How to Start an IV: Essential Guide

Hey guys, my name is Sam and welcome to PrepMedic. This week's video I'm going to show you how to start an IV. So IV stands for intravenous, which is a route of medication administration directly into the vein. It's one of the fastest routes of medication absorption and it is a very common intervention in pretty much any kind of medical scenario. So in this week's video I'm going to go through all the supplies you need to start an IV and then I'm actually going to demonstrate the procedure. to give you an idea of how it works. So in front of you, I have all the supplies you might need to start an IV. Now, there are some minor differences in brands depending on what your employer buys or what you buy, but the procedure remains largely the same. So the first thing you're gonna need here is some kind of PPE. PPE stands for personal protective equipment. These are gloves. Now, these gloves do not have to be sterile. This is not a sterile procedure. It's just something that has to be aseptic. So we want to keep it as clean as possible, and this is just as much for my protection as it is for the patient's protection. Next up, we have the IV catheters, and these come in a variety of sizes. In front of you, I have kind of the common gamut of sizes. There are some extremes at both ends, but they are all color coded, and those colors are pretty universal across healthcare, at least in the United States. So here we've got yellow, which is a 24 gauge. Now you can think of these as like shotgun cartridges where the smaller they are in number, the larger the catheter is. So 24 is very, very tiny. This is what we're starting on small children. We've got a 22 gauge, a 20 gauge, which is kind of a standard sizing for IVs, and then we have an 18 gauge. Now if you want to get into large bore IVs, you have your 16 gauge and 14 gauge, but those get quite a lot bigger. And in my experience, unless you have somebody with really, really large veins, they can be difficult to get. Gone are the days of getting bilateral 14-gauge IVs in your massive trauma patients. We're just not doing that quite as much in actual clinical practice. So we've got the catheters here. We have to have some kind of alcohol prep or chlorhexidine to clean the site. We have a start kit with everything you need inside of it, and then we have a pigtail and a flush. Now, this is what's actually going to connect to the hub of the IV catheter. probably two to three days with an IV in. So going through the actual anatomy of each one of these pieces of supplies, we'll just open one of these catheters here. So I've got the 20 gauge and this is color-coded pink. So as we open this up, we have a cover over the needle. Once I take this off, I wanna keep this off. I don't really want to resheath it because that's asking for a needle stick. We have the flash chamber back here and this is what you hold. And then we have the needle and the hub up front. So I'm gonna take that out here And right here you can see that we've got the needle at the front and then this is actually the catheter that slides into the vein. So unlike IVs, you know, 20-30 years ago, this doesn't actually keep a needle in your arm. It keeps a clear plastic tube. So no matter where it is on the patient's arm, they can still bend and move and not worry about a needle sticking through the vein or ruining that IV site. Be aware though if you do start an IV at the AC joint or anywhere where there's a crease or any kind of joint pretty much. they might occlude the flow of a drip or of a medication you're trying to give, so they can be relatively positional. You'll notice this is a safety catheter, and almost everything on the market is going to be a safety catheter anymore. So as I put this into the vein, I've got this thing here, and like I said, this is kind of that bendy catheter that stays in the body, and then I've got this needle. Now this is a spring-loaded retractable device. You have some that put a cap on the end of the needle. But as I pull it out, I can just hit that button and it will retract the needle in and hopefully limit the possibility of IV sticks. Now, one thing I didn't talk about at first, we've got this guy here. This is just a sharps container. We want to make sure we always dispose of our sharps correctly after we're done using them. So as we look at the chlorhexidine here, there's a bunch of different brands. This guy, to start sterilizing the site, it's just a crack. And it's going to allow you to clean the site in an aseptic technique. And then we've got our... Start kit and this guy has everything you need to kind of get the ball rolling as far as securing that IV and prepping it. So this has a chlorhexidine swab in it already. We've got our Tegaderm which keeps the site clean. A tourniquet. Now this isn't a tourniquet as like a cat tourniquet or something to stop blood flow. What it does is it stops venous return to the heart but it doesn't stop arterial flow to the arm so it's going to kind of pump up the veins and make it a little bit easier to stick. We've got some tape and some gauze that you can cover the site with or basically if you miss you can take the needle out and stop the blood flow so you're not causing any issues. And lastly, like I talked about, we've got the J-Loop here and we've got an IV flush. So on these devices, the only thing that is sterile on this is going to be this end with the blue cap. If I take this off, This is supposed to be a sterile field. We don't want to touch that or let that touch the ground. This blue cap will keep it relatively clean as we prepare it. And then we've got our flush right here. And same thing is that if I remove this cap, I don't want to touch there. That's technically a sterile field. I'm going to take this, connect it to the lure lock, and I can flush it through just enough for the water to come out. And we're going to let this and put this on the side. All right, so the first thing I'm going to do, I'm going to put on my personal protective equipment. Like I said, you want to make sure these gloves fit as best you can, and this just protects you as well as the patient. You'll never have a harder time getting on gloves than when you're doing it in front of somebody or in front of a camera as it happens. All right, once your gloves are on, I'm going to start opening up some of the kit. So I like getting out the J-loop and making sure that is flushed and ready to go first. So I'm going to get the J-Loop. I'm also going to get the saline flush ready to go. And this saline flush is going to go on here. Technically, you should be wiping the end of this Whirlwock with an alcohol wipe prior to using it. So we fill that up, and now I'm going to set that aside. Now, like I said earlier, it's a little bit unorthodox, but especially in an ambulance, a lot of times the patient's the easiest place. to put this stuff just because it's an easy arms reach and it's a lot easier if you have a partner that you're doing it with as well. I'm going to get the chlorhexidine I'm going to use ready to go. I'm just going to keep that in the package and now I'm going to get all my tape ready to go and just prepare myself for success. You know if you've worked in EMS or healthcare for any amount of time you've definitely started an IV without proper prep and then you're trying to hold tamponade on that IV while getting everything ready and it just doesn't work very well. So I've got the Tegaderm here, and I'm just going to make sure that tab's undone so I can peel that really easily. I'm going to get my tape set up, so I like just peeling two strips, and then I'm going to just stick that to the edge of the table, and this is going to allow me to secure that IV, and I've got the extra tape right there just in case. I've got my gauze pads just in case I miss or I need to mop up some blood, and I've got the venous tourniquet here and my IV catheter. All right, so now I'm going to take this tourniquet and I'm going to put it above the site I'm going to start. Now, it's worth noting that when you're starting IVs, generally speaking, you want to start lower and go higher. Different floors and units have different things they like and dislike with IVs. In EMS, we go for AC sites just because they're more of a sure thing than smaller veins on the hands or wrists. But if you're like on a med-surg unit, a lot of those nurses really like the IVs down here. so that when the patient starts eating their food, bends their arm, it doesn't stop whatever medication they have going. For me right here, I'm starting it up here. Also be aware that if I, technically, if I miss up high, I don't want to start anything lower than that just because I have a chance of inserting into the same vein. And then if I've infiltrated up here, I've got a bad IV, and I'm injecting fluid in here, it'll start just going into the interstitial space and won't actually be feeding into the patient like it should. So technically, we start low. go high when we're looking at starting any kind of IV. So I'm going to get kind of an idea of what I want to start here. Everybody has veins in their AC and the anatomy is relatively similar, so this is a good place to start. I will say that veins that you can feel are far better than veins that you can't feel. So if you can see something but it doesn't have any bounce to it, it's not always your best bet for an IV start. And right here, I've got one that I can feel. right on this side of his arm. So next thing I'm going to do is I'm going to take my chlorhexidine. And like I said, this isn't a sterile procedure, but it is aseptic, which means that I want to take this chlorhexidine, and I'm going to start in the middle of the site and work my way outwards. And I want to do this for about 15 seconds. That's what the book says here. And just get that nice and saturated with the chlorhexidine. Now I'm going to take my IV catheter. You can just rip these out the back, that's probably the easiest way to do it instead of like peeling it very specifically apart. I'm going to make sure this catheter is out and ready to go and usually I'll just slightly move that hub to make sure that it's free. Sometimes you have these guys that they kind of freeze up and it's harder to feed in. When I hold this catheter, I have my middle finger and my thumb are going to pinch it. And my pointer finger is going to rest kind of on that hub and that directs it. The book says to put in at 45 degree angle. I usually feel like that's just a little bit too steep to really get a good stick, but that's what the book says. So I go a little bit shallower and that's how you start. And then once you get in, you kind of level it off. There, so I've got Brian's arm right here. I'm going to go towards the skin. I'm going to insert, and I'm watching the flash chamber to see when I have flash. All right, so right now I've got flash in the flash chamber. I don't know if you can see that on camera or not. And as that's filling up, I don't want to start threading this just yet. I want to insert just a little bit farther, and then I'm going to insert to... the hub with that finger. You can also take this hand and insert it in as well. I'm going to pop the tourniquet because that can become a mess and I'm going to hold tamponade. I want to hold tamponade beyond the plastic catheter because if I'm holding it right there it's not actually going to occlude blood flow and I'm going to press pretty firmly. As I pull this out I'm going to retract the needle and I'm going to put this in a safe place. Now I'm going to take this guy with this hand and I don't want to touch the end once this cap comes off so I'm going to be kind of careful with that. I'm going to take this end Insert it onto that hub. I'm going to hold this with my hand down and now I'm going to flush 5 to 10 mLs of saline through this IV just to make sure it's a good IV. Now if this wasn't a good IV, what I'd see is I'd see some bubbling in the skin that's called infiltration. The other thing the patient might experience is just some severe pain. It might hurt a little bit more. Now this isn't a painless procedure, but as you're injecting meds, it shouldn't hurt very much. And oftentimes patients can even tell you they taste the saline if it's a good IV. So I'm going to disconnect the saline flush from this hub. And now this is not a clean site, so anytime I use that, I do want to make sure that I scrub it next. I'm going to take my Tegaderm, and this protects my site. I'm going to undo that and put it right over the hub and the start of the J-loop. This keeps this site clean. It's going to keep it good for a longer period of time. It's also going to prevent infections or any kind of contaminants from getting in there. And we can remove the paper around it. And then finally, we're going to use our tape. So like I said, there's a bunch of fancy ways of doing this. The easiest way is just to take this tape, lay it over the top, take a second piece of tape, and tape the hub facing up the arm just like this. And now we can use this port to give meds any time we want. Just a couple quick points here. When it comes to starting IV, you're always starting the IV towards the heart. So I'm always pointing this needle towards his heart, up his arm, up his leg, or if you were starting like a scalp IV on a baby, down towards the heart that way. Same with EJs on the neck, you're gonna point that down. So in this case, I'm pushing up. I wouldn't want to start any IVs going this way. Now, like I said, this IV might be kind of positional, but he can bend his arm, and it's not going to completely ruin that IV right away. right on their arm. So right here I'm going to start peeling back that tegaderm, holding the IV in place. And like I obviously don't want to touch around the site too much just because that can cause increased risk of infection. Next thing I want to do, I'm just going to take my gauze right over that hub and I'm going to slowly remove that. This can go away, it doesn't necessarily need to be a sharps container because there's no needle but there is some blood in it so you have to be careful. And we can just take whatever tape we have left. Tape it over the site and you are good to go.

It's one of the fastest routes of medication absorption and it is a very common intervention in pretty much any kind of medical scenario. So in this week's video I'm going to go through all the supplies you need to start an IV and then I'm actually going to demonstrate the procedure. to give you an idea of how it works.

So in front of you, I have all the supplies you might need to start an IV. Now, there are some minor differences in brands depending on what your employer buys or what you buy, but the procedure remains largely the same. So the first thing you're gonna need here is some kind of PPE.

PPE stands for personal protective equipment. These are gloves. Now, these gloves do not have to be sterile.

This is not a sterile procedure. It's just something that has to be aseptic. So we want to keep it as clean as possible, and this is just as much for my protection as it is for the patient's protection. Next up, we have the IV catheters, and these come in a variety of sizes.

In front of you, I have kind of the common gamut of sizes. There are some extremes at both ends, but they are all color coded, and those colors are pretty universal across healthcare, at least in the United States. So here we've got yellow, which is a 24 gauge.

Now you can think of these as like shotgun cartridges where the smaller they are in number, the larger the catheter is. So 24 is very, very tiny. This is what we're starting on small children.

We've got a 22 gauge, a 20 gauge, which is kind of a standard sizing for IVs, and then we have an 18 gauge. Now if you want to get into large bore IVs, you have your 16 gauge and 14 gauge, but those get quite a lot bigger. And in my experience, unless you have somebody with really, really large veins, they can be difficult to get. Gone are the days of getting bilateral 14-gauge IVs in your massive trauma patients.

We're just not doing that quite as much in actual clinical practice. So we've got the catheters here. We have to have some kind of alcohol prep or chlorhexidine to clean the site.

We have a start kit with everything you need inside of it, and then we have a pigtail and a flush. Now, this is what's actually going to connect to the hub of the IV catheter. probably two to three days with an IV in.

So going through the actual anatomy of each one of these pieces of supplies, we'll just open one of these catheters here. So I've got the 20 gauge and this is color-coded pink. So as we open this up, we have a cover over the needle.

Once I take this off, I wanna keep this off. I don't really want to resheath it because that's asking for a needle stick. We have the flash chamber back here and this is what you hold.

And then we have the needle and the hub up front. So I'm gonna take that out here And right here you can see that we've got the needle at the front and then this is actually the catheter that slides into the vein. So unlike IVs, you know, 20-30 years ago, this doesn't actually keep a needle in your arm. It keeps a clear plastic tube.

So no matter where it is on the patient's arm, they can still bend and move and not worry about a needle sticking through the vein or ruining that IV site. Be aware though if you do start an IV at the AC joint or anywhere where there's a crease or any kind of joint pretty much. they might occlude the flow of a drip or of a medication you're trying to give, so they can be relatively positional.

You'll notice this is a safety catheter, and almost everything on the market is going to be a safety catheter anymore. So as I put this into the vein, I've got this thing here, and like I said, this is kind of that bendy catheter that stays in the body, and then I've got this needle. Now this is a spring-loaded retractable device. You have some that put a cap on the end of the needle.

But as I pull it out, I can just hit that button and it will retract the needle in and hopefully limit the possibility of IV sticks. Now, one thing I didn't talk about at first, we've got this guy here. This is just a sharps container.

We want to make sure we always dispose of our sharps correctly after we're done using them. So as we look at the chlorhexidine here, there's a bunch of different brands. This guy, to start sterilizing the site, it's just a crack. And it's going to allow you to clean the site in an aseptic technique.

And then we've got our... Start kit and this guy has everything you need to kind of get the ball rolling as far as securing that IV and prepping it. So this has a chlorhexidine swab in it already.

We've got our Tegaderm which keeps the site clean. A tourniquet. Now this isn't a tourniquet as like a cat tourniquet or something to stop blood flow.

What it does is it stops venous return to the heart but it doesn't stop arterial flow to the arm so it's going to kind of pump up the veins and make it a little bit easier to stick. We've got some tape and some gauze that you can cover the site with or basically if you miss you can take the needle out and stop the blood flow so you're not causing any issues. And lastly, like I talked about, we've got the J-Loop here and we've got an IV flush. So on these devices, the only thing that is sterile on this is going to be this end with the blue cap. If I take this off, This is supposed to be a sterile field.

We don't want to touch that or let that touch the ground. This blue cap will keep it relatively clean as we prepare it. And then we've got our flush right here.

And same thing is that if I remove this cap, I don't want to touch there. That's technically a sterile field. I'm going to take this, connect it to the lure lock, and I can flush it through just enough for the water to come out. And we're going to let this and put this on the side.

All right, so the first thing I'm going to do, I'm going to put on my personal protective equipment. Like I said, you want to make sure these gloves fit as best you can, and this just protects you as well as the patient. You'll never have a harder time getting on gloves than when you're doing it in front of somebody or in front of a camera as it happens.

All right, once your gloves are on, I'm going to start opening up some of the kit. So I like getting out the J-loop and making sure that is flushed and ready to go first. So I'm going to get the J-Loop. I'm also going to get the saline flush ready to go. And this saline flush is going to go on here.

Technically, you should be wiping the end of this Whirlwock with an alcohol wipe prior to using it. So we fill that up, and now I'm going to set that aside. Now, like I said earlier, it's a little bit unorthodox, but especially in an ambulance, a lot of times the patient's the easiest place. to put this stuff just because it's an easy arms reach and it's a lot easier if you have a partner that you're doing it with as well. I'm going to get the chlorhexidine I'm going to use ready to go.

I'm just going to keep that in the package and now I'm going to get all my tape ready to go and just prepare myself for success. You know if you've worked in EMS or healthcare for any amount of time you've definitely started an IV without proper prep and then you're trying to hold tamponade on that IV while getting everything ready and it just doesn't work very well. So I've got the Tegaderm here, and I'm just going to make sure that tab's undone so I can peel that really easily. I'm going to get my tape set up, so I like just peeling two strips, and then I'm going to just stick that to the edge of the table, and this is going to allow me to secure that IV, and I've got the extra tape right there just in case. I've got my gauze pads just in case I miss or I need to mop up some blood, and I've got the venous tourniquet here and my IV catheter.

All right, so now I'm going to take this tourniquet and I'm going to put it above the site I'm going to start. Now, it's worth noting that when you're starting IVs, generally speaking, you want to start lower and go higher. Different floors and units have different things they like and dislike with IVs.

In EMS, we go for AC sites just because they're more of a sure thing than smaller veins on the hands or wrists. But if you're like on a med-surg unit, a lot of those nurses really like the IVs down here. so that when the patient starts eating their food, bends their arm, it doesn't stop whatever medication they have going. For me right here, I'm starting it up here. Also be aware that if I, technically, if I miss up high, I don't want to start anything lower than that just because I have a chance of inserting into the same vein.

And then if I've infiltrated up here, I've got a bad IV, and I'm injecting fluid in here, it'll start just going into the interstitial space and won't actually be feeding into the patient like it should. So technically, we start low. go high when we're looking at starting any kind of IV. So I'm going to get kind of an idea of what I want to start here. Everybody has veins in their AC and the anatomy is relatively similar, so this is a good place to start.

I will say that veins that you can feel are far better than veins that you can't feel. So if you can see something but it doesn't have any bounce to it, it's not always your best bet for an IV start. And right here, I've got one that I can feel.

right on this side of his arm. So next thing I'm going to do is I'm going to take my chlorhexidine. And like I said, this isn't a sterile procedure, but it is aseptic, which means that I want to take this chlorhexidine, and I'm going to start in the middle of the site and work my way outwards.

And I want to do this for about 15 seconds. That's what the book says here. And just get that nice and saturated with the chlorhexidine.

Now I'm going to take my IV catheter. You can just rip these out the back, that's probably the easiest way to do it instead of like peeling it very specifically apart. I'm going to make sure this catheter is out and ready to go and usually I'll just slightly move that hub to make sure that it's free. Sometimes you have these guys that they kind of freeze up and it's harder to feed in. When I hold this catheter, I have my middle finger and my thumb are going to pinch it.

And my pointer finger is going to rest kind of on that hub and that directs it. The book says to put in at 45 degree angle. I usually feel like that's just a little bit too steep to really get a good stick, but that's what the book says. So I go a little bit shallower and that's how you start.

And then once you get in, you kind of level it off. There, so I've got Brian's arm right here. I'm going to go towards the skin.

I'm going to insert, and I'm watching the flash chamber to see when I have flash. All right, so right now I've got flash in the flash chamber. I don't know if you can see that on camera or not.

And as that's filling up, I don't want to start threading this just yet. I want to insert just a little bit farther, and then I'm going to insert to... the hub with that finger.

You can also take this hand and insert it in as well. I'm going to pop the tourniquet because that can become a mess and I'm going to hold tamponade. I want to hold tamponade beyond the plastic catheter because if I'm holding it right there it's not actually going to occlude blood flow and I'm going to press pretty firmly. As I pull this out I'm going to retract the needle and I'm going to put this in a safe place. Now I'm going to take this guy with this hand and I don't want to touch the end once this cap comes off so I'm going to be kind of careful with that.

I'm going to take this end Insert it onto that hub. I'm going to hold this with my hand down and now I'm going to flush 5 to 10 mLs of saline through this IV just to make sure it's a good IV. Now if this wasn't a good IV, what I'd see is I'd see some bubbling in the skin that's called infiltration.

The other thing the patient might experience is just some severe pain. It might hurt a little bit more. Now this isn't a painless procedure, but as you're injecting meds, it shouldn't hurt very much.

And oftentimes patients can even tell you they taste the saline if it's a good IV. So I'm going to disconnect the saline flush from this hub. And now this is not a clean site, so anytime I use that, I do want to make sure that I scrub it next. I'm going to take my Tegaderm, and this protects my site.

I'm going to undo that and put it right over the hub and the start of the J-loop. This keeps this site clean. It's going to keep it good for a longer period of time.

It's also going to prevent infections or any kind of contaminants from getting in there. And we can remove the paper around it. And then finally, we're going to use our tape.

So like I said, there's a bunch of fancy ways of doing this. The easiest way is just to take this tape, lay it over the top, take a second piece of tape, and tape the hub facing up the arm just like this. And now we can use this port to give meds any time we want. Just a couple quick points here. When it comes to starting IV, you're always starting the IV towards the heart.

So I'm always pointing this needle towards his heart, up his arm, up his leg, or if you were starting like a scalp IV on a baby, down towards the heart that way. Same with EJs on the neck, you're gonna point that down. So in this case, I'm pushing up.

I wouldn't want to start any IVs going this way. Now, like I said, this IV might be kind of positional, but he can bend his arm, and it's not going to completely ruin that IV right away. right on their arm. So right here I'm going to start peeling back that tegaderm, holding the IV in place.

And like I obviously don't want to touch around the site too much just because that can cause increased risk of infection. Next thing I want to do, I'm just going to take my gauze right over that hub and I'm going to slowly remove that. This can go away, it doesn't necessarily need to be a sharps container because there's no needle but there is some blood in it so you have to be careful. And we can just take whatever tape we have left. Tape it over the site and you are good to go.

Transcript for:How to Start an IV: Essential Guide

Transcript for:
How to Start an IV: Essential Guide