Introduction to Intravenous IVs and IV Insertion

Review this note with IV insertion and discontinue rubric.

Intravenous Lines

Indications

1. Medication Administration

   • Administration via IV push or IV piggyback.

2. Fluid Replacement

   • Situations include:

     • Blood loss

     • Vomiting

     • Diarrhea

     • Dehydration

3. Hydration

4. Electrolyte and Nutrient Supplementation

   • Includes potassium and magnesium.

5. Transfusions of Blood or Blood Products

   • Types:

     • Whole blood (includes red blood cells and plasma)

     • Packed red blood cells

     • Fresh frozen plasma

     • Platelets

6. During Surgery and Emergency Care

Equipment Required

• IV Start Kit

  • Supplies needed include:

    • Catheters: 16 – 24 gauge for adults; 20 to 26 gauge for neonates or children.

    • Clean gloves.

    • Single-use hair clippers or scissors (if indicated for hair removal).

    • Short extension tubing.

    • 10 ml syringe prefilled with normal saline (NS).

    • Alcohol-based 2% chlorhexidine swabs or alternative antiseptic swabs (70% alcohol or povidone iodine for those with sensitivity).

    • Sterile, alcohol-free skin barrier product compatible with skin antiseptic agent.

    • Engineered catheter securement device (if available).

    • Polymer-based skin protectant swabs.

    • IV solution or medication.

    • IV administration tubing set.

    • Personal protective equipment (PPE) per policy.

    • IV pole.

    • Vein visualization device (as needed).

    • Sharp container for disposal.

IV Catheters

• Many different styles, sizes, lengths, and functional abilities exist in IV catheters.

IV Sites

Ideal Veins

• Characteristics:

  • Resilient, soft, and bouncy feeling while releasing pressure (Potter, p. 1093, 2026).

Difficult Access Situations

• Conditions that complicate access include:

  • Dehydration

  • Shock

  • Chemotherapy

  • IV substance abuse

Sites to Avoid

• Lower Extremities

  • Increased risk of thrombosis and embolism, although this risk is lower in children and infants, making veins of legs and feet acceptable in these populations.

• Areas of Joint Flexion

  • Example: wrist, antecubital fossa.

• Pain on Palpation

• Distal to Previous Venipuncture Site

  • Areas with sclerosed or hardened veins, previous infiltrations or extravasations.

• Compromised Skin

  • Including areas with open wounds or infections.

• Compromised Veins

  • Examples include: veins on the side of breast surgery with axillary node dissection, lymphedema, after radiation, arteriovenous (AV) fistulas/grafts, or extremities affected by cerebrovascular accident (CVA).

• Fragile Dorsal Veins in Older Adults

Finding a Vein

• Refer to the check-off rubric.

• Techniques for a Hard Stick

  • Lower arms should be positioned below the heart, tapping on the vein gently.

  • Instruct the patient to open and close their fist repeatedly.

  • Apply a warm compress to the selected site for 3 – 5 minutes to increase vasodilatation.

  • Utilize a transilluminator or ultrasound as needed.

Complications and Treatment

Infiltration

• Definition: IV catheter dislodges from the vein, and IV fluid enters subcutaneous tissue.

• Signs:

  • Slow or occluded infusion

  • Coolness and paleness at the infusion site

  • Swelling and pain

• Treatment for Infiltration:

  1. Stop infusion.

  2. Aspirate drug and administer an antidote through IV per facility policy.

  3. Elevate the extremity.

  4. Contact the health provider.

  5. Apply warm moist heat or cold compress, depending on the solution infiltrated.

  6. Discontinue IV.

  7. Start a new IV in a different location.

  8. Document assessment and treatment.

Phlebitis

• Definition: Inflammation of a vein.

• Signs:

  • Heat, erythema, tenderness, and pain at the infusion site.

• Treatment for Phlebitis:

  1. Stop infusion.

  2. Discontinue IV.

  3. Start a new IV in a different location.

  4. Apply moist warm compress.

  5. Contact health provider.

  6. Document assessment and treatment.

Safety with IV Lines

• Ensure aseptic insertion (use clean gloves).

• Always wear gloves during the procedure.

• Use an appropriately sized catheter.

• Exercise caution when the needle is exposed.

• Discard needles in sharps containers.

• Change IV site as needed and according to facility’s policy.

• Change dressings as needed and as per facility’s policy.

• Assess IV site per facility’s policy: flush the site with saline to prevent thrombosis and embolism.

• Regularly check IV fluid bags; avoid allowing them to become empty.

• Document all assessments, insertion, removal, complications, and treatment.

• Discontinuing IV:

  • Remove the IV catheter slowly, keeping it parallel to the vein.

Introduction to IV Medications

Safety

• Ensure the following before administering IV medications:

  1. The right medication.

  2. The right dose.

  3. The right patient.

  4. The right route.

  5. The right time.

  6. The right documentation.

  7. The right indication.

Compare Medications with MAR

• Conduct checks three times:

  1. Before removing medication from pyxis.

  2. Before placing medication in a cup or transporting it to the patient’s room.

  3. Before administering medication to the patient at the bedside.

Differences Between IVP, IVPB, and Y-Site

• IVP (Intravenous Push)

  • Administered via a peripheral intravenous line and via a PICC (Peripherally Inserted Central Catheter).

• IVPB (Intravenous Piggy Back)

  • Intermittent infusion where a secondary infusion is connected to the primary IV line.

• Y-Site

  • Allows two medications/fluids to run simultaneously but not necessarily at the same rate.

Best Practice for Administration of IV Solutions and Medications

• Refer to Box 31.23 (Potter, p. 673, 2026).

Safety Guidelines Prior to Administering IVP Medications

1. Use commercially available or pharmacy-prepared IV push medications whenever possible.

2. Do not dilute IV push medications unless instructed by the manufacturer, agency policy, or reference literature.

3. Administer IV push medication at the rate recommended by manufacturer, agency policy, or reference literature.

4. Appropriately label clinically prepared syringes.

5. Determine the infusion rate and duration of administration.

6. Identify all incompatibilities (e.g., drug or solution) with existing infusions.

7. Review medication receiving rate per minute, recommended concentration, and rate of administration.

8. Understand the purpose of medication and potential adverse reactions related to rate and route of administration (Potter, 2026).

Administration Techniques

• Watch videos on:

  • Administering Intravenous Push (IVP).

  • Administering Intravenous Piggy Back (IVPB).

References

• NURSINGcom with Jon Haws, RN. (Sep 22, 2021). IV Push Medication Technique - Nursing Skills. [Film]. YouTube.

• Potter, P.A., Perry, A.G., Stockert, P.A., Hall, A.M., & Ostendorf, W.R. (2026). Fundamentals of Nursing (12th ed.).