Skill Stack: Intravenous Catheter: Over-The-Needle-Insertion

Step 1

Performs standard greeting & prep

Step2

Assesses patient for allergies (e.g. ChloraPrep, povidone iodine, latex); if allergic use 70% alcohol

Step 3

Inspects arms for appropriate IV site (starts with distal veins & works proximally)

Step 4

Selects over-the-needle catheter (ONC) size appropriate to vein, purpose of IV therapy

Step 5

Inspects integrity of ONC (visually inspects that needle extends beyond distal catheter tip)

Step 6

Positions arm in dependent position; places tourniquet 4 to 6 inches above intended site; palpates radial pulse to ensure perfusion

Step 7

Selects dilated, soft vein; releases tourniquet; states maximum tourniquet time (2 minutes)

Step 8

Performs hand hygiene & applies clean gloves

Step 9

Disinfects entry site using topical disinfectant (default: chlorhexidine 2% via ChloraPrep frepp applicator or Swab stick) using a back-and-forth scrubbing motion over a two inch square area; allows to air dry

Step 10

Prepares equipment; primes saline lock tubing with NS & ensures sterility of distal tip

Step 11

Re-places tourniquet 4 to 6 inches above intended site & palpates radial pulse

Step 12

Holds skin taut by placing thumb 1-2 inches below intended insertion site & gently pulls skin downward toward wrist

Step 13

Alerts patient of stick; positions needle above the vein & inserts needle into the vein through subcutaneous tissue at 30-degree angle with bevel up

Step 14

Upon entry into the vein, checks for blood flashback into the ONC chamber; then decreases angle of catheter & advances the ONC approximately 1/8" into the vein; with other hand releases tourniquet

Step 15

Advances the catheter ONLY (not needle) into the vein up to the hub

Step16

Stabilizes the catheter hub with one hand; with other hand removes needle & engages needle safety-shield device

Step 17

Continues to stabilize the catheter hub; with other hand maintains sterility while connecting primed IV tubing or saline lock tubing; flushes catheter with 3 mL normal saline (initiates IV infusion, if prescribed)

Step 18

Continues to stabilize the hub; uses dry 2X2 sterile gauge to remove any blood on skin (avoids insertion site)

Step 19

Stabilizes IV catheter with tape (tape positioned to be outside of occlusive dressing area*)

Step 20

Applies occlusive transparent membrane dressing over site (*stabilization tape should be outside of dressing); secures IV tubing with tape; initiates IV infusion (if prescribed)

Step 21

Disposes used needle in sharps/biohazard waste; removes & discards gloves; performs hand hygiene

Step 22

Labels site, IV tubing, & solution with date, time, provider's initials

Step 23

Standard Documentation: date, time, signature; procedure, ONC type & gauge, insertion site; patient tolerance; type of site dressing applied