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How To Start an IV? – A Complete Guide

Ever felt your heart race as you approached a patient with an IV catheter in hand? That flutter in your chest is a reminder of the responsibility you carry. If you’ve ever faced the pressure of finding the right vein, avoiding complications, or even handling a tricky insertion, you know how important it is to follow the right procedure. 

But, for some, the process is just brand new. Frankly, little knowledge in this field can be incredibly dangerous. That’s why you need to sit tight and learn how to start an IV to ensure the best for your patients.

Now maybe you’re here because you’ve struggled with a difficult vein, or perhaps you’re looking to sharpen your skills and avoid common IV mishaps. Whatever the reason, this guide will walk you through every elemental step, giving you the confidence to handle even the most challenging cases with ease.

Let’s get started on making your next IV insertion smoother, safer, and more successful.

What You Need to Know Before Starting an IV?

Knowing the necessary tools and proper steps for how to start an IV is necessary to ensure patient safety and prevent complications during the procedure.

Tools You’ll Need for Starting an IV

  • IV Start Kit: This contains the basics:
    • Tourniquet: Helps locate a vein.
    • Antiseptic wipes: Used to clean the IV site to prevent infection.
    • Needle gauge: Choose the appropriate size needle.
    • Identification sticker: Labels the IV with the insertion time and who placed it.
    • Gauzes, Tape, Tegaderm: Used for securing the IV and keeping the site clean.
  • IV Needle: This is the needle used to insert a plastic cannula into the vein. The needle is removed after the cannula is in place.
  • Extension Tubing or Cap: Once the IV is inserted, the tubing connects it to fluids or medication. Use a cap if the IV is just for future use.
  • Normal Saline Flush: A pre-filled syringe of saline to clear the IV line and ensure it’s working properly.

Preparation for IV Insertion

  • Check Patient Details: Always check the medical details of your patient.
  • Check Prescription: Review the prescription chart, noting the fluid type, volume, and administration time.
  • Check for Allergies: Verify if the patient has any allergies.
  • Explain the Procedure: Make sure the patient understands the procedure and give them time to consent.
  • Inspect the Fluid Bag: Check the bag for cloudiness or particles; if impurities are found, do not use it.
  • Prepare the Drip Stand: Remove the outer packaging from the fluid bag and hang it on the drip stand.

Setup for Administering an IV

Setting up an IV is more than just inserting a needle—it’s about ensuring the patient is comfortable and prepared, and that all materials are ready for use. Here’s how to set up an IV properly:

  1. Prepare the IV Kit: Open the IV start kit and place all materials, such as gauze, tape, and catheter, within easy reach. Draw up the saline flush if you’re not using a pre-filled syringe.
  2. Flush the Extension Tubing: Connect the extension tubing or cap to the catheter connector and flush it with saline to ensure it’s clear and functional.
  3. Open the Catheter Package: Once the tubing is flushed and ready, open the catheter package, keeping it sterile and prepared for insertion.
  4. Clean the IV Site: Use antiseptic wipes to thoroughly clean the area where the IV will be inserted to reduce the risk of infection.
  5. Insert the IV Needle: Gently insert the needle into the vein, leaving the cannula in place once the needle is removed.
  6. Secure the IV: Use gauze, tape, and Tegaderm to secure the cannula and keep it in position.
  7. Label the IV: Properly label the IV site with the necessary details, such as the date and time it was placed, to help the healthcare team monitor and manage it.
  8. Flush the Line: Use the saline flush to ensure the line is clear and ready for fluid or medication administration.

From Vein Selection to Cannulation: How to Start an IV?

Starting an IV can seem complicated, but with the right preparation and a clear understanding of the steps, it becomes easier. Here’s a simplified, easy-to-follow guide to ensure you can place an IV safely and effectively:

Choose the Right IV Gauge

The first step is determining the correct IV gauge size based on your patient’s needs and situation. Gauge size refers to the diameter of the IV needle, with larger numbers indicating smaller needles. Here’s a breakdown of the most common sizes:

  • 24g IV: The smallest size, mainly used for infants or very small children. These are delicate and not suitable for larger veins or adults.
  • 22g IV: Smaller and often used for children or adults with delicate veins. It works well for slower fluid administration but isn’t ideal for situations requiring a lot of fluid quickly.
  • 20g IV: This is the standard size for most adult patients. It’s suitable for various purposes, including blood draws, lab work, and typical fluid administration.
  • 18g IV: A large size typically used in emergency settings for fast fluid delivery. Like the larger sizes, avoid this for patients with smaller veins.
  • 14g-16g IV: These are the largest needles, used in rare situations where rapid fluid administration is needed, such as emergencies. These are not suitable for patients with small or fragile veins.

Prepare the Patient for IV Placement

After choosing the correct IV gauge, the next step is to prepare the patient for the procedure:

  • Hand Hygiene: Always begin by washing your hands and wearing clean gloves to prevent infection.
  • Apply a Tourniquet: Place a tourniquet above the chosen IV site to help the veins stand out more clearly. Look for a straight, accessible vein that will work well for insertion.
  • Disinfect the Area: Use antiseptic wipes, such as alcohol or chlorhexidine, to thoroughly clean the skin where the IV will be placed. Allow the area to dry before continuing.

Prepare the IV Line and Bag

While the patient’s skin dries, you can set up the IV equipment:

  • Hang the IV Bag: Attach the IV bag to a stand, ensuring it’s elevated to help with the fluid flow.
  • Prime the IV Tubing: Connect the tubing to the IV bag and fill it with saline. Be sure to remove any air bubbles in the line by gently tapping or squeezing them out.
  • Get the Needle Ready: Remove the cap from the needle, and ensure the catheter hub is ready for use. Avoid touching the needle to anything besides the patient’s skin to maintain sterility.

Insert the IV Needle

Once everything is prepped, you’re ready to insert the IV:

  • Position the Needle Correctly: Hold the needle in your dominant hand, keeping it at a slight angle (10-30 degrees) with the bevel facing upward.
  • Hold the Skin Taut: With your other hand, gently stretch the skin around the IV site to stabilize the vein and make insertion easier.
  • Insert the Needle: Slowly insert the needle into the vein. Once you see a flash of blood in the needle chamber, you know you’ve entered the vein.
  • Advance the Catheter: After lowering the angle of the needle to make it nearly parallel with the skin, gently advance the catheter a few millimeters. Then, slide the catheter into the vein while withdrawing the needle.
  • Release the Tourniquet: Once the catheter is in place, remove the tourniquet and use gentle pressure on the vein to prevent blood flow while securing the IV.
  • Retract the Needle: Activate the needle’s safety mechanism to retract it and prevent injury.

Secure the IV Line

Once the IV is successfully inserted, you need to secure it properly:

  • Apply a Dressing: Use gauze or a transparent dressing like Tegaderm to cover the IV site and keep it secure. This ensures the IV stays in place without restricting blood flow.
  • Secure the Tubing: Attach the extension tubing if necessary, and ensure everything is fastened to prevent accidental dislodgement.
  • Extra Wrapping for Protection: If the patient might accidentally pulls on the IV (such as a child or someone disoriented), wrap the area with an elastic bandage, leaving the IV cap accessible for future use.

This explanation provides a theoretical understanding of starting an IV. Truth be told, you’ll grasp the process much better in a live setting under the guidance of an experienced professional.

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Essential IV Post-Care Guidelines

Proper care after IV insertion is just as crucial as the procedure itself. Ensuring the IV stays in place and works effectively can prevent complications and ensure the patient’s comfort.

  • Securing the IV Catheter: After placing the IV, secure it with transparent dressings or specific devices to prevent accidental movement. Ensure the dressing is firm but not too tight to avoid restricting blood flow. Regularly check the site to ensure everything stays in place.
  • Flushing the IV Line: Flush the IV line regularly to prevent clots and keep it clear. Using a sterile saline syringe, flush slowly to keep the line open for future use and to ensure medications or fluids can flow properly.
  • Documenting the Procedure: Record important details like the time of insertion, catheter size, location, and any reactions. Proper documentation ensures smooth communication with the healthcare team and safe patient care.

Common Mistakes to Avoid When Starting an IV

When starting an IV, even small mistakes can lead to discomfort for the patient or complications with the treatment. Here are some common errors to watch out for and how to avoid them in how to start an IV process:

  • Using a Catheter That’s Too Short A short catheter can make the IV unstable or easily dislodged, leading to issues like infiltration. Always choose a catheter that fits the vein size and the purpose of the IV to keep it stable and comfortable.
  • Not Inserting the Needle Deep Enough If the needle isn’t inserted deep enough, the IV might leak into surrounding tissue or fall out. Ensure the needle is inserted to the proper depth to securely place the catheter inside the vein.
  • Inserting the Needle at the Wrong Angle Inserting the needle at too steep an angle can puncture the vein or miss it altogether, causing pain. Aim for a 15-30 degree angle to access the vein correctly and reduce discomfort.

Knowing and avoiding these common mistakes can improve the success of your IV placements and ensure a safer, more comfortable experience for your patients.

How to Select the Best Vein for IV Insertion: Tips and Techniques

Finding the right vein for IV insertion can be challenging, but it’s crucial for successful placement. Here are some tips and techniques to help you select the best vein for IV insertion:

  1. Choose the Antecubital (AC) Area:
    The antecubital fossa, located on the front of the elbow, is often the first choice for IV insertion due to its easily accessible veins. This area typically offers veins that are larger and more prominent.
  2. Assess Both Arms:
    Always examine both arms for veins that are straight, visible, and firm. If veins in the AC area are not suitable, other sites like the forearm or the back of the hand can be considered.
  3. Use a Tourniquet:
    Apply a tourniquet 3-4 inches above the selected insertion site to make the veins more prominent. Ensure it’s tight enough to highlight the veins but not too restrictive.
  4. Palpate the Vein:
    Gently feel the vein to assess its size and depth. Use your fingertips to trace its path and identify any valves or areas where the vein splits, which could make insertion more difficult.
  5. Prepare the Area:
    Clean the chosen site with antiseptic wipes to reduce the risk of infection before inserting the needle. Let the area dry completely before proceeding.

Following these steps increases the chances of selecting the best vein for a smooth and successful IV insertion.

How to Handle Difficult IV Insertions?

Difficult IV insertions can be stressful, but with the right techniques, you can increase your chances of success. Here are some expert tips to help you manage challenging cases:

  1. Communicate Effectively
    Start by talking to the patient, the healthcare team, and the nurse. Ask about any previous IV attempts, areas to avoid, or concerns the patient may have. This communication helps you understand the situation better and can put the patient at ease, which may make the insertion easier.
  2. Use a Tourniquet Properly
    Apply it a few inches above the insertion site, and give it some time to work, allowing the veins to fill with blood and become more prominent. Make sure not to leave it on for too long, as this can cause discomfort.
  3. Try Ultrasound-Guided Cannulation
    In cases where veins are difficult to find, using an ultrasound can help you locate deeper or hidden veins. This tool provides a clear visual guide, reducing the need for multiple attempts and improving accuracy.
  4. Warm the Vein and Skin
    Applying warmth to the area before attempting insertion can help dilate the veins. You can use a warm compress or even a heated glove filled with warm water to encourage blood flow and make the veins easier to locate.
  5. Be Patient and Prepared for Failure
    Not every attempt will be successful, and that’s okay. Take your time, stay calm, and know when to ask for help if needed. If a vein is proving difficult, it’s better to switch to another site or call in a more experienced colleague rather than continue with unsuccessful attempts.

Following these strategies will help you handle difficult IV insertions with confidence and improve your patients’ overall experience.

IV Insertion Best Practices: Ensuring Patient Comfort and Safety

In addition to the basic steps for IV insertion, it’s essential to follow certain safety practices to ensure infection control, proper disposal of sharps, and monitoring for complications. These extra measures help maintain patient safety and prevent issues during and after the procedure.

Infection Control 

You need to have a good hand hygiene. Wash your hands with soap and water or use an alcohol-based sanitizer before and after the procedure. Use aseptic techniques by cleaning the access port with antiseptic for at least 15 seconds and letting it dry. This reduces the risk of infections by keeping bacteria out of the bloodstream.

Safe Disposal of Sharps and Equipment 

Proper handling of needles and other sharp tools is necessary to avoid injury. Dispose of all used needles in puncture-resistant sharps containers immediately. Follow your facility’s guidelines for safely discarding syringes, tubing, and other single-use items.

Monitoring for Complications 

Once the IV is placed, monitor the site regularly for complications like:

  • Phlebitis: Look for redness or inflammation around the vein.
  • Infection: Watch for signs like warmth, swelling, or redness.
  • Bleeding: Any blood at the insertion point.
  • Swelling or Pain: These can indicate improper placement or infiltration.

Early detection of these symptoms allows for prompt action, helping to prevent more serious complications.

Troubleshooting IV Insertion: What to Do When Things Go Wrong?

The potential issues that can arise from IV insertion errors are important for both medical professionals and caregivers to understand, as they can lead to serious complications if not addressed promptly. Here is what can go wrong during an IV insertion:

  • Fluids may collect in the surrounding tissue, causing swelling and pain at the IV site.
  • The tissue around the insertion point can be damaged, leading to irritation or more serious injuries.
  • Medication or fluids won’t reach the bloodstream, making the treatment less effective.
  • Excess fluid buildup in the tissue can cause complications like fluid overload.
  • There’s an increased risk of infection if the fluids leak into the surrounding tissue.
  • Fluids infiltrating near nerves can cause nerve damage, leading to pain or numbness.
  • In rare cases, severe mismanagement of fluids can result in serious complications like stroke or brain injury.
  • Certain medications can cause severe burns or scarring if they leak into the surrounding tissue, sometimes leading to the need for amputation.

Steps to Take When IV Infiltration Occurs

Knowing what to do if IV insertion goes wrong can help reduce discomfort, prevent serious tissue damage, and minimize the risk of long-term complications like infection or nerve damage. 

  1. Stop the Infusion Immediately: As soon as there is swelling, pain, or discomfort, stop the IV infusion to prevent further issues.
  2. Remove the IV Line: After stopping the infusion, carefully take out the IV catheter to prevent more fluid from leaking into the surrounding tissue.
  3. Elevate the Affected Limb: Have the patient raise the affected limb to help reduce swelling and allow fluid to drain from the tissue.
  4. Apply a Cold Compress: Use a cold compress to reduce pain and swelling. Apply it for short periods and check often to prevent irritation or discomfort.
  5. Monitor the Patient: Keep an eye on the patient for any signs of infection or worsening symptoms, and consult a healthcare provider if needed.
  6. Document the Incident: Record the time, site, and details of the incident. This documentation ensures proper follow-up and helps future caregivers stay informed.

How to Take Care of an IV Site After Insertion?

Properly caring for an IV site after insertion is indispensable for promoting healing and preventing complications. That’s what we’ll cover in this section, helping you recognize early signs of potential problems:

  • Monitor the area: Keep an eye on the IV site for a few days, watching for signs of bruising, swelling, or other issues.
  • Apply ice or a cold pack: If you notice bruising or swelling, apply ice or a cold pack for 10-20 minutes at a time, with a cloth between the ice and your skin.
  • Be gentle with the arm: Try to avoid heavy use of the arm where the IV was inserted for a day or two to prevent discomfort.
  • Resume normal activities: You can usually return to your regular activities unless your doctor advises against it.
  • Bathe or shower as usual: It’s generally safe to bathe or shower as long as the IV site is kept clean and dry.
  • Watch for signs of infection: Call your doctor if you notice increased pain, swelling, warmth, redness, pus, blood draining from the site, or if you develop a fever.
  • Report unusual symptoms: Seek medical help if you observe new or worsening bruising or a large lump at the IV site.

In Closing!

To make sure your patient feels safe and relaxed, you need to knowhow to start an IV and handle any challenges that come up. With a focus on preparation, technique, and aftercare, you’re setting yourself up for success with every IV insertion, ensuring better outcomes for your patients.

But, truth be told, you need to perform this method under the watch of someone who has been doing it for a while. That’s because making mistakes on the human body can cause more harm than normal. What’s more, it can cause the person to lose trust in you and raise safety concerns. As people from the medical field, it is our duty to ensure mistakes as big as this don’t happen.

If you need support, Legere Pharm is here to help. We offer high-quality IV therapy supplies, IV kits, and expert guidance to make sure you have all the tools and knowledge necessary for safe and successful IV insertions. Whether it’s for starting an IV or managing post-care, we’ve got you covered to ensure effective and reliable care every step of the way.

Dr .Taylor Froiland

President of Legere Pharmaceuticals

Taylor Froiland is the president of Legere Pharmaceuticals in Scottsdale, Arizona and serves on the Board of Directors for RK Logistics Group. He also owns and operates Medmetrics Compounding Pharmacy in Chandler, Arizona, specializing in various pharmaceutical services. Taylor holds a PharmD and has expertise in compounding, medicinal chemistry, and quality control.

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