Safety

• Observe the Six Rights of Medication Administration.
• Maintain aseptic technique during all aspects of IV therapy, including insertion, replacement, site dressing, tubing changes, and accessing the system for medication administration.
• Do not palpate or touch the insertion site after the skin has been cleansed.
• To prevent exposure to bloodborne pathogens, use clean gloves during all aspects of IV care.
• Do not rub or repeatedly or vigorously tap a vein, especially in an older adult, since doing so can cause hematoma formation and/or venous constriction.
• Avoid using the superficial dorsal veins because of the risk for infiltration due to movement. Because of the risk for nerve damage, avoid using the veins on the thumb side and palmar side of the wrist.
• Report all needlestick injuries, as required by the Occupational Safety and Health Administration (OSHA). OSHA also requires that the health care agency provide medical evaluation and follow-up.
• Follow your agency’s infection control plan, including measures intended to reduce health care workers’ exposure to biohazardous waste.

Equipment

(Roll cursor over items to see labels)

20- or 22-gauge 1-inch peripheral IV catheter

Tourniquet

Tape

Clear, occlusive dressing

Alcohol swabs

Chlorhexidine swabs

2x2 gauze pads

IV Administration set

IV piggy-back administration set (optional)

IV solution

Clean gloves

Extension set with needleless adaptor

Warming pack (optional)

Washcloth

Delegation

The skill of initiating intravenous therapy may not be delegated to nursing assistive personnel (NAP). Delegation to licensed practical nurses (LPNs) varies by state nurse practice act. Be sure to inform NAP of the following:

• Instruct NAP to notify you if the dressing becomes wet or if the patient complains of any IV-related complications, such as pain, redness, swelling, or bleeding.

Preparation

• Review the accuracy and completeness of the health care provider’s orders for the type and amount of IV fluid, medication additives, infusion rate, and length of therapy.
• Assess if the patient is right or left handed. For comfort and mobility, place the IV in the nondominant arm.
• Assess the patient’s knowledge of the procedure, reason for the prescribed therapy, and arm placement preference.
• If hair removal is needed, do not shave the area with a razor, which may cause microabrasions that increase the risk for infection. Instead, clip the hair with scissors.
• In order to select the correct catheter length and gauge, determine the reason for the IV fluid infusion.
• Assess the patient’s history of allergies, especially to iodine, adhesive, and latex.
• When possible, have all equipment ready and tubings primed before coming into the patient’s room, to diminish anxiety associated with preparing equipment in view of the patient.

Follow-up

Perform the venipuncture and begin therapy as ordered. (For details, see the Video Skill “Performing Venipuncture and Initiating an Infusion.”)

Documentation

Record IV site preparation as part of your documentation of the venipuncture and initiation of an IV infusion. It is not necessary to document it separately. (For details, see the Video Skill “Performing Venipuncture and Initiating an Infusion.”)