Transcript Preferred Sites

May 2015
Steps to Inserting a Peripheral IV
 Verify physician’s order
 Verify patient identity per policy
 Perform hand hygiene
 Explain procedure to patient
 Select appropriate catheter gauge

(see next slide)
Catheter Selection
 Select smallest gauge and shortest length appropriate
 Nexiva angiocaths are appropriate for most patients
 Diffusics angiocaths are to be used for any patient that
may need CT Angiography
 CT PE Protocol
 CT Abdomen for Aortic Aneurysm
Catheter Selection
 16-18 gauge (gray/green):
 Trauma, anticipated surgery or blood product infusion
 20 gauge (pink):
 General infusions, appropriate for blood product infusion
 22 gauge(blue):
 General infusions, appropriate for blood product infusion, if
needed
 24 gauge(yellow):
 Children, elderly and patients with limited access
 General infusions
Steps to Inserting a Peripheral IV
 Site Selection

(see next six slides)
Preferred Sites
 Use the most distal site possible
 In the event of a complication, proximal veins may still be used
 Metacarpal and Dorsal Veins
 Easy to visualize
 Lower risk of phlebitis than forearm and upper arm sites
 Do not use for vesicant medications
 Distal Cephalic Vein
 Large and easily accessed
 Good choice for blood product or irritating infusions
 Insert IV 4-5 inches above the wrist to avoid nerve damage
Preferred Sites
 Median Vein
 Easy to stabilize
 Empties into basilic vein
 Basilic Vein
 Large and easy to visualize
 Can be difficult to stabilize
 Can accommodate large catheters
 Accessory Cephalic Vein
 Easy to stabilize
 Can accommodate large catheters
Preferred Sites
 Median Cubital Vein
 Generally easy to access
 Infiltrates can be difficult to detect
 Proximal Cephalic Vein
 Can be difficult to visualize and stabilize
 Can accommodate large catheters
Sites to Avoid:
 Sites distal to infiltrate or phlebitis
 Sites with pain, bruising, increased friction or tattooed
areas
 The Wrist
 Increased risk of nerve damage and complications

NEVER insert an IV in the palmer side of the wrist
 Difficult to prevent movement in patients
 Lower extremity veins
 Increased risk of complications (DVT, embolism)
 A physician order is required for IV insertion in a foot
Other Considerations
 Avoid sites affected by mastectomy, edema, blood clots
or infection
 A physician order is needed if accessing an extremity
affected by a mastectomy
 Arms with arteriovenous shunts or fistulas
 A physician order is needed if accessing an extremity
with a fistula
 Insert IV catheter in non-dominant arm if possible
Steps to Inserting a Peripheral IV
 Apply tourniquet 4-6 inches proximal to intended
insertion site
 Do not leave the tourniquet in place for more than 3
(three) minutes
 Visually inspect skin integrity and condition
 Palpate extremity/anticipated insertion site
 If feels “ropelike”, hard, or bumpy, select another site
 Vein should feel soft, elastic, and engorged
Steps to Inserting a Peripheral IV
 If site is appropriate, remove tourniquet
 Remove any unnecessary hair with clippers or scissors
 Do not shave with razor
 Don gloves
Steps to Inserting a Peripheral IV
 Prepare insertion site
 If skin is visibly dirty, wash with soap and water or clean with
alcohol pad
 Using friction, clean with chloroprep swab pad scrubbing
from center of site outward for at least 30 seconds
 Allow site to dry completely

Chloroprep is a neurotoxin -NEVER insert catheter while site is
damp
 Betadine swab should be used, following the same procedure
if the patient is allergic to chloroprep
 If blood cultures are to be drawn from site, cleanse site with
iodine or blood culture prep kit
Steps to Inserting a Peripheral IV
 Reapply tourniquet
 Stabilize vein
 Stretch skin taught with thumb of nondominant hand
 Insert catheter
 Hold needle bevel up and insert at a 0-15 degree angle
Steps to Inserting a Peripheral IV
 Observe for flashback
 If observed, lower catheter almost parallel to skin
 Advance entire unit slightly

This ensures the catheter tip is within the vein
 Advance remainder of catheter
 Use stabilizer tabs to stabilize device while removing needle
by pulling white finger grips away from insertion site
 Allow entire extension to fill with blood
 Clamp tubing
 Obtain labs, if indicated

(See next two slides)
Specimen Collection from a
Peripheral Line
 Remove vent plug
 Attach Leur Lock Access Device (LLAD)
 Insert vacutainer tubes and fill to appropriate level
 Avoid manipulation of angiocath during specimen collection

Manipulation increases risk of hemolysis
 If no blood culture is to be drawn, obtain a light blue “waste” tube
 If blood culture indicated, obtain first, following policy
 Order of draw for vacutainers:


Light blue
Serum or non-additive tubes




Red
Yellow
Green
Purple
Specimen Collection from a
Peripheral Line
 Remove tourniquet
 Draw any additional specimens to be collected without
a tourniquet
 Clamp tubing
 Remove LLAD
 Attach saline lock cap
 Flush IV tubing with 10cc saline flush
Steps to Inserting a Peripheral IV
 After tubing is clamped, if no lab collection indicated,
remove tourniquet
 Apply transparent dressing making sure to cover
septum of angiocath
 Label dressing with date inserted, gauge, and initials
 Secure extension tubing
 Remove vent plug and attach saline lock cap
 Unclamp tubing, aspirate and monitor for blood
return to ensure proper placement
Steps to Inserting a Peripheral IV






Flush with 5cc to 10cc saline flush
Reclamp tubing
Dispose of supplies appropriately
Doff gloves
Perform hand hygiene
Notify the patient’s primary nurse of IV insertion, site,
gauge and supplies used (for charging purposes)
 NOTE: If unable to successfully insert IV after 2 (two)
attempts, have another staff member try
Steps to Inserting a Peripheral IV
 Document in patient's medical record
 Time and date of insertion
 Insertion site
 Type and gauge of angiocath
 Presence of blood return
 Ability to flush catheter
 If labs were obtained
 Patient’s tolerance to procedure
 Patient education
 Notification of primary nurse
See Video on Next Slide
Miscellaneous
 Do NOT start IV’s on pediatric patients (anyone under
18 years of age), until further notice
 Do NOT insert IV’s on your own until competency has
been completed and verified (more info to come)
 Be familiar with each unit’s process
 If you don’t know, just ask
References
 Hadaway, L. C., RN-C, CRNI, & Milliam, D. A., RN, MS. (2007). On the
Road to Successful I.V. Starts. Nursing2005, 35(1), 1-14. Retrieved
May 7, 2015, from https://www.nursingcenter.com/upload/journa
ls/documents/ivstartsnocode.pdf
 Lippincott’s. (2013). Nursing Procedures. (6th edition). Ambler, PA:
Wolters Kluwer, Lippincott, Williams, and Wilkins.
 Pomerene Hospital. (2015).Intravenous therapy angiocath: over the
needle catheter insertion and dressing change. (T01.11).
Millersburg, OH.