Intravenous (IV) Catheter Insertion (Nursing)

00:04 Now that we've gathered all of our equipment, now, let's look at actually inserting the IV.

00:09 So, number one, make sure you put on gloves.

00:12 Then we're gonna apply the tourniquet to the arm.

00:15 We then wanna assess the veins and see which insertion site's gonna be best for us.

00:21 Now, once we found our site, we wanna release the tourniquet.

00:26 Now, we do this because we wanna locate our vein, then we wanna release this because the longer that tourniquet's on, the more circulation for your patient can be impaired, so that's why we release it at this point.

00:38 Then once we found that site, we're gonna clean this thoroughly with alcohol for at least 30 seconds.

00:48 So, now that we've gotten our equipment ready, now, let's talk about the actual IV insertion.

00:53 So, because I'm gonna make contact with my patient, I'm gonna first put on gloves.

00:58 And when I'm using my gloves, I can use standard just clean gloves for this procedure.

01:03 Sometimes, they stick.

01:07 Alright, so here's something also to know about gloves, especially when they bunch up like this.

01:12 So, with a skill like IV, you really don't want gloves that are too loose, because that may make it difficult to palpate or feel the vein, so it's nice to have some that are a little bit snug as well, so that's something to consider.

01:26 So, next, I'm gonna apply the tourniquet which is this nice, stretchy blue thing, that's gonna come into your kit.

01:32 This is what's gonna help apply pressure to the arm.

01:36 So, when I apply this to my patient's arm, know that once we apply, it's going to be a little bit tight, so you may wanna forewarn and let your patient know about this.

01:48 So, here's the key when we apply it.

01:51 We're gonna go underneath the arm and everybody does this, it's just a little bit different but I'm gonna pull it close.

01:59 Do you see where my hands are? Close to the patient's arm.

02:02 I'm gonna pull it nice and taut, and then I'm gonna cross them over.

02:07 So, you see how my right and left hand cross over, this is a skill in itself, I know.

02:12 But I cross my hands over and hold them with my left hand.

02:17 So, what that allows me to do is to grab this piece that's still nice and taut, put my finger here in the middle like making an X, and then, I'm gonna loop this here underneath the patient, or, excuse me, underneath the tourniquet itself, so we're gonna have a loose loop here and you're gonna see that tail out.

02:38 So, hopefully that makes sense to you.

02:40 So, if I need to release it, it's gonna look like this.

02:44 So, I'm gonna show you one more time what that looks like.

02:46 Students typically struggle a little bit with this skill, so this is a nice thing to practice.

02:52 So, I'm gonna put this underneath the patient arm, and again, the closer that you put it towards the patient arm, it makes it much easier to keep it nice and taut.

03:01 What we don't want is a very loose, as you can see, tourniquet, because what is that doing? Not a lot, right? Okay, so let's relook at the skill part.

03:13 So, when I'm putting on the tourniquet, if you will hold it nice and taut, close to the patient, cross over your hands, if you will hold onto it with the left hand.

03:24 And we're trying to make an X.

03:26 So, once I've made that X, I can hold these together, and I'm gonna loop this left side underneath and do not put it all the way through, and here we've applied our tourniquet.

03:39 So, this should be nice and tight on the arm, so know the longer we keep this on, this can definitely impede circulation, so keep that in mind.

03:47 So, now that this is on our patient's arm, now we get to assess the veins, and see which insertion site we wanna go.

03:54 This is a good time to really make a decision where we wanna go, before we stick.

03:59 Now, when we're looking at our patient's arm and we're choosing a site, one thing to remember, you do not want to stick on the inner wrist of a patient.

04:08 Reason why this is, this is very uncomfortable and there's a lot of nerves, there's some very tempting veins here for sure, but this is a high-risk area of really causing some sort of nerve damage for your patient, so try to avoid the inner wrist if possible.

04:23 So, when we're looking at veins, we wanna start with IV catheter insertion from distal to proximal.

04:29 The reason why we wanna do this, if we start an IV down here, and we have complications, we want the ability to move up.

04:36 Alright. So, we're assessing an IV, what we wanna look for is, there's great veins in the hands, but this can be uncomfortable if a patient's eating.

04:44 I have a personal favorite, there's some that are here on the side as well that kind of run the thumb side and you can kinda see me pressing on it.

04:53 Also, of the very popular, there's some in what we call the AC or the antecubital on the inside aspect of the arm.

05:10 So, when we're doing this, you wanna make sure you palpate that vein and it's nice and bouncy.

05:17 Once we've identified that site, we wanna release the tourniquet.

05:21 So, I'm gonna go ahead and release that so we can give his arm a break.

05:24 So, again, just to talk about vein selection. Avoid the inner wrist.

05:28 There's some great ones on the hand, there's also some nice ones on the side of the thumb.

05:34 Also, in the AC or antecubital area is a very nice place to go because it's easy to visualize and usually, you have a large vein here and there's typically a pretty easily identified site in the AC area.

05:49 So, as the nurse, you need to choose of what's gonna be best.

05:54 Alright. So again, here's the other thing about IVs is, you can see on Peter's arm, you can see lots of coloration of what the vein would look like.

06:05 That doesn't mean it's going to be a great vein to puncture.

06:10 So, let me say that again.

06:12 You can see the different colors of where Peter's veins are here, now the problem with that doesn't mean it's good for IV insertion.

06:20 So, we wanna go by feel.

06:23 So, when we go by feel, when the tourniquet's on, when we use our finger and push, or what we call palpate the vein, you should feel a nice little bounce.

06:33 That's what we want, so that's the vein to go for.

06:36 Alright. One more really important key, if you're in this area, and you're going to feel a vein and you feel a pulse, that is an artery, do not stick that.

06:49 I'll say that one more time. If you're in this area, and you feel or see a pulsating, that is not what we wanna stick, that is an artery, not a vein.

06:59 And this is peripheral IV insertion, so just keep that in mind.

07:04 Alright. So, once we've identified that site, considering all those things, release the tourniquet, and now that I know where I wanna go, I'm gonna take my cleaner, and make sure this is clean for insertion.

07:16 So, depending on your site -- on your IV start kit, excuse me. You have options.

07:22 So, this particular kit has what we call ChloraPrep, pretty handy little guy here so we're gonna point this down and we're going to crack this and usually, you can hear it, hear that nice little crunch, very satisfying.

07:38 So, we're going to make sure this is feed in the pad, and we're going to really scrub this in a motion for at least 30 seconds.

07:46 So, as you noticed, I'm using a nice circular motion and notice I'm not just cleaning the site, I'm cleaning everything out and around of where that possible transparent dressing, and where I'm gonna be.

08:00 So, this is ChloraPrep. Now, some kits may come with what we call an alcohol pad which is really common for most of our procedures.

08:09 So, you can also do the same thing with an alcohol pad, open this up, and do the same sort of circular outward cleaning.

08:21 Now, that we've cleaned the site, we're gonna reapply the tourniquet.

08:25 Then, at the insertion site, we're gonna use our non-dominant hand to stretch the skin and stabilize the vein. This is gonna help keep the vein in place.

08:35 Then we're gonna place that IV catheter on top of the vein at a 10-to-15-degree angle.

08:42 So, we're gonna puncture the skin and vein wall and watch the blood flash back in the catheter itself, then we're gonna use the hand holding the IV catheter, use our dominant index finger to separate the catheter from the needle and advance it into the vein.

09:00 Now, at this piece, we wanna make sure we advance the IV catheter all the way to the hub.

09:07 Next, we're gonna hold pressure above the insertion site with our other non-dominant hand and hold the hub of the catheter in place so it doesn't wiggle.

09:17 Now, we can release our tourniquet, and with the same hand that is holding the catheter, using the dominant index finger to activate the safety mechanism and remove the needle itself.

09:29 So, if you see this picture, notice that we're only advancing the plastic part of the catheter and the needle part itself is removed.

09:43 Okay, so we've just identified our vein, and we cleaned, so now, we're gonna move on.

09:48 So, I'm gonna go back to reapplying the tourniquet, and if you guys remember, we're gonna hold this nice and taut.

09:56 Op, well, too taut. Nice and taut, and then cross this over, and then I'm gonna hold and support it with my finger here and make that X and then loop this back through, so this can be nice and quick release when I need it.

10:11 So, notice, I put this a little bit higher up on the arm for my patient.

10:16 Alright. So, now, I get my catheter ready.

10:18 So, when I have my catheter, for needle safety, I wanna make sure I go straight out.

10:23 So, every device is a little bit different, so we need to keep that in mind, and before we puncture the skin, we need to be able to see the bevel up.

10:32 What that means is when I look down on my catheter, I can see a little bit hole, a little bitty hole, and that's what we want, bevel up.

10:40 Alright, so now that I've cleaned, I can advance.

10:43 So, I need to hold my skin taut and now, when I puncture, I'm gonna go at a very 10-to-15-degree angle.

10:50 I don't wanna go like this, because I can puncture through the vein.

10:54 Alright, so now that I've punctured the vein, what I'm looking for is flash.

11:04 So, now what you see, blood return in the catheter, that's what we want.

11:08 I'm gonna take my index finger and you see this little hub, I'm gonna slowly, smoothly advance that in all the way to the hub.

11:17 So, now this is where we need to watch and go fast.

11:21 So, now that this has happened.

11:23 I'm gonna take this finger and hold pressure because there's blood coming out of this catheter.

11:30 So, I'm going to push the button for the safety device, I'm going to release the tourniquet, and quickly.

11:36 Now, I know there's bleeding. That's okay. That just means we're in a good one.

11:42 So, don't be worried about all of this. That just means we're in.