Skill 18[1]..Insertion of a Peripheral IV Line.pdf

SKILL 18

Insertion of a Peripheral IV Line

EQUIPMENT

Needle, scalp vein or angiocath

Antiseptic solution (povidone-iodine and/or alcohol)

Tourniquet

Gloves, nonsterile

INSERTION OF SCALP VEIN

NEEDLE

PROCEDURE

1. Steps 1–10 of General Guidelines.

2. Apply a rubber band tourniquet if using a scalp vein, or

a tourniquet if using an extremity. Distends vein and

makes it easier to enter.

3. Prepare needle by attaching a syringe with normal saline

to the needle and forcing out a few drops of saline.

Determines patency of needle and removes air from nee-

dle.

4. Select a fairly straight segment of vein; place the needle

in the direction of the blood flow.

5. Grasp the needle by the winged tabs bevel up and at a

23°–30° angle. Produces less trauma to the skin and

vein.

6. Anchor the vein with a finger of the free hand by

stretching the skin. Applying traction to the skin helps to

stabilize the vein.

7. Hold the needle parallel to the long axis of the vein.

Decreases the risk of thrusting the needle through the

wall of the vein as the skin is entered.

8. Gently advance the needle into the vein until blood

appears in the tubing. Do not advance the needle once

blood is seen. Reduces risk of piercing the distal wall of

the vein. Increased venous pressure from the tourniquet

increases backflow of blood.

9. Release the tourniquet. Permits venous flow of blood.

Reduces backflow of blood.

10. Infuse 2–3 ml of saline from the syringe into the vein.

Checks patency of the system.

11. Secure IV by taping. Reduces risk of needle becoming

dislodged from the vein. (Figure 17A)

12. Attach hub of needle to adapter of the infusion tubing.

13. Set appropriate rate on infusion pump and begin infu-

sion.

14. Place medicine cup or drinking cup cut in half and

padded over IV site. Commercial devices are also avail-

able. Protects site from child’s touch. (Figure 17B)

15. Dispose of used equipment in appropriate container.

Consistent with body fluid precautions.

16. Remove gloves. Wash hands. Reduces transmission of

microorganisms.

GENERAL GUIDELINES

1. Check physician’s order. Ensures appropriate adminis-

tration of prescribed intravenous therapy.

2. Prepare child and family. Enhances cooperation and

participation and reduces anxiety and fear.

3. Check child for allergies, especially allergies to tape,

latex, and povidone-iodine.

4. Gather equipment. Promotes organization and effi-

ciency.

5. Wash hands. Reduces transmission of microorganisms.

6. Choose site and type of device.

a. Use most distal portion of vein found. Proximal site is

still usable if needed.

b. Avoid using dominant hand if possible. Interferes less

with the child’s usual activities.

c. Avoid bony prominences. Difficult to access and

maintain.

d. Avoid inserting IV through an infection or rash.

Reduces risk for IV-associated bacteremia.

7. Apply a warm compress over the area if needed. Helps

distend the vein.

8. Put on gloves. Protects from contact with body fluids.

9. Position child.

a. For scalp vein insertion, use a mummy restraint.

b. For infants and children who are unable to fully

cooperate, have a second nurse restrain as necessary.

10. Cleanse the insertion site by using povidone-iodine or

alcohol; use a circular motion moving outward from the

puncture site. Reduces the transmission of microorgan-

isms and carries microorganisms away from site of

entry.

a. If using povidone-iodine allow to dry for 1–2 min-

utes. Povidone-iodine must dry to be effective.

b. If povidone-iodine makes it difficult to visualize the

vein, it can be wiped off with alcohol.

c. If using alcohol alone, scrub site until last applicator

is visually clean.

continued

SKILL 18

Insertion of a Peripheral IV Line

continued

INSERTION OF ANGIOCATH

FIGURE 17A Placement of a scalp IV.

PROCEDURE

1. Steps 1–10 of General Guidelines.

2. Apply tourniquet above insertion site. Tourniquet

should be tight enough to impede venous flow, but not

arterial flow. Check pressure of distal pulse. Distends

vein and makes it easier to enter. Decreased arterial flow

prevents venous filling.

3. With free hand pull skin taut about 2 inches from inser-

tion site. Stabilizes vein and extremity.

4. Select straightest portion of vein. Align needle in same

direction as blood flow.

5. Hold needle bevel up at a 10°–30° angle. Enter the skin.

Do not enter the vein at this time. Decreases risk of pen-

etrating other side of vein. Causes less trauma to skin

and vein.

6. Decrease the angle of the needle depending on the

depth of the vein and enter the vessel. Blood will enter

the flash chamber. You may feel catheter “release” as it

enters the vein. Increased venous pressure from tourni-

quet decreases backflow of blood.

7. Decrease the angle of the needle and slightly advance

further into vein, 1 / 16 to 1 / 8 inch. Ensures plastic

catheter has entered the vein.

8. Hold needle hub/stabilize flash chamber and advance

catheter off needle into the vein. Reinsertion of needle

can cause catheter breakage in vein.

NOTE: Never reinsert the needle into the catheter.

FIGURE 17B Securing a scalp vein IV site.

9. Release the tourniquet. Apply pressure on vein just

beyond the catheter tip and slowly remove the needle

while holding the catheter in place. Permits venous

blood flow. Reduces backflow of blood.

10. Connect the primed extension tubing with the injection

cap. Flush catheter slowly. Checks for proper place-

ment/infiltration.

11. Place transparent dressing over insertion site and secure

catheter and tubing. Protects IV site and reduces risk of

catheter becoming dislodged from the vein.

12. Attach extension tubing to the infusion set tubing.

13. Set appropriate rate on infusion pump and begin infu-

sion or heplock as ordered.

14. Place a label on the dressing with date, time, gauge, and

name of person who started IV.

continued

SKILL 18

Insertion of a Peripheral IV Line

continued

15. Immobilize area if needed. (Figures 18 and 19)

16. Place medicine cup or drinking cup cut in half and

padded over IV site. Commercial devices are also avail-

able. Protects site from child’s touch.

17. Dispose of used equipment in appropriate container.

Reduces transmission of microorganisms and maintains

body fluid precautions.

18. Remove gloves. Wash hands. Reduces transmission of

microorganisms.

FIGURE 18 Footboard used to secure IV

placement.

DOCUMENTATION

1. Insertion site.

2. Type and gauge of needle or catheter used.

3. Date and time.

4. Person who placed the IV.

5. IV solution started and rate of infusion.

6. Type of dressing over site.

FIGURE 19 IV secured on handboard.

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