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Refer to the additional resources at the end of the chapter to view a brief video demonstration of the insertion of a peripheral intravenous catheter. Below is a list of the sequential steps required to establish intravenous access.

1 Explain the procedure to the patient and answer any questions the patient may have.

2 Prepare the intravenous tubing and fluid to be used.

3 Place a tourniquet on the patient’s upper arm.

4 Clean your hands and put on disposable gloves (see Clinical Pearls #4 below).

5 Inspect the patient’s hand and forearm for the best site for venous access.

6 Gently tap the vein. This promotes dilation of the vein, increasing its diameter and the chance for success.

7 Clean the site with an alcohol swab.

8 If using local anesthesia for intravenous insertion, inject a small amount of local anesthetic at the entry point.

9 Break the seal between the intravenous cannula and needle.

10 Immobilize the vein by applying gentle distal traction on the skin.

Distal traction on the skin to is used to immobilize the vein (Fig. 5.6). Once the needle tip pierces through the skin at a 20 – 30 degree angle, decrease the angle of insertion to a shallower 5 degree angle approach to avoid advancing the needle tip beneath the vein. Note that the operator’s thumb used to apply distal traction on the veins remains below the patient’s knuckles to permit the needle to be advanced at a shallow angle (Fig. 5.6).

1 Insert the needle tip just beneath the skin at a 20 – 30 degree angle.

2 Decrease the angle of entry such that the needle is almost parallel to the skin.

3 Advance the needle towards the vein.

4 Watch for a flashback of blood in the intravenous needle chamber. Some safety needles (e.g., BD InsyteTM 24, 22, and 20 gauge catheters) have incorporated ‘InstaflashTM’ technology. These catheters have a side port in the needle at the distal end such that blood will spill through the port between the needle and catheter as soon as the needle enters the vein. A flash of blood between the needle and catheter immediately confirms that the needle has entered the vascular lumen.

5 Advance the needle another 1 – 2 mm to ensure the catheter is in the vein lumen.

6 Without moving the needle, advance the catheter off the needle and into the vein.

7 Release the tourniquet.

8 Apply pressure over the skin at the tip of the intravenous catheter to prevent back bleeding.

9 For safety needles, deploy the safety needle retraction spring.

10 Attach the intravenous tubing to the catheter.

11 Tighten the luer lock connection between the intravenous tubing and the catheter.

12 Open the intravenous roller clamp and verify that the fluid flow is unrestricted.

13 Place a transparent sterile dressing over the intravenous catheter.

14 Secure the tubing to the patient with tape.

15 Dispose of any needles in an appropriate ‘sharps’ container.