How to Start an IV Using a Peripheral IV Catheter: A Step-by-Step Guide

Starting an IV (intravenous) line is one of the most common and essential procedures in healthcare, used to administer fluids, medications, and other treatments directly into the bloodstream. Mastering this skill requires both knowledge and practice. Here’s a step-by-step guide to help you perform an IV start using a standard peripheral IV catheter.

Step 1: Gather Your Supplies

Before starting, make sure you have all the necessary materials:

• IV catheter (choose the correct gauge based on patient needs and the type of infusion)
• Tourniquet
• Antiseptic wipes (such as alcohol or chlorhexidine)
• Gloves
• Saline flush or IV solution
• Gauze and adhesive tape
• Transparent dressing

Confirm the patient’s identity and explain the procedure to them. Taking a moment to answer any questions can help reduce anxiety and make the process smoother.

Step 2: Choose and Inspect the Vein

Once the patient is ready, place a tourniquet around their arm, 4-6 inches above the planned insertion site, to help locate a suitable vein. Look for a straight, firm, and visible vein—typically on the hand, forearm, or the antecubital fossa (inner elbow area). Avoid areas close to joints, areas with visible damage or scarring, or veins that feel fragile.

Step 3: Clean the Insertion Site

Once you’ve selected a vein, use an antiseptic wipe to clean the insertion site thoroughly. Start at the center and move outward in a circular motion to disinfect the area. Allow it to air dry completely—this helps prevent infection and ensures proper adherence of any dressings or adhesives.

Step 4: Prepare and Insert the Catheter

Put on gloves to maintain sterility and avoid contamination. Hold the catheter with the bevel (the slanted part of the needle tip) facing up. With the needle at a 15-30 degree angle to the skin, puncture the skin over the selected vein and advance the catheter.

Once you see blood in the flashback chamber (indicating vein entry), carefully lower the angle of the catheter, moving it slightly forward to ensure it is fully within the vein.

Step 5: Advance the Catheter and Withdraw the Needle

With a steady hand, advance the catheter fully into the vein while simultaneously retracting the needle slightly. As you move the catheter forward, keep the needle still to prevent accidental vein damage or puncturing through the other side of the vein.

When the catheter is completely advanced, remove the needle completely and dispose of it in a sharps container. At this stage, the catheter should be entirely within the vein, with the needle safely removed to reduce injury risk.

Step 6: Flush and Secure the IV Line

Release the tourniquet, then attach the saline flush or IV tubing to the catheter hub. Test the catheter’s placement by slowly flushing a small amount of saline and checking for any signs of swelling or leakage, which could indicate improper placement.

Once patency is confirmed, secure the catheter by taping it down and placing a transparent dressing over the site. This keeps the catheter stable and protects the insertion site from contamination.

Step 7: Final Checks and Documentation

Make sure the patient is comfortable and check for any signs of discomfort. Explain any necessary aftercare, and instruct them to report any unusual symptoms like pain, swelling, or warmth at the site.

Finally, document the procedure in the patient’s chart, noting the time, location, gauge of the catheter, and any other relevant details.

Troubleshooting Tips

• Difficulty Finding a Vein: Apply warm compresses for a few minutes to make veins more visible, or lower the patient’s arm to increase blood flow.
• No Blood Return: If you don’t see blood return in the flashback chamber, slightly adjust the angle or reattempt at a new site.
• Vein Rolls: Consider using your non-dominant hand to stabilize the vein and provide traction to prevent it from rolling.

Conclusion

Starting an IV may seem daunting at first, but with practice, it becomes a routine skill. Each step of this process plays an important role in ensuring successful IV insertion and patient comfort. By following these guidelines and practicing good technique, healthcare providers can confidently and safely perform IV starts, improving patient care.