What are the things to consider before starting an IV access?

Consider this in the IV cannulation procedure

When the best vein available is identified and right size of catheter is chosen, the next step is insertion. First-stick success is always the goal. Any additional attempt of insertion increases pain and stress for the patient, adds workload to the caregiver and costs to the healthcare system. Consider using a heating pad, with caution, to increase venous distension and make the veins more visible and accessible.

It is very important to observe the flashback of blood to know when the needle is in the vein. Flashback will be visible in the chamber connected to the needle as soon as the needle is in the vein. Always continue and insert an additional 1-2 millimetres to let the catheter, not only the needle tip, reach the inner lumen of the vein. Continue to insert only the catheter and carefully withdraw the needle at the same time. You will now see blood between the catheter and needle, the second flashback, which confirms that also the catheter is in the blood vessel.

When working with small babies, neonates or patients with small and fragile veins, it’s important to have an instant blood response. For this reason, with our smaller sizes (24 and 26 G) the needle is notched in a very precise way and place to facilitate blood flashback. This speeds up visual feedback, because blood immediately appears between the catheter and the needle in front of the wing housing.

As soon as the needle is out, you immediately need to close off the luer end of the IV catheter, either with the white cap that comes with the product, or with an extension line or needle free connector of your choice.
“Always fixate the IV catheter carefully to keep it in place and in a stable position. Use a transparent dressing over the insertion site to facilitate regular inspections. You might also need another layer of protection, such as tube or gauze, to further protect the IV catheter and minimise movements and vein irritation.”

Before any infusion or injection, it’s always important to confirm correct placement of the IV catheter and good flow. Flush the catheter with saline and ask the patient if he or she feels the cold coming up the vein. If it’s not a communicative patient, place your fingertips of your non-dominant hand (the one not holding the syringe) at the level of the catheter tip and feel the cold yourself. Also look for any swelling in the tissue.

After placing an IV catheter

Always flush the IV catheter with saline after each usage, to prevent from clotting of blood and be able to use the catheter as long as possible. Attaching an extension line is a common recommendation in guidelines. The extension line could possibly increase the indwell time of the IV catheter as it enables the medical staff to operate away from the catheter, minimising the risk of contamination and movements.
“Remember to fixate also the extension line to avoid getting caught with it hanging from the hand or arm. Be careful with the skin and place a piece of gauze underneath the end of the extension line with its stopcocks or needle free connectors. Always make it as comfortable as possible for the patient,” Pernilla says.

Avoid complications, follow our step-by-step guides:

How to place an IV catheter: CLiP Winged
How to place an IV catheter: CLiP Ported
How to place an IV catheter: CLiP Neo

Peripherally inserted central catheter lines Peripherally inserted central catheter lines, or PICC lines, are IVs inserted directly into a major vein that connects directly to the heart. They are known for their longevity – they can last up to 12 months – and are used for long-term IV treatments such as chemotherapy or antibiotics. IV placement factors to consider Now that you know the various types of IVs, we can now discuss placement. Where an IV is placed largely depends on several factors, including a patient’s age or the type of medicine being delivered. Nurses are also on the hunt for a spot avoiding what’s called an “area of flexion” – a place where your IV might be prone to pressure or bending. Areas of flexion include your wrist and your arm at the elbow. Placing an IV at an area of flexion increases the risk that your IV has complications such as an infiltration or extravasation. READ MORE: IV infiltrations and extravasations: Causes, signs, side effects, and treatment Common IV placements for PIV Of all the placements considered by a nurse, the forearm or the back of the hand are usually the first options.2 Veins on the back of the hand, known as the dorsal venous network, can be prone to rolling if not stabilized. READ MORE: What is a rolling vein? Moving up the arm, there are two more common placement areas that nurses use for IVs. One of those areas is called the median antebrachial vein. This vein comes out of the palm of your hand and runs along your arm.3 However, this vein is not as large and is also quite prone to rolling. From the antebrachial vein and moving up the arm, you’ll also locate the accessory cephalic vein. This vein is known for being easy to stabilize and can hold much larger IVs. This vein is also a great spot when trying to avoid an area of flexion because the vein extends down below the bend of your elbow. Common IV placements for PICC The PICC line’s main purpose is to help deliver medication into major veins that go straight to the heart. PICCs are generally seen as an option for longer medication treatments with the added benefits that they can also be used for blood draws and reduce the number of times a patient has to deal with needles.4 Generally, a PICC line is usually installed above the elbow in the cephalic vein, basilic vein, or brachial vein. PICCs can also cause CLABSIs, or central line-associated bloodstream infections. They can be deadly and are associated with doubling the risk of mortality. READ MORE: CLABSIs: Risk Factors, Causes, and Prevention Common IV placements for infants Even the smallest of patients may need access to IV therapy. With infants still growing, access to veins in the arm are extremely limited. That’s why most hospitals who need to provide infants with IV therapy usually give them an IV in the feet or scalp.5 Babies may need an IV line or catheter post-birth to help deliver vital nutrients or medicines. ivWatch received FDA approval last year for SmartTouch®, a miniaturized and disposable sensor small enough to detect problem IVs in patients as small as infants. If you find yourself still wondering about IV therapy, we have a wealth of topics covered on myIV.com, including an entry on the 10 Most Commonly Asked IV Questions. READ MORE: 10 Most Commonly Asked IV Therapy Questions

What is the first thing you should always do before getting started with starting an IV?

What should be assessed before inserting an IV?

What factors are considered when determining an appropriate IV site?

What is needed to start an IV?