How to place an IV catheter? A Comprehensive Guide

According to a study published in the Journal of Infusion Nursing, up to 90% of hospital patients receive an intravenous catheter during their stay. Knowing how to place an IV catheter is therefore a fundamental skill for healthcare professionals. This guide provides a detailed, authoritative overview of the process from preparation to aftercare.

Quick Summary

Placing an IV catheter involves patient preparation, selecting the right vein, meticulous sterile technique, precise insertion, and secure dressing. Successful cannulation requires understanding the equipment, following a step-by-step process, and managing potential complications to ensure patient safety and comfort.

Key Points

• Sterile Technique: Always use proper sterile technique to prevent infection during the procedure.

• Vein Selection: Choose a straight, bouncy, and palpable vein, typically in the non-dominant arm, avoiding joints.

• Catheter Insertion: Hold the catheter at a 15–30 degree angle with the bevel up; look for a blood flash before advancing.

• Flushing and Patency: After insertion, flush the catheter with saline to confirm it's working correctly and not infiltrated.

• Secure and Maintain: Secure the IV site with a transparent dressing and regularly monitor for complications like phlebitis or infiltration.

• Proper Removal: Upon removal, apply firm pressure to the site with gauze to prevent a hematoma.

Preparing for IV Catheter Placement

Before you can begin, proper preparation is crucial for a smooth and successful IV insertion. This stage includes gathering the necessary equipment, preparing the patient, and ensuring a sterile field to prevent infection.

Equipment Checklist

Having all your supplies ready beforehand saves time and reduces patient anxiety. Key items include:

• IV catheter: The correct gauge is vital. For most adults, a 20 or 22-gauge is sufficient, while a larger bore (18 or 16-gauge) is used for rapid fluid administration. A 24-gauge or smaller is typically used for infants or the elderly.
• Tourniquet: To temporarily occlude venous flow and make veins more prominent.
• Antiseptic wipes: Such as chlorhexidine or isopropyl alcohol, for skin preparation.
• IV start kit: May include a transparent dressing, tape, and sterile gauze.
• IV tubing: Primed with saline if a continuous infusion is needed.
• Syringe with saline flush: To verify patency after insertion.
• Gloves: Sterile for the procedure.
• Sharps container: For safe disposal of the needle.
• Waste container: For all other disposables.

Patient and Site Preparation

1. Explain the procedure: Communicate clearly with the patient to reduce their anxiety. Explain what you are doing and why. Obtain their consent.
2. Position the patient: Ensure the patient is comfortable and the chosen extremity is supported. Gravity can assist with venous filling.
3. Select the vein: Look for a straight, bouncy, and palpable vein, preferably in the non-dominant arm. Avoid areas over joints, near valves, or in bruised or sclerotic veins. Use a tourniquet to enhance vein visibility.
4. Clean the site: After donning gloves, clean the insertion site with an antiseptic wipe using a circular motion, moving outwards from the center. Allow the area to air-dry completely.

Step-by-Step Guide to Insertion

The Insertion Technique

1. Apply tourniquet: Place the tourniquet about 4-6 inches proximal to the selected insertion site.
2. Anchor the vein: Use your non-dominant thumb to pull the skin taut below the insertion site. This prevents the vein from rolling.
3. Insert the catheter: Hold the catheter at a 15–30 degree angle, with the bevel facing up. Puncture the skin and enter the vein. A flash of blood in the catheter chamber indicates successful venipuncture.
4. Advance the catheter: Once you see the flash, lower the angle of the catheter to almost parallel with the skin. Advance the catheter slightly to ensure the catheter tip is fully inside the vein. Slide the catheter off the needle and into the vein completely while holding the hub firmly.
5. Secure and flush: Release the tourniquet. While maintaining pressure over the tip of the catheter with a finger to prevent bleeding, connect the saline flush and aspirate for blood return. Flush with saline to ensure patency and that there is no infiltration. Secure the catheter with the transparent dressing and tape.

Troubleshooting during Placement

Problem	Cause	Solution
No Flashback	Needle not in the vein, or vein collapsed.	Withdraw slightly, redirect the needle, and re-advance. Reassess patient hydration.
Resistance to Insertion	Catheter hitting a valve or vein bifurcation.	Gently rotate the catheter while advancing. Do not force it.
Infiltration	Fluid leaking into surrounding tissue.	Stop the infusion immediately. Remove the IV and restart it at a new site.
Hematoma	Blood leaking into surrounding tissue, causing bruising.	Apply direct pressure after removing the needle. Avoid this site for future attempts.

Post-Insertion Care and Removal

Once the IV is successfully placed, ongoing care is vital to prevent complications like phlebitis or infection. This involves regular site checks and proper removal when the IV is no longer needed.

Maintaining the IV Site

• Assess regularly: Check the site for signs of phlebitis (redness, warmth, swelling, pain) or infiltration. The transparent dressing should allow for easy visualization.
• Change dressings and tubing: Follow facility protocol for changing dressings and IV tubing, typically every 72–96 hours for dressings and more frequently for specific tubing types.
• Keep the dressing dry: Instruct the patient to keep the dressing and site dry while showering. This helps prevent infection.

IV Catheter Removal

1. Prepare: Gather gauze, tape, and gloves.
2. Stop infusion: Turn off any infusion pump and clamp the IV tubing.
3. Loosen dressing: Carefully remove the transparent dressing and any tape while holding the catheter hub.
4. Remove catheter: Place a piece of gauze over the insertion site. Apply light pressure and smoothly pull the catheter straight out, parallel to the skin.
5. Apply pressure: Maintain direct pressure on the site for 1–2 minutes, or longer if the patient is on anticoagulants, to prevent hematoma formation.
6. Secure: Cover the site with fresh gauze and tape.

For additional authoritative information on infusion therapy, you can consult the Infusion Nurses Society guidelines.

Conclusion

Mastering how to place an IV catheter is an indispensable skill in the medical field. By meticulously following the steps for preparation, insertion, and aftercare, healthcare providers can ensure patient safety and comfort. Practicing proper technique, understanding potential complications, and adhering to strict sterile procedures are cornerstones of this critical procedure, leading to better outcomes and increased proficiency over time.

Frequently Asked Questions

What is the best way to find a vein for an IV?

To find a vein, use a tourniquet to increase venous pressure. Ask the patient to clench and unclench their fist. Gently tap the area, and consider using warm compresses to promote vasodilation. A good vein will feel bouncy and soft to the touch.

What angle should I use to insert the IV catheter?

Insert the IV catheter at a shallow angle of 15–30 degrees. Once you see the initial flash of blood, lower the angle almost parallel to the skin before advancing the catheter fully.

What do I do if I can't get a flash of blood?

If there is no blood flashback, the needle may not be in the vein. Withdraw slightly, re-evaluate your positioning, and try to re-advance. Sometimes the vein collapses, in which case you may need to try a different site.

How do I prevent a hematoma during or after IV placement?

To prevent a hematoma, ensure the vein is anchored well during insertion. After removal, apply firm, direct pressure to the site with sterile gauze for several minutes, especially if the patient is on blood thinners.

How do I choose the correct gauge IV catheter?

The gauge depends on the patient and the intended use. Larger gauges (16-18G) are for rapid fluid infusion, while smaller gauges (22-24G) are better for smaller veins, elderly patients, or pediatric use. A 20G is a common choice for general use.

What are the signs of IV infiltration?

Signs of IV infiltration include swelling, coolness, and tenderness around the insertion site. The flow rate may also slow down, and the patient may complain of pain. If you suspect infiltration, stop the infusion immediately and remove the catheter.

How long can an IV catheter stay in?

Peripheral IV catheters should be replaced according to hospital policy, typically every 72 to 96 hours. This reduces the risk of infection and phlebitis. Always check the site regularly for any signs of complication.