IV Therapy: Hand-To-Hand Combat

To reduce patient anxiety, it is suggested that you briefly explain the procedure before beginning.  This can be done during your hunt, or while cleaning the insertion site.  Be sure to tell your patient  that there is a small pinch involved; that the procedure is associated with a relatively small amount of pain and that pulling away or flinching may only cause the need to be stuck again.  It may also be helpful to talk throughout the procedure, updating the patient as to the status to completion.  

Now you are ready to begin the stick.  First, remove the cap from the end of the IV line.  Place the line on a clean surface within close reach for easy access and to avoid contamination.  Now you can unsheath your IV needle.  Be careful not to touch anything with this needle to ensure its sterility.  Next, anchor the vein you will be victimizing with the thumb of your non-dominant hand.  Keep a firm hold of the limb with the rest of your hand.  Hold the needle with your thumb and forefinger on either side.  

Insert the needle into the vein and a shallow angle, watching for blood to enter the flash chamber in the handle or the catheter itself.

With the bevel of the needle in the upward position, insert the needle into the skin at an approximately 30 degree angle.  Push less than ½ inch, or until you see blood in the flash chamber of the introductory needle handle or within the cannula itself.  Push the needle in about ⅛ to ¼ additional inches.  Lower the angle of the needle and advance the catheter while holding the needle in place.  Estimate the location of the end of the catheter and place your anchoring thumb on the vein just above this location.  This will keep blood from flowing out of the hub while you are retrieving your IV line.  Withdraw the needle without changing its angle.  Safety needles will either self-blunt their ends or may require you to push a button to activate a spring that retracts the needle into the handle.  Place the device aside, but in clear view or directly into a sharps container, if it is within reach.  Insert the male end of the IV tubing into the hub and twist the locking cap to secure. Release pressure from the proximal vein and hold the hub in place while you open the roller clamp.  

Look at the insertion site for signs of infiltration.  If you do not see any signs of infiltration, look at the drip chamber to see if the fluid is flowing freely.  If there are signs of infiltration, you will need to remove the catheter and start again.  If the fluid is not flowing freely, try to withdraw the catheter slightly and reassess.  If there continues to be no flow close the roller clamp, remove the catheter and start again.

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