02.01 Starting an IV

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IV Dressing and placement (Image)
IV Cannula Gauges (Image)
Vein Sites (Cheat Sheet)
Starting an IV (Cheat Sheet)
Medication Administration Pro-Tips (Cheat Sheet)
IV Therapy (Cheat Sheet)

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In this video we’re going to look at starting an IV. This is one of the most coveted skills for nursing students during clinicals.

It’s one of those things you’ll brag about being able to do on the first try! The more you practice, the better you’ll get at it!
So the first thing you’ll do once you’ve gathered all of your supplies is look for a good vein. Now we try not to go in the AC unless it’s an emergency because it’s where they flex their elbow. So always start in the distal aspect of the patient’s nondominant side if possible.
Open your IV start kit to get your tourniquet and place it about 6-8 inches above where you’re wanting to look, that should plump the veins up nicely. When you see one you like, give it a little press and make sure it’s nice and bouncy and that there aren’t any valves and it isn’t hard and firm. My biggest rule of thumb is you go for what you can FEEL, not just what you can SEE. Your eyes will play tricks on you!
Once you found a good spot, remove the tourniquet while you get the rest of your supplies ready
Open your saline lock and your saline syringe. Connect the syringe to the saline lock and prime it with saline. You may need to loosen the cap at the end, but don’t take it all the way off.
Pull off a small piece of tape from the roll and place it on the side of the table so you can reach it easily. You can also go ahead and take the angiocath out of its package, but don’t take the cap off yet.
Make sure the rest of your supplies are within easy reach with one hand - so don’t leave them behind you!
Now that you’re ready, go ahead and replace your tourniquet about 6 inches above your insertion site.
Palpate again to make sure the vein is still there, and then use the alcohol swabs or antiseptic scrub to clean the site. You want to clean in concentric circles starting in the middle and working your way out.
Now grab your angiocath, in this case we chose a 20 gauge needle. Take off the cap and make sure the catheter isn’t damaged or kinked in any way - if it is, take the tourniquet off and go grab another one.
If you’re good to go, you want to use your non-dominant hand to stabilize the vein below where you’re going to insert. Then make sure the bevel is up on your angiocath - usually there’s a little plastic piece at the top you’ll use to guide your way in.
Hold the needle at about 15 degrees to the skin. Any steeper and you can go through the vein, any shallower and you’ll miss it. Insert it firmly, but not too fast. This is the part that becomes muscle memory. Once you’re in, you’ll see a flash in the chamber. If it’s a super slow flash, advance your needle EVER SO SLIGHTLY - like MAYBE 1 mm. If it’s a REALLY good flash, then you know you’re good to go.
Here’s where you need to hold the needle STILL and advance JUST the catheter. Some needles allow you to do this with one finger. But if it won’t advance, you can use your opposite hand to help advance the catheter.
Once the catheter is in, use your non-dominant ring finger to put pressure on the vein about an inch to an inch and a half above your insertion site. Then you can pull out the needle and activate the safety device.
Now quickly grab your saline lock and twist it onto the hub of the catheter.
Gently pull back on your saline syringe to make sure you have good blood return, then flush with about 5 mL of saline.
If you’re good to go - release the tourniquet, then grab the piece of tape you prepped and put it over the hub of the catheter.
Now you can grab your dressing and apply it firmly over the insertion site.
Now that the IV is secure, you can get another piece of tape and loop the saline lock tubing up on the patient’s arm. Then you’ll write time, date, and your initials on the dressing.

Throw your sharps in the sharps container and the rest of your trash away, then document the new IV! Great job!
This is a task that you will get better and better at the more you do it. Even if it’s your first time, go in with CONFIDENCE and it will be awesome!

You’ve got this! Now, go out and be your best selves today! And, as always, happy nursing!
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