One essential skill that nurses need to learn is how to insert intravenous catheters into patients. So, whether you’re a nursing student, want to be a medical assistant for IV treatments, or are already a registered nurse seeking to refine your skills, this article is your introductory guide.
We’ll discuss topics such as vein selection, common mistakes, and some expert IV insertion tips. Join us as we explore the step-by-step process of how to start an IV effectively and safely.
Note: This guide offers educational information and is not a substitute for professional medical advice.
What You Need to Know Before Starting an IV: Tools, Preparation, and Setup
When gearing up for IV insertion, a thorough understanding of each tool and its specific function can ensure a smooth and successful procedure. Try to familiarize yourself with the following standard IV starter kit items:
- Tourniquet: Used to constrict blood flow, helping to locate a suitable vein
- Antiseptic wipes: Essential for cleaning the IV site to prevent infection
- Needle gauge: Select the right size for the specific procedure, with an identification sticker for labeling
- Gauzes: For site cleaning and managing any blood
- Tape: Secures the IV catheter in place
- Tegaderm: A transparent dressing to protect the IV site
- Curos cap: A cap for disinfecting the IV line
- Gloves: To maintain sterile conditions
- Extension set: For extending the length of the IV line
- IV catheter: A very thin tube inserted into the vein for the administration of fluids or medication
- Saline flush: Used to ensure the line is clear and functioning properly
Knowing the following needle gauges for IV, their precise applications, and sizes (gauges, abbreviated as “G”) is essential for achieving an effective execution [1]:
- Blue 22G: Suitable for patients with small or fragile veins
- Pink (routine) 20G: Commonly used for IV fluids, drugs, and blood transfusions
- Green 18G: Ideal for blood transfusions and administration of IV medications and fluids
- White 17G: Also used for blood transfusions and IV medication/fluids
- Grey 16G: Provides large bore access, often used in emergency situations
- Orange 14G: Another large bore access option for emergency scenarios
When learning how to start an IV, it’s crucial to familiarize yourself with the tools and needle selections to ensure safe and effective procedures. Access to high-quality IV therapy supplies can also enhance the overall process.
Additionally, be cautious with IV supplements and always stay informed with reputable sources or consult your preferred manufacturer for expert advice.
Process of IV Insertion: From Vein Selection to Cannulation
With your IV kit materials ready and within arm’s reach, start by preparing the saline flush. If you have a prefilled syringe, this step is simplified. Next, connect the IV catheter and flush the extension tubing or cap to ensure it’s clear of any obstructions. Now, you can open the catheter package in preparation for the procedure.
Here’s a guide for the entire process:
1. Select the Vein
Once you have prepared your materials, the next step is choosing the insertion site. Determine which vein to use by avoiding areas with edema, burns, or other issues. Look for clear skin with visible veins where the IV cannula fits well. It is often best to choose the patient’s non-dominant arm to minimize discomfort.
2. Patient Interaction
Begin by introducing yourself to the patient and explaining the procedure. For instance, you might say, “I’ll be inserting an IV to administer your medications.” Verify their details and gain verbal consent before proceeding.
3. Choose the Correct IV Gauge
Determining the proper IV gauge is essential, as it dictates the needle and IV catheter size you’ll use. Larger gauges can administer medication faster but can be more challenging to insert, cause more pain, and increase vein irritation.
4. Prep the Patient for IV Insertion
Once the right gauge is chosen, prepare your patient. Start by washing your hands thoroughly and putting on a pair of clean gloves to protect against potential bloodborne contaminants.
Then, place a tourniquet on the patient’s arm above the intended insertion site. This helps make veins more prominent and easier to locate. Look for a straight and large vein, or palpate to feel for the vein if it’s not visible. Clean the area thoroughly with antiseptic swabs, such as chlorhexidine (CHG) or alcohol, and let it dry completely.
5. Prepare the IV Line and Set Up the IV Bag
While the disinfectant dries, get your IV setup ready. Hang the IV bag on an elevated hook and fill the tubing with saline solution. Check the line for any bubbles, as any trapped air could cause an embolism.
Remove bubbles by gently tapping or squeezing the line.
You can then remove the needle cap, twist the catheter hub to ensure it’s loose, and avoid letting the IV touch anything other than the patient’s skin.
6. Insert the IV Needle
Now comes the insertion. Hold the needle in your dominant hand at an angle between 10 to 30 degrees from the insertion site, with the bevel facing up.
Using your non-dominant hand, stretch the skin taut over the vein to prevent it from moving. Insert the needle and look for a flashback of blood in the flash chamber or catheter, indicating the correct placement.
Lower the needle angle until it’s almost parallel with the skin, advance it slightly, and then slide the catheter off the needle into the vein [2].
If you encounter resistance or see dimpling, you may have missed the vein and need to try again. Once the catheter is correctly in place, remove the tourniquet, apply pressure beyond the catheter tip with your index finger, and activate the needle retraction mechanism.
7. Secure the IV Line
Finally, it’s time to secure the IV. Use a dressing like Tegaderm or gauze and tape to hold it in place. If using an extension loop, make sure it’s also secure. Ensure that nothing can easily snag the IV line.
For patients who might inadvertently pull at the IV, such as young children or disoriented individuals, wrapping the area with Coban can add an extra layer of security. Make sure the cap remains accessible.
By following these steps methodically, you can master how to start an IV, ensuring both efficacy and patient safety.
Common Mistakes to Avoid When Starting an IV
Starting an IV can be a delicate procedure, and avoiding common mistakes is essential for success. Being aware of these pitfalls can make the process smoother and more comfortable for both you and the patient. Here are some frequent errors to watch out for:
- Inadequate vein selection: Choosing veins that are too small, hard to access, or located in compromised areas like those with edema or scars.
- Poor preparation: Not having your IV kit materials within easy reach leads to interruptions and increased risk of contamination.
- Improper needle angle: Inserting the needle at an incorrect angle can cause pain and might lead you to miss the vein entirely.
- Insufficient patient communication: Failing to explain the procedure thoroughly can make a patient anxious and not cooperate.
- Neglecting sterility: Not properly cleaning the insertion site or using dirty gloves significantly increases infection risk.
How to Select the Best Vein for IV Insertion: Tips and Techniques
As you begin to practice IV insertion in a real-world scenario, the optimal vein for IV insertion is your friend, especially when it comes to patient comfort and procedural success. Here are some tips to learn:
- Begin by choosing the lowest distal veins and then work your way upward. This method preserves potential sites below the initial insertion point.
- Avoid cannulating near joints, as this can cause discomfort and trigger alarms on the drip machine.
- Look for clear, undamaged skin with visible veins that can accommodate the IV cannula.
If the patient is difficult to cannulate, consult a senior clinician. Areas with edema or burns are unsuitable. When in doubt, always consult experts or confirm details with your instructors.
How to Handle Difficult IV Insertions: Expert Tips for Challenging Cases
There would be very, very difficult scenarios wherein you can’t insert the IV. Here are some things you can do [3]:
- Warm compress: Apply a warm, moist compress or warm towels to the area for 10 to 20 minutes before cleansing. The heat helps dilate veins, making them more visible and accessible.
- Gravity: Let the patient’s arm dangle off the side of the bed to promote venous filling. Gravity slows venous return and distends the veins.
- Tourniquet application: Apply the tourniquet tightly enough to hinder venous flow but not impede arterial flow, allowing blood to distend the veins.
- BP cuff use: For patients with low blood pressure, use a BP cuff instead of a tourniquet. Inflate it to an appropriate pressure to dilate veins, especially useful for older patients or those with difficult veins.
- Clenched fist: Remember when we advised engaging with your patient? Instructing them to repeatedly clench and unclench their fist compresses the distal veins and aids venous filling.
- Multiple tourniquets: Apply two or three latex tourniquets to enhance vein visibility. Place one high on the arm and leave it for 2 minutes, then apply the second one mid-arm below the antecubital fossa. Collateral veins should become visible. Use a third tourniquet if necessary.
When in doubt, consult experts or confirm details with your instructors. This is vital because each patient is unique, and your approach may require adjustments based on their individual circumstances.
Relying on experienced professionals or seeking guidance from instructors ensures you are using the best techniques and helps prevent complications. It also reinforces your learning and builds confidence in your skills, ultimately leading to better patient care.
IV Insertion Best Practices: Ensuring Patient Comfort and Safety
A good rule of thumb is to consider your patients as partners in their care. Avoid slapping the vein, as it can cause the veins to contract and make the insertion more difficult.
Instead, ask your patient about their previous IV history; they might know which veins work best. Always observe infection control measures, such as wearing gloves, since IV insertion is an invasive procedure requiring an aseptic technique.
Lastly, assess for needle phobia, as previous experiences may have left the patient anxious about needles.
Troubleshooting IV Insertion: What to Do When Things Go Wrong
When things go wrong during IV insertion, it’s always best to consult experts, such as a senior nurse or a doctor in a clinical setting, or ask your instructors if you’re in a classroom setup.
Here are some other steps to take:
- Check if the chosen vein is appropriate or if another site might be better.
- Reassess the angle and depth of needle insertion.
- Ensure that all IV kit components are functioning properly.
- Pause and explain the situation to the patient to keep them calm and cooperative.
- Sometimes it’s best to remove the needle and start over with a new site.
- Don’t hesitate to ask a colleague for help.
How to Care for an IV Site After Insertion: Maintenance and Monitoring
Remember, proper documentation is a very important step in caring for an IV site after insertion, as it will help you understand how you can monitor your patient. Record the date, time, and details of the procedure. Then, you can do the following [4]:
- Perform hand hygiene and put on non-sterile gloves.
- Carefully remove the adhesive dressing while keeping the cannula in place.
- Hold a piece of sterile gauze or cotton wool over the exit site without applying pressure.
- Slowly withdraw the cannula, maintaining a neutral angle with the patient’s skin. You can then cover the site with a suitable dressing, such as a pressure dot, cotton wool and tape, or a Band-Aid™.
- Advise the patient and/or family that the dressing should remain in place for up to 24 hours.
- Remove gloves and perform hand hygiene again.
Ready to learn more about treatments such as MICC injection, Vitamin C infusions, or hydration therapy? If you have any questions about anything IV-related, we at Legere Pharmaceuticals can help. We can even talk about IV supplements, as we are also a private-label supplement manufacturer.
Contact us today.

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.