This will be an instruction guide for medical personnel, with a basic knowledge of anatomy and physiology, and the allowed scope of practice to insert an intravenous(iv) line in an adult patient using aseptic techniques. IV lines can be placed for fluid resuscitation, medication routes, and even blood products. This will be a 19-step guide to IV insertion that will take only a few minutes to complete. This task will ideally be completed in a clean, medical facility, however, can be used in a combat environment. Extra steps will just need to be taken to clean the environment.

HOW TO INSERT INTRAVENOUS(IV) LINE

Materials required:

1 IV kit that includes:

1- 18 or 20G IV Catheter needle

1- Constricting band or tourniquet

1- 5 to 10mL Saline flush

1- Transparent film dressing

1- Alcohol or chlorhexidine prep

1- Saline lock

1- 2x2 gauze

1 IV line

1 IV bag

1 pair of nitrile gloves

1 2-in tape roll

1 Chux or absorbent pad

Figure 1. IV Kit displayed that can be ordered by hospitals (Chinook Medical, 2023).

INSTRUCTIONS

1. First start by gathering and prepping your equipment and taking body safety precautions. Lay down the Chux pad to place all materials on and underneath the patient’s arm to absorb any possible fluid or blood. Perform handwashing techniques and don nitrile gloves. Make sure that you have all the necessary materials in your reach, as once you start, you will be unable to walk away and be mostly one-handed. Be sure to prep the IV line by puncturing the bag and letting the fluid flow to the end of the line to remove all air bubbles.

2. Locate the IV site.

Note: For beginners, it is usual to first look at the Antecubital Fossa as the veins are usually more pronounced and have easier access. You can mark the site by pressing down on the skin with a cap or with a skin marker.

Figure 2, Common veins in arm used for venipuncture (proceduralist, n.d.)

3. Once you have the site located you will place the tourniquet 2-3 inches above the desired site.

4. Disinfect the site using the disinfectant given in the kit. Use a pinwheel motion, starting in the middle and circling out for 30 seconds.

5. Once the disinfectant has dried stabilize the vein by pulling the skin taut with your non-dominant hand.

6. Hold the IV needle in your dominant hand with your thumb and index finger, using your other three fingers to stabilize your hand on the patient’s arm.

Caution: Remember needle safety when removing the cap before insertion and sharps protocol.

7. Insert the needle bevel up at an approximate 20–30-degree angle into the desired site.

8. Pierce the skin and insert until blood is seen in the flashback chamber.

9. Once you have seen blood in the chamber, lower the needle 10-15 degrees and advance approx. 1/8 of an inch further into the vein.

10. Thread the catheter into the vein and off the needle until the hub reaches the skin, DO NOT remove the needle.

11. Release the constricting band.

12. Apply pressure with your non-dominant hand slightly above the site to occlude blood flow out and remove the needle.

Note: There may be blood that leaks out and that is okay just make sure to clean it.

13. Attach the saline lock to the catheter hub.

14. Secure with the transparent film dressing

15. Attach the flush syringe.

16. Check for blood return by pulling back on the syringe and if there is then continue to flush 5ccs of the sterile saline into the site. While flushing check for infiltration that can be seen with bubbling around the site, redness, and the patient might feel pain.

Caution: It is important to identify infiltration ASAP and remove the IV as leaving it can cause further damage to the patient

17. Attach the prepped IV line and IV bag to the saline lock and hang the bag on an IV pole or appropriate holding apparatus above the patient and select the desired flow rate.

18. Secure the line to the patient’s hand or wrist with the 2-in tape so that it does not come out as they move.

19. Finally, dispose of everything in the correct receptacle, clean your space, and the task is complete.

References

IV Start Kit with Catheter, 18Ga. (2023). Chinook Medical Gear Inc. Retrieved June 14, 2023, from https://www.chinookmed.com/020210/iv-start-kit-with-catheter-18ga.

Veins in arm. (n.d.). POCUS Pro and Proceduralist.org. Retrieved June 14, 2023, from https://proceduralist.org/us-guided-iv/us-iv-technique/.