IVs are procedures that allow medicines, fluids, and liquid nutrients to flow into the body.


Hello colleagues, thank you for reading another of our post on our website, today we will talk about one of the very important issues since as nurses in the hospital area we use intravenous lines and therapies (IV) every day with the purpose of infusing fluids and medications.

While IVs are very useful, they can sometimes be difficult to insert and become a nightmare especially for a novice or inexperienced nurse. But you have nothing to worry about as time will give you the necessary experience and skills that will make the IV lines improve. In the meantime, we leave you with these 10 tips that could possibly help you improve your IV lines and help you become a great professional.

As good professionals, first of all, we must define intravenous therapy and although you have read it before we must remind you that it refers to the administration directly into a vein of liquid substances used for hydration or the administration of medications or nutrition.

    It is done through a needle or tube (catheter) allowing immediate access to the bloodstream

Compared with other routes of administration, the intravenous route is the fastest means of providing serum and drugs, and is also the only route of administration for some treatments such as blood transfusions.

It is essential in the management of many hospitalized patients and increasingly, in the management of the home patient. It is used not only for treatments, but also for diagnostic tests (contrasts for radiological tests) or to give nutrition.

Although the need to have a venous line is sometimes occasional, in many others it lasts for days or weeks, and in many people, it becomes chronic.

IV therapy is a process that has three steps:

    Channeling the vein, which includes selecting the type of vein to channel and how to channel it.

    The maintenance and care of said venous route.

    The withdrawal of the pipeline.

All of them are important but this time we will focus on points 1 and 2, thereby providing you with the necessary tools to be able to succeed in choosing maintenance and care of the IV line.

Without further ado we leave you the information:

1. location and pathologies.


The best placement of your IV really depends on the configuration it is in, as it can become the number one patient specific complaint. It’s common for inpatients to be bothered with AC ulnar ante lines, but the fact is, an AC line is probably an ER nurse’s best friend.

The pathology, it is important to know the patient’s condition and the reason for their admission, since we may have patients who may have to undergo contrast radiological studies, and the last thing we would want would be to have to touch said patient unnecessarily again.

Therefore, if the patient has a neurological condition (stroke), a heart condition, or a lung condition, it is very likely that they will be ordered a radiographic contrast test and in most hospital facilities the radiology staff will they will not inject the high pressure contrast medium unless an 18G or 20G catheter has been installed in a large vein. Additionally, patients who are hemodynamically unstable should receive 16G – 18G for large fluid resuscitation.

Forearms !! The forearms are the perfect location for continuous fluids because they do not twist when bending the arms. However, not everyone has great forearm options. Also, forearm veins do not always reliably provide a large blood return for blood tests, although this may only be a consideration in the emergency department, where they usually draw blood with IV inserts.

IVs in the hands are sometimes the easiest veins to see, however, they are generally relatively small veins and usually only fit 20-22 G. They are great for short periods of time, but can get irritated easily. In addition, they limit the use of the hand and are more likely to begin to hurt the patient, especially with vasocaustic infusions such as vancomycin or potassium.

2. Small Veins? Make them bigger !!

Heat Heat is great because it causes vasodilation. When veins dilate, they get bigger. This can help you visualize the vein, palpate the vein, and can even make threading the IV catheter easier. You can use aheat pack or other warm compress as well as a heat lamp. Just make sure the pad or lamp is not too hot to cause thermal burns.

By Gravity Putting the arm in a position dependent on the force of gravity will help the accumulation of blood in the distal veins, which will make them larger and easier to see and palpate.

3. Brittle veins color line I love nursing

Use larger and more proximal veins. Sometimes elderly patients tend to have venous fragility. Of course, it is common you can see them well but do not trust yourself, because once you hit them, they strike out, they explode! immediately, even with a 22G. This is definitely a good time to look for more proximal veins, as they tend to be more stable and tend not to burst as easily.

4. Forget the tourniquet color line I love nursing

If you can visualize or palpate the vein without a tourniquet and it appears to be swollen enough to insert the catheter, try IV insertion without the tourniquet. Tourniquets are great for inflating the vein and causing it to dilate, but they also add pressure to the vein. If the veins are fragile they will probably hold up much more than they would with a tourniquet.

5. Don’t give up color line I love nursing

Well this is certainly good advice across the board. Some people HATE digging for an IV – and this is understandable. However, it is sometimes minimally painful and you can fit the catheter within seconds of searching after inserting the catheter. The trick is not to “enter” blindly, but to use your fingers to palpate the precise direction of the vein.

After inserting the needle with the catheter, if you are not getting blood flow, pull the needle “almost” out of the skin, re-palpate the vein and point it in the direction of the vein.

I can’t even count how many times I missed on the first try, but I immediately hit the IV on the second or third breakthrough. The patient also experiences a certain desensitization of their pain receptors, which generally makes it less painful than being subjected to multiple stitches in different areas again.

It is worth mentioning that there are patients with low pain thresholds, who really DO NOT tolerate this. Neglect, it is easy to identify these cases and you will realize according to their facial expressions of pain and verbal expression and it is best not to insist on looking for more with this type of patient.

Sometimes after inserting the needle, you get blood coming out, but it is not as much as usual. One useful little trick is to pull out the IV needle partially, but not all the way. This allows you to see if the blood will fill the rest of the catheter container, and if not you can simply reinsert the needle the rest of the way to continue searching.

6. Go big or go home color line I love nursing

Smaller is not always easier. Sometimes 22G or less is too flimsy. In cases where the veins are sclerosed, hardened or there is scar tissue, it is better to choose a 20G could be a better option to insert the catheter without problems. Also, larger meters are better for emergencies, tend to last longer, and cause less vein irritation.

7. Arterial insertion color line I love nursing

Sometimes we accidentally hit an artery instead of a vein. First, if the IV is pulsating, take it out immediately !! The vein may be right next to the artery, but it is likely actually in the artery. This is usually accompanied by blood filling the catheter VERY fast, depending on the patient’s mean arterial pressure. Arterial blood tends to be bright red, in contrast to the darker red of venous blood.

So what is the harm? Access is access, right? Well, it sure makes sense on the surface. But peripheral IVs inserted into arterial lines tend to have much higher complications, the worst of which is thrombophlebitis. It can literally cause a blood clot in the patient’s arm. This is even more of a risk if drugs are infused through it. Remove the catheter and try a real vein again.

8. Thinking out of the ordinary color line I love nursing

Or rather think of other areas that you would not use in normal situations. If you can, look at the upper arm as sometimes there are large veins near the surface in that area. Yes, most facilities prefer you to put an IV in an arm, but there are exceptions.

If the patient is extremely complicated and needs immediate access, you can observe in the lower extremities (but be careful in the matter of infections in that area, remember: from the waist down it should be considered contaminated, for l or both you must be extremely careful with the issue of asepsis before inserting the catheter), or even the superficial thoracic veins.

Some time ago when I worked in the ER, I was touched by a patient with respiratory failure but this time she was extremely obese which made it quite difficult to channel her, and my colleague plunged 20G directly into the chest on the left side!

No, don’t go through these strange areas at first, but keep in mind that in an emergency any access is better than none. However, in a code situation, temporary placement of an intraosseous catheter is preferred. If a better IV site cannot yet be obtained, someone with experience in ultrasound-guided IV placement should try it, or a PICC / Central line should be considered.

9. Angle hazard color line I love nursing

I have seen MANY nurses and nursing students lose IVs purely due to poor technique. They keep the skin taut, stabilize the vein, and insert, but pass directly through the vein and cannot insert the catheter. I have found that this is often from having too much angle to the skin.

You really should aim to be parallel to the skin (0-15 degrees). Sliding the needle into the vein at this angle means that once you get a flash, the needle is likely still inside the vein and the catheter can advance. The exception is if you happen to be looking for a deeper vein, you may need to increase the angle accordingly.

If you find that you insert the needle and cannot float the catheter inside the vein, despite having a good »blood flow, try to remove the needle and catheter a millimeter or two and try to advance only with the plastic catheter. .

Sometimes the patient’s veins just move, and they will likely warn you about this. There are a few things you can do to minimize this.

    First, choose a larger, more proximal vein. These veins tend to be more stable.

    Second, be sure to stabilize the vein by holding the skin around it with your non-dominant hand.

    Lastly, make sure the patient does not strain their muscles during insertion. The tension in the muscles will cause the veins to move. To minimize muscle contractions, tell the patient to relax and that in this way the procedure will be faster and less painful.

10. Patient comfort color line I love nursing

This tip is really more for patient comfort than anything else. After aseptic the site where you will place the IV, place the needle flush with the skin just where it will puncture.

Press it on the sterilized skin for 3-5 seconds before inserting. The longer you wait, the more your skin receptors will be desensitized, this theoretically decreases pain. With less perceived pain, the patient is less likely to strain and should lead to a smoother and more successful IV placement. In the ER, he always used this technique and it seemed to have good results.

Well there you have it, 10 tips to improve your IV setup. If you have any additional tips that haven’t been mentioned, leave them in the comments below so everyone knows!

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