Peripheral IV insertion

Resident: Ok. So, what considerations should be taken into account when choosing an IV site?

Nurse: The patient’s condition and medical history for a mastectomy, a recent surgical site or the presence of contractures or paralysis in the extremity. We then provide the patient with maintenance fluids, antibiotics or medications or blood for infusion or sampling.

Resident: What supplies would you need for this?

Nurse: Usually, non-sterile gloves, tourniquet, tape, gauze, cleansing solution and a transparent dressing. And of course, the type of angiocatheter, that’s for the kind of treatment the patient is receiving.

Resident: Right, let’s now role-play it. I’ll be the patient, and you’ll be the nurse?

Nurse: Here we go… Hello. The doctor has ordered an IV for you. So, I’m going to check your ID band. Can you tell me your name and date of birth, please?

Patient: Sure. I’m Jean Hackman. 25 February 1994.

Nurse: Are you right-handed or left-handed?

Patient: Left-handed.

Nurse: Did you have an IV before?

Patient: No, and to be honest, I’m always a bit nervous when I see needles.

Nurse: Don’t worry about that. I’ll explain everything to you as I do this or that. Ok? So, now I’m going to insert the IV on the non-dominant hand, it’s a little bit easier when you move, eat and drink. I’ll be flu-shing the saline lock and the extension tubing to ensure the tube is patent and prevent air bolus, and then release the catheter from the needle to help in insertion. Look, I’m doing this by a slight twist of the catheter. You’re ok, so far?

Patient: Yes, fine.

Nurse: I’ll apply the tourniquet for your veins to dilate and make them palpable. You see, I’m wearing non-sterile gloves, and now I’m applying the cleansing solution, and disinfecting the IV site. That’s the preparation phase. Are you ok with that?

Patient: Yes.

Nurse: Everything will be all right. Now I’ll bevel up as I insert the needle into the skin, like that. As I do it, blood will flashback to confirm I’m in the vein. You’ll feel no pain. And now I’m separating the angiocath and the needle, and apply pressure on the insertion site to minimize bleeding. I’m then releasing the tourniquet, applying the saline lock by twisting the saline lock onto the angio, and placing a piece of gauze underneath to catch any blood. Now I’m flushing with saline and observing the site for any redness or swelling. Are you ok?

Patient: I’m fine.

Nurse: Ok, now I’ll secure the angiocath with a transparent dressing, and fill in the date and time sticker, and place it so that the insertion site can be seen and assessed, and I’ll secure with tape. That’s all. You see, it was fast and nicely done.

Patient: Thanks. It didn’t hurt at all! That was much easier than I expected.

Nurse: You see!