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Tricks of the Trade for Starting Peripheral IVs on Adults

Part of the IV Therapy For Dummies Cheat Sheet

Starting peripheral IVs on adults is one of the most basic yet fear-evoking experiences in nursing. But don't worry; whether you're administering fluids and electrolytes, medications, or blood components, you can use the following tips to get a head start to success:

  • Start by slowly and deliberately assessing the hand, wrist, forearm, and then antecubital area. Using your finger, palpate (feel for) a vein that's straight, soft, and bouncy when a tourniquet is applied.

  • Apply an anesthetic cream, such as EMLA (a mixture of equal quantities of lidocaine and prilocaine), or a freezing spray (such as Pain Ease), or inject a small amount of normal saline with preservative at the insertion site to numb the area and decrease the patient's pain (and fear) when you insert the needle into the skin.

  • Gently tighten the skin by placing your thumb a few inches distal to the site and pulling down on the skin to anchor the vein. Doing so tightens the skin and eliminates the possibility of vein movement.

  • Place the needle directly above the vein and insert it, bevel up, at a shallow angle to the vein. The closer the needle approximates the actual angle of the vein, the easier it will be to land the tip inside the vein.

  • Penetrate all layers of the vein in one motion. You know the needle is in the vein when you feel less resistance or see blood flashback (when the blood flashes into the catheter or blood chamber).

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