How to Start an Intravenous (IV) Infusion

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Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein. It can be intermittent or continuous; continuous administration is called an intravenous drip. The word intravenous simply means “within a vein”, but is most commonly used to refer to IV therapy. Therapies administered intravenously are often called specialty pharmaceuticals.

Compared with other routes of administration, the intravenous route is the fastest way to deliver fluids and medications throughout the body. Some medications, as well as blood transfusions and lethal injections, can only be given intravenously.

Before Anything Else do an Assessment

Determine the following:

  • The type and amount of solution to be infused
  • The exact amount (dose) of any medications to be added to a compatible solution
  • The rate of flow or the time over which the infusion is to be completed
  • Assess for any allergies (e.g., to tape or povidone-iodine)

Assess the following:

  • Vital signs for baseline data
  • Skin turgor
  • Allergy to latex, tape or iodine
  • Bleeding tendencies
  • Disease or injury to extremities
  • Status of veins to determine appropriate venipuncture site

Purposes of Intravenous Therapy

  • To supply fluid when clients are unable to take in an adequate volume of fluids by mouth
  • To provide salts and other electrolytes needed to maintain electrolyte imbalance
  • To provide glucose (dextrose), the main fuel for metabolism
  • To provide water-soluble vitamins and medications
  • To establish a lifeline for rapidly needed medications.

Implementation

Preparation:

  • Introduce self and verify the client’s identity.
  • Explain the procedure to the client. A venipuncture can cause discomfort for a few seconds, but there should be no discomforts while the solution is flowing.
  • Use a doll to demonstrate for children and explain the procedure to the parents.

Performance:

  1. Open and prepare the infusion set.
  2. Spike the solution container
  3. Apply a medication label to the solution container if a medication is added
  4. Apply a timing label on the solution container
  5. Hang the solution on the pole. It should be suspended about 1m above the client’s head to enable gravity to overcome venous pressure and facilitate flow of the solution into the vein.
  6. Partially fill the drip chamber with solution
  7. Prime the tubing Perform hand hygiene just prior to client contact.
    1. a. Remove the protective cap and hold the tubing over a container.
    2. b. Release the clamp and let the fluid run through the tubing
    3. c. Reclamp the tubing and replace the tubing cap, maintaining sterile technique.
    4. d. For caps with airvent, do not remove the cap when priming the tubing.
  8. Select the venipuncture site
    1. a. Use the client’s nondominant arm, unless contraindicated.
    2. b. Identify possible venipuncture sites by looking for veins that are relatively straight, not sclerotic or tortuous, and avoid venous valves.
    3. c. The vein should be palpable, but may not be visible, especially in clients with dark skin.
    4. d. Consider the catheter length; look for a site sufficiently distal to the wrist or elbow that the tip of the catheter will not be at a point of flexion.
    5. e. Check agency protocol about shaving.
    6. f. Place a towel or bed protector under the extremity to protect linens.

10.  Dilate the vein.

  1. a. Place the extremity in a dependent position (lower than the client’s heart). Gravity slows venous return and distends the veins. Distending the veins makes it easier to insert the needle properly.
  2. b. Apply a tourniquet firmly 15 to 2 cm above the venipuncture site. Explain that it will feel tight. Tourniquet must be tight enough to occlude venous flow but not so tight that it occludes arterial flow. Obstructing arterial flow inhibits venous filling. If a radial pulse can be palpated, the arterial flow is not obstructed.
  3. c. If the vein is not sufficient dilated:
    1. i.      Massage or stroke the vein distal to the site and in the direction of venous flow toward the heart. This action helps fill the vein.
    2. ii.      Encourage the client to and unclench the fist. Contracting muscles compresses the distal veins, forcing blood along the veins and distending them.
    3. iii.      Light tap the vein with your fingertips. Tapping may distend the vein.
    4. d. If the preceding steps fail to distend the vein so that it is palpable, remove the tourniquet and wrap the extremity in a warm, moist towel for 10 to 15 minutes. Heart dilates superficial blood vessels, causing them to fill. Then repeat step 10.

11.  Put on clean gloves and clean the venipuncture site. Gloves protect the nurse from contamination by the client’s blood.

  1. a. Clean the site with topical antiseptic swab. Some may use anti-infective solution such as povidone-iodine. Check for allergies.
  2. b. Use a circular motion, moving from the center outward for several inches. This motion carries microorganisms away from the site entry.
  3. c. Permit solution to dry on the skin. Povidone-iodine should be in contact with the skin for 1 minute to be effective.

12.  Insert the catheter and initiate infusion.

  1. a. Use the nondominant hand to pull the skin taut below the entry site. This stabilizes the vein and makes the skin taut for needle entry. It can also make initial tissue penetration less painful.
  2. b. Hold the over-the-needle catheter at a 15-to 30-degree angle with bevel up, insert the catheter through the skin and into the vein. Sudden lack of resistance is felt as the needle enters the vein. Jabbing, stabbing or quick thrusting should be avoided because it may cause rupture of delicate veins.
  3. c. Once blood appears in the lumen or you feel the lack of resistance, lower the angle of the catheter until it almost parallel with the skin and advance the needle catheter approximately 1cm father.
  4. d. Holding the needle portion steady, advance the catheter until the hub is at the venipuncture site. The catheter is advanced to ensure that it, and not just the metal needle, is in the vein.
  5. e. Release the tourniquet.
  6. f. Put pressure on the vein proximal to the catheter to eliminate or reduce blood oozing out of the catheter. Stabilize the hub with thumb and index finger of the nondominant hand.
  7. g. Remove the protective cap from the distal end of the tubing and hold it ready to attach tot the catheter, maintaining the sterility to the end.
  8. h. Carefully remove the needle, engage the needle safety device, and attach the end of the infusion tubing to the catheter hub.
  9. i. Initiate the infusion.

13.  Tape the catheter

  1. a. Tape the catheter by the “U” method or according to the manufacturer’s instructions. Using three strips of tape (about 3 inches long).

14.  Dress and label the venipuncture site and tubing according to agency policy.

  1. a. Use a transparent occlusive dressing if there is an allergy.
  2. b. Discard the tourniquet. Remove soiled gloves and discard appropriately.
  3. c. Loop the tubing and secure it with tape. Looping and securing the tubing prevent the weight of the tubing or any movement from pulling on the needle or catheter.
  4. d. Label the dressing with the date and time of insertion, type, gauge of catheter used, and your initials.
  5. e. Ensure appropriate infusion flow.
    1. i.      Apply padded arm board to splint the joint, as needed.
    2. ii.      Adjust the infusion rate of flow according to the order.
    3. f. Label the IV tubing
      1. i.      Label the tubing with the date and time of attachment and your initials. Labeling ensure that it is changed at regular intervals.

15.  Document the relevant data, including assessments.

  1. a. Record the start of the infusion on the client’s chart.
  2. b. Include the date and time of the venipuncture
  3. c. Amount of solution used, including any additives
  4. d. Container number
  5. e. Flow rate
  6. f. Type, length and gauge of the needle or catheter
  7. g. Venipuncture site, how many attempts were made and location of each attempt
  8. h. The type of dressing applied
  9. i. And the client’s general response.

Intravenous Fluids

There are two types of fluids that are used for intravenous drips; crystalloids and colloids.

Crystalloids

Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules. The most commonly used crystalloid fluid is normal saline, a solution of sodium chloride at 0.9% concentration, which is close to the concentration in the blood (isotonic). Ringer’s lactate or Ringer’s acetate is another isotonic solution often used for large-volume fluid replacement. A solution of 5% dextrose in water, sometimes called D5W, is often used instead if the patient is at risk for having low blood sugar or high sodium.

The choice of fluids may also depend on the chemical properties of the medications being given. Intravenous fluids must always be sterile. Crystalloids are commonly used for rehydration, and electrolyte replacement.

Colloids

Colloids contain larger insoluble molecules, such as gelatin; blood itself is a colloid. Colloids preserve a high colloid osmotic pressure in the blood, while, on the other hand, this parameter is decreased by crystalloids due to hemodilution. Another difference is that crystalloids generally are much cheaper than colloids. Colloids have large particles in them so they are not as easilly absorbed into the vascular bed. Because of this property colloids are used to replace lost blood, maintain healthy blood pressure, and volume expansion.

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