you need to think about anticipated therapy. So are they going to get any sort of thick viscous fluids? Like dextro. Those types of fluids are very, very, very thick. And so if you put a, um, if you tried to think about putting an IV in the hand, you're probably going to blow it. So what you want to do is you want to think about what kind of therapy might they need and if they're going to need some sort of heavy type of or they're going to be receiving a lot of fluids or medications or what have you through those IVs, then your ideal vein selection is going to change.

Maybe the hand isn't the greatest spot and maybe we need to modify that and go in the, the AC, or maybe it's in the forearm. We need to find a better location. The next thing that you're going to do is gather all of your supplies. You should be thinking about all of this, all of the supplies that you're going to need in order to make sure that this IV is going to stay secure. Maybe you need extra tape. Maybe you're going to need a different type of dressing, that kind of stuff, so just anticipate what kind of supplies you're going to need and gather those and get them all ready. The other thing that you're going to want to do is set up and you're going to see this video here in just a minute. We'll go over how you set it up and how you get everything ready and available for you to reach over and grab whatever you need.

This is a really important step right here. Mixing you're going to do is placing the IV. We have lots of videos on the nuances of different types of patients that you may run into different types of locations and I want you to refer back to those videos, but for this, just think about, Hey, I'm going to go in there. I'm going to knock this out. Am I getting this IV place and I'm not going to worry about it anymore? The next thing you want to think about this securing the IV, so you're gonna do this with transparent dressings or whatever the other, the other important part is to follow a policy. The unit that you work in, the facility you work in may indicate a specific type of policy that you need to follow that's backed by evidence or backed by a specific physician or provider.

So make sure that you are following that policy. Now, as we talked about in that last video, these are everything. This is everything you're gonna need. You're gonna need the IV, you need this IV kit, you've got your syringe, and then you've got your extension said. Now let's kind of go over all of these pieces. The first thing you're going to want to do is open that saline flush up. Now a little tip, most of these have a little seal and what you'll do is take the cap off and pull back to break the seal and then you can push the air out. That's usually a really easy way to do it. The next thing you'll do is open up this extension set kit. This one comes with a cap by default. Always makes sure that the cap is there and then you want to prime it.

One of the things I like to think about is that this end right here is going to be the part that actually attaches to the IV. So you want to make sure that it actually stays as sterile as possible. Once it's primed, then you want to clamp off the extension set to make sure that no arrogance, it's trapped in there and make sure that it's all ready to go for your patient. The next thing you're wanting to do is open up that IV kit, and the reason you want to do this is that you want to make sure that you have everything ready to go and you also want to make sure that it includes everything. That's your core prep, that's the bullet version. Then you have the tourniquet. Then there's the micropore tape and gauze, and so the micropore tape is one of my favorite tapes to absolutely use.

And then you also have your transparent dressing here. And then the other cool thing about this kit is it actually has this little time, date and initial sticker, which is very, very, very important. But what you want to do, the first thing you want to do is undo that tourniquet. You want to make sure that it's available for you to grab. The last thing you want to do is walk in and not be prepared. So just grab that, unwind it and make sure it's ready. The next thing you want to do is get the prep ready. That's really important. Now for this device or for this particular one, wouldn't checks you have to do is break it similar to like an ampule. Now the next thing you want to do is grab your tape and you want to do a couple of things with it. 

First off, you want to make the tape, you want to tear off two pieces and you want to create this loop that you're seeing right here. What that does is it actually allows you to reach over and grab the tape really easily. The reason I put it on the back of my hand is that I want to make sure that number one I'm following best practice and putting it on the bedside is actually going to grab all that bacteria so this keeps it nice and clean. Then you want to open up that IV. That's your next step. What I like to do is pop this cap off because the last thing you wanna do is have the tourniquet on. Everything's prep and you can't get the cap off and you look kind of silly and also it's very frustrating for you and it kind of doesn't get you out of that mindset.

Once that's all set, just make sure that that's put back in, but once it's all set up, then set it up the way that you feel most comfortable that you will. You can grab it in sequence. For me, I like to have kind of everything laid out like this, but it is also preference. Now for the procedure, what you want to do first is you've identified that vein where you're going to go, then you need to take the tourniquet out and you're going to, you're going to grab the tourniquet, you're gonna place it 10 to 12 centimeters above the site. I have seen nurses, uh, place it far above that. What you don't want to do is place it too close to the site because that actually prevents a venous distention. We want to, um, make sure that that vein is going to fill up and if it's too close to the actual site, that's not gonna happen. 

So it's okay to go a little bit further than 10 to 12, but I would actually not go any closer than that. Next thing you want to do is you want to apply that antiseptic. You want to use those concentric circles and you move outward starting in the middle and never come back. Because what that does is that brings back bacteria back to the site of insertion. And we don't want that. That's not best practice. So use those concentric circles moving outward and a layer, allow it to air dry. That's what's really important about the antiseptic. You can use a vigorous scrubbing that will actually do the mechanical moving of the intercept or mechanical moving of removing of the bacteria. But the, the other important part is to allow the interceptive to completely air dry. Now with your nondominant hand, you want to actually anchor that vein and what that'll do is actually prevent that rolling back and forth and we'll make that thing stay in place and then use your 10 to 20-degree insertion angle and you want to insert the catheter.

Now this is a kind of standard guideline. Some veins are going to be deeper in underneath the tissue and they're going to require steeper angles. Some are going to be closer to the surface, so they're going to require more shallow angles, but this is kind of the guideline to start with 10 to 20 then you want to advance that IV catheter. Now, one thing I wanted to caution you about is to remember the way the IV works, you have the entire ax, you have the cannular and then the end of the Canyon and then you have the needle with the bevel. Now once this actually gets inserted in there, you still need to advance another two to three millimeters, sometimes less. It depends on how big the vein is. It also depends on some other factors, but once you get it, what you want to do is advance it only slightly until you get, uh, you get that flash. And then once you see the flash, advance it and then, uh, advanced the in the entire catheter into the vein. And then what you'll do is activate that safety device and attach your extension set.

There are lots of different ways to secure the IV catheter. I, my preferred method is it called a two a two tape Chevron. And the way it actually looks is like if this is a hub and this is a catheter, what I actually will do is I will take a tape and go underneath to where the sticky side is up in the sticky side, actually adheres to the underside of the catheter and then the sticky side actually comes down onto the patient. And then I use another piece of tape across, uh, there's a video that specifies an of different various methods. This is just my personal preference. Now also, one thing I want you to take into consideration is there may actually be a facility or unit policy that talks about this. So make sure that you know what that is and that if you have to adhere to it.

Some emergency nurses like to put that transparent dressing directly over and then secure the extension set with a single piece of tape, which is totally a totally practical. It's a great method, especially if your patient's compliant. It's easy, there's very little, there's very few problems that happen with that. But use whatever method is comfortable for you. And also the one that follows policy. There are. There's one other aspect of securing the catheter that comes into play and that's making sure that the site is clean, dry and that the dressing stays intact. And the last thing you want to do is put your time, date and initials of when it's placed. This is mostly for infection control. Now, the old school way of thinking of this was that IV sites needed to be rotated after so many hours, but that's not the case. Most if not all evidence nowadays is showing that the policy is that the dressing needs to be changed. 

The dressing is that source of infection. So putting the time, date and initials of when the dressing was applied will be your greatest indicator for infection control. So let's watch this process all the way from start to finish. I'm just going to walk you guys through it, but I want you to see what the process looks like. So the tourniquet is already applied and now we're just palpating that vein. Now there's a concentric circles with the antiseptic, the chloro prep. She's going to use that left hand to anchor down the vein and then use that 10 to 20 degree angle, which is right about here to insert into the vein. Once she gets it, she gets a flash, she advances the catheter applies pressure. This is another method you can use. It's called tampon. Then apply the extension set. This extension set is already primed. 

Now one of the feature that I want you guys to check out is this. She will actually pull back and see blood in the extension set and then flush it through. Once that's done, you're going to clamp off that extension set to keep blood from back flowing into that uh, set and to keep clots from messing up your IV, apply your secure device. So in this case it's a transparent dressing and then she's going to take another piece of tape and secure the extension set over the patient's arm just to make sure that it's not going to get snagged on anything and pull that IV catheter out. Then finally, like we talked about time, date and initial. This is so important for infection control. We want to make sure that we're keeping our patients free from infection. All right guys, so let's recap. We first want to make sure that we have an order or some sort of standing order or policy that indicates that we can actually place an IV, Catherine and a patient. 

We can't just arbitrarily do it, we can't do it because we think we need to. We have to verify the need for it. Also, identify the need. This is your ability to be a clinician. We want you to go out there and make sound decisions. If I have a patient that may need a central line over a peripheral IV, then I need to advocate for the patient. Hey, this patient does not need a peripheral IV. They actually needed a central line. Didn't do so because all you're doing is delaying care and you're not advocating for your patient. So make sure you identify the right need for this patient and then educate them. Make sure, Hey, if I'm going to put this IV in the in the AC, I want to make sure that they're not going to bend their elbow and if it's in their hand, I need them to be cautious about when I'm moving about. 

Make sure it doesn't get snagged on anything, so educate your patient on that and also the process. It can be uncomfortable for some patients. Next, gather your supplies doing this as a multifaceted task. You want to be thinking about the supplies you need and then once you get them, consider setting how you're going to set them up prior to inserting that IV. Once you get the IV, apply that extension set and then flush the catheter to confirm patency. Sometimes you'll get you're going to get blood return and that's totally okay. Sometimes you won't. What you want to do is make sure that it's Peyton so that you're not going to extra. Say if there are any or any sort of VESA kits that you give the patient. Finally, you want to make sure that catheter is secure. You want, you want to use whatever various methods are comfortable for you, including following whatever protocol or policy is in place. Okay, guys, I hope that this lesson has been super helpful in helping you to understand all of the little intricacies and nuances of placing an IV from the very beginning to the very end. Now, we love you guys go out and be your best selves today, and as always, happy nursing.

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