How to Use An IV Start Kit: Step-By-Step Guide For Nurses

Intravenous (IV) therapy is a staple in modern healthcare, as it provides a direct route for delivering fluids, medications, and nutrients to patients. As the ones responsible for administering IV therapy, nurses should confidently know how to use an IV start kit effectively. Honing this skill can significantly impact the success of intravenous catheter insertion, reduce complications, and improve patient care.

Starting an IV line is a fundamental skill for any nurse. While it’s a routine procedure, it requires precision and adherence to aseptic techniques to ensure patient safety and successful execution. 

Consider this your go-to guide for IV start kits, where we will provide a step-by-step approach to using them while incorporating the latest evidence-based practices and guidelines.

Understanding the IV Start Kit Components

Let’s start with a quick familiarization of what’s typically in this start kit. An IV start kit usually contains everything necessary to initiate IV therapy and support peripheral IV placement. While the exact components may vary slightly by brand, most kits contain:

• Alcohol swabs: Swabs or wipes are typically alcohol or chlorhexidine-based. While traditional alcohol wipes are effective, studies show chlorhexidine-based antiseptics significantly reduce infection rates by 49% in comparison. [1]
• Tourniquets: A tourniquet engorges veins and facilitates vein palpation, making it easier to insert the catheter accurately.
• Gauze pads: Used to apply pressure to the venipuncture site after catheter insertion, aiding hemostasis and preventing hematoma.
• Adhesive tape: Secures the IV catheter and tubing in place to prevent displacement during patient movement.
• IV catheter: A small, flexible tube inserted into the vein. Catheters come in various sizes (gauges), and choosing the appropriate size is crucial for patient comfort and treatment efficacy.
• Transparent dressing: Covers and protects the IV insertion site while allowing visibility for monitoring potential complications such as redness or swelling.
• Saline flush: A pre-filled syringe with sterile saline solution used to flush the IV line and confirm patency.

Modern IV start kits have introduced chlorhexidine-based antiseptics in place of traditional alcohol or iodine. This aligns with the latest U.S. Food and Drug Administration (FDA) guidelines, which recommend single-use IV start kits to minimize cross-contamination risks. [2] These new components enhance infection prevention by providing more effective antimicrobial activity.

Preparing for IV Insertion

Preparation is a critical phase in achieving successful IV insertion and involves creating an optimal environment for both the nurse and the patient. This phase sets the stage for reducing procedural complications and ensuring patient comfort.

Before initiating IV insertion, a diligent review of the patient’s Electronic Health Record (EHR) is essential to verify the healthcare provider’s order accuracy. [3] Ensuring a safe and effective setup begins with the WIIAPA approach: 

• Wash your hands to maintain hygiene.
• Introduce yourself to establish rapport.
• Identify the patient using two identifiers to confirm you have the right person. 
• Ask about any allergies, including food allergies, as they can impact the procedure.
• Outline the plan of care. 
• Perform a thorough patient assessment to tailor the procedure to their specific needs and enhance comfort.

Patient Assessment and Vein Selection

Before proceeding with a peripheral IV placement, conduct a thorough patient assessment. Understanding the patient’s medical history can help identify factors such as allergies, previous IV insertion complications, and current medications that may affect the utilization of IV therapy supplies. Also, assess whether the patient is well-hydrated, as dehydration can make vein location more challenging.

Selecting the appropriate vein is pivotal to successful IV insertion. The antecubital fossa (inside the elbow), forearm, or wrist veins are often preferred for their accessibility. However, patient-specific factors, like vein visibility, site preference, and previous IV sites, should guide vein selection. If necessary, consult visual aids or use a tourniquet to assist in locating suitable veins.

Gathering Necessary Supplies 

Efficiently collecting all necessary supplies before starting the procedure can help guarantee a smooth and successful process. In addition to the IV starter kits, nurses should have:

• Vascular access devices (VADs): An easy solution to the need for repeated reinsertion process for a long period of time
• Gloves: Maintain asepsis and protect yourself and the patient
• IV solution bag and administration set: Required if administering fluids
• Prescribed medication: Required if administering medication
• Sharp materials container: For safe disposal of used needles
• Patient identification labels: To label the IV line

Gathering these resources in advance will help avoid disruptions during the IV insertion process, allowing a seamless transition from preparation to performance.

Step-By-Step IV Insertion Process

Always use a structured approach to the IV cannulation procedure to reduce risks and promote patient comfort.

Applying the Tourniquet

Start by applying the tourniquet approximately 4–6 inches above the selected insertion site. The tourniquet must be tight enough to impede venous flow and engorge the veins. However, it should not be so tight that it reduces arterial blood flow, as this can result in patient discomfort and obscure vein palpation.

You can also ask the patient to make a fist or open and close their hand to help engorge the veins.

Cleaning the Insertion Site

Thorough skin antisepsis is important before proceeding with IV catheter insertion. Utilize the chlorhexidine-based antiseptic wipe from the IV start kit. Clean the insertion area using a back-and-forth scrubbing motion for at least 30 seconds to eliminate surface bacteria. [4] 

Allow the site to air dry completely before proceeding, as alcohol evaporation ensures maximal antiseptic effectiveness and prevents the antiseptic from being diluted.

Inserting the IV Catheter 

Hold the IV catheter with the bevel facing upward and insert it into the vein at an angle of 15–30 degrees. You may feel a slight “give” when the needle enters the vein, indicated by a flashback of blood in the catheter’s chamber. Once a flashback of blood is observed, advance the catheter slightly to confirm proper placement, then advance the catheter over the needle into the vein lumen. Immediately release the tourniquet to minimize patient discomfort.

Securing the IV Line

Properly securing the IV catheter will help to prevent accidental dislodgment, maintain patency, and allow for efficient IV line management. Use the sterile transparent dressing provided in the kit to cover the insertion site fully. Then, apply adhesive tape to secure the catheter’s hub and connecting tubing, making sure it stays in place as the patient moves or receives care.

Once you have completed these steps, you can label the IV line with the date, time, and your initials.

Post-Insertion Care and Maintenance

Proper post-insertion care and maintenance are essential for the longevity and effectiveness of an IV site and for preventing infections or complications.

Nurses should regularly inspect the insertion site for signs of infiltration or phlebitis, marked by redness, swelling, or pain. Proper dressing changes as per hospital protocols can help maintain skin integrity and cleanliness around the site. 

Additionally, frequently flushing the line with sterile saline will help maintain catheter patency and prevent line clots.

Troubleshooting Common IV Insertion Issues

Despite following best practices, healthcare professionals may encounter difficulties during IV insertion. Here are some common issues and how to address them:

• Difficulty finding a vein: Try warming the site, using a different tourniquet, or asking the patient to hang their arm down. Consider using a vein finder device if available.
• Catheter not advancing: Make sure the bevel is facing up, and the angle is correct. You may need to slightly withdraw and redirect the catheter.
• Blood flashback but no flow: The catheter may be against a valve or the vein wall. Try rotating the catheter slightly or gently flushing it with saline.
• Infiltration: If fluid leaks into the surrounding tissue, stop the infusion, remove the catheter, and apply a cold compress. Elevate the extremity if possible.
• Phlebitis: Inflammation of the vein can sometimes happen. In this case, stop the infusion, remove the catheter, and apply a warm compress. Notify another healthcare professional if necessary. [5]

Best Practices for IV Start Kit Usage

Effectively using an IV start kit extends beyond following procedural steps and involves understanding the latest guidelines. Here are some best practices you may want to take note of: 

• Utilize the single-use nature of IV start kits as recommended by the FDA, emphasizing enhanced infection prevention strategies. 
• Continue educating yourself and regularly conducting skill assessments so that you remain updated and competent in the latest venipuncture techniques.
• Always follow your institution’s policies and procedures for IV insertion.
• Adhere to a strict aseptic technique for IV insertion to prevent infection.
• Choose the appropriate size catheter for the patient and the intended therapy.
• Communicate effectively with the patient throughout the procedure.
• Document the procedure accurately, including the site, catheter size, and any complications.

Conclusion

Knowing how to use an IV start kit effectively significantly impacts the success of IV therapy. Familiarizing yourself with the components, engaging in thorough preparation, and adhering to step-by-step instructions can help you enhance patient outcomes and minimize infection risks. Continued attention to post-insertion care, troubleshooting, and best practices will further improve the practicality and effectiveness of IV therapy.

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Whether you’re looking to boost vitality or manage weight challenges, our products are designed to support your clinic’s goals. Contact us today to discover our extensive range of offerings.