Supplies Needed to Start an IV

● IV start kit- This kit includes a tourniquet , antiseptic (to clean the patient’s skin before
starting the IV), gauzes, tape, tegaderm, sticker to label the IV with your initials, date,
time, and gauge of IV needle.how to set upp an iv
● Extension Tubing or Cap-This will be used to connect to the IV once you have
successfully inserted the IV.
● Normal Saline Flush-This will be used to flush the IV to ensure it is patent and works
properly. Saline flushes normally come in pre-filled syringes but if you don’t have the
pre-filled syringe you will need a vial of Normal Saline and a syringe (you will have to
draw it up yourself).
● IV Needle-This is the needle you will use to access the vein. Once it is accessed you will
remove the needle by engaging the safety and the plastic cannula will stay in the vein. I
think of it as a straw in the vein.
Note: IV needles come in various sizes, also known as gauges. So pick the correct size
according to what type of treatment your patient will be receiving. If you are confused on
the different types of IV gauge needles please see this video on the explanation of them.

Priming IV Tubing

Priming refers to placing IV fluid in IV tubing to remove all air prior to attaching the IV tube to the
patient. IV tubing is primed to prevent air from entering the circulatory system. An air embolism
is a potential complication of IV therapy and can enter a patient’s blood system through cut
tubing, unprimed IV tubing, access ports, and drip chambers with too little fluid (Perry et al.,
2014).

Steps Other information /Rationale

1. Perform hand hygiene. This step prevents the transmission of

microorganisms.

2. Check order to verify solution, rate, and This ensures IV solution is correct and helps
frequency. prevent medication error.

3. Gather supplies. You will need IV solution, primary IV tubing,

time label, change label, alcohol swab, and
basin or sink.
 Sterile IV solution

4. Remove IV solution from outer packaging Tear the perforated corner of the outer
and gently squeeze. packaging; check colour, clarity, and
expiration date.

Remove IV solution from packaging

5. Remove primary IV tubing from outer

packaging

IV tubing
6. Move the roller clamp about 3 cm below
the drip chamber and close the clamp.

Move roller clamp

7. Remove the protective cover on the IV Be careful and do not contaminate the spike.
solution port and keep sterile. Remove the
protective cover on the IV tubing spike.

Remove protective cover from spike on IV

tubing

8. Without contaminating the solution port,

carefully insert the IV tubing spike into the
port, gently pushing and twisting.

Insert IV spike into sterile solution using

sterile technique

9. Hang bag on IV pole. The IV bag should be approximately one

metre above the IV insertion site.

10. Fill the drip chamber one-third to one-half Filling the drip chamber prevents air from
full by gently squeezing the chamber. entering the IV tubing.
Remove protective cover on the end of the
tubing and keep sterile.
11. With distal end of tubing over a basin or
sink, slowly open roller clamp to prime the IV
tubing. Invert backcheck valve and ports as
the fluid passes through the tubing. Tap
gently to remove air and to fill with fluid.
12. Once IV tubing is primed, check the entire
length of tubing to ensure no air bubbles are
present.
13. Close roller clamp. Cover end with sterile
dead-ender or sterile protective cover. Hang
tubing on IV pole to prevent from touching the
ground.
14. Label tubing and IV bag with date, time,
and initials.
Fill drip chamber
Inverting and tapping the access ports and
backcheck valve helps displace and remove
air when priming the IV tubing.
Invert IV tubing when priming with solution
This step confirms that air is out of the IV
tubing.
Keep the distal end sterile prior to connecting
IV to patient.
Label IV solution bag as per agency policy.
Do not write directly on the IV bag.
 Labelled IV bag

15. Perform hand hygiene. This reduces the transmission of

microorganisms.

Changing an IV Solution Bag

Steps Other information /Rationale

1. Verify and select correct IV solution bag IV solutions are considered a medication and
and compare to the medication administration must be checked using the SEVEN RIGHTS
record (MAR) or physician orders. x 3, as per agency policy.

2. Introduce yourself, identify patient, and Proper identification of a patient prevents

explain procedure. medication errors. Explaining the procedure
provides an opportunity for the patient to ask
questions.

3. Perform hand hygiene. Hand hygiene prevents the transmission of

microorganisms.

4. Remove outer plastic packaging and This ensures the correct IV solution is used.
squeeze bag to test for leaks and expiration
date. Assess for precipitates or cloudiness.
Hang new IV solution on IV pole.

5. Pause the EID or close the roller clamp on Stops the infusion to prevent air bubbles from
a gravity infusion set. forming in IV tubing.
6. Remove protective plastic cover from the Keep IV tubing port sterile at all times. If IV
new IV solution tubing port. tubing port becomes contaminated, dispose
of it immediately and replace.

7. Remove the old IV solution bag from the IV
pole. Turn IV bag upside down, grasping the
tubing port.
With a twisting motion, carefully remove IV
tubing spike from old IV solution bag.
Removing old solution from IV pole prevents
spilling of solution.
Ensure IV tubing spike remains sterile during
removal to avoid contaminating IV tubing.

8. Using a gentle twisting motion, firmly insert This ensures that a sterile technique is used
the spike into the new IV bag. during the process.

9. Fill the drip chamber by compressing it Fluid in the drip chamber helps prevent air
between your thumb and forefinger. Ensure from being introduced into IV tubing.
the drip chamber is one-third to one-half full.
Check IV tubing for air bubbles.

10. Open clamp and regulate IV infusion rate Once rate is set, count the drops per minute
via gravity, or press start on the EID as per on the gravity set or ensure the EID is running
physician orders. at the correct rate as per physician orders.

11. Label new IV solution bag as per agency Labelling IV solutions provides easy viewing
policy. Time tape gravity IV solutions as per of infusing solutions and additives.
agency policy

12. Dispose of used supplies, perform hand Document time, date, type of solution, rate,
hygiene, and document IV solution bag and total volume.
change according to agency policy.

IV Tubing Administration Set and IV Solution Change

Steps Other information /Rationale

1. Verify physician orders for the type of This step verifies the patient’s need for IV
solution, rate, and duration. Collect necessary fluids/medications. It also confirms the correct
supplies. rate and solution for patient safety.

2. Perform hand hygiene. Hand hygiene prevents the transmission of

microorganisms.

3. Identify yourself, identify the patient using Proper identification of patient prevents
two identifiers, and explain the procedure to errors.
the patient.

4. Prime new administration set using a new
IV solution bag and new IV tubing.
5. Hang new administration set (primed
primary line and IV solution) on IV pole.
6. Clamp old IV administration set. Remove
IV tubing if on an EID.
7. Clean the connection between the distal
end of old IV tubing and the positive pressure
cap. Scrub the area for 15 seconds and let it
dry for 30 seconds.
8. Remove the protective cap on the distal
Compare MAR with patient wristband
IV solutions are considered a medication.
Prime as discussed above. Keep distal
protective cap attached to IV tubing to ensure
sterility of distal end. Label IV solution and IV
tubing as per agency policy.
Keep distal end sterile with sterile cap
This prepares the equipment and adheres to
the principles of aseptic technique.
Stop the flow of infusion during tubing and
solution change.
Proper disinfection of equipment decreases
bacterial load and prevents infections.
Scrub the connection between the IV tubing
and positive pressure cap
end of the new IV administration set.

9. Carefully disconnect the old tubing from the

positive pressure cap and insert the new IV
tubing into the positive pressure cap attached
to the extension tubing.

Disconnect IV tubing from hub

10. Open the roller clamp on the new tubing This step ensures the IV solution is infusing at
to regulate flow rate, or insert new tubing into the correct rate.
the EID and restart IV rate.

Regulate IV tubing using a roller clamp

11. Check IV site for patency, and signs and IV site should be free from redness, swelling,
symptoms of phlebitis. and pain. Dressing on IV site should be dry
and intact.

Assess IV site for patency

12. Discard old supplies and perform hand This step prevents the spread of
hygiene. microorganisms.
13. Document procedure as per agency Document the date and time of IV tubing and
policy. solution change.

What to document?
Make sure to document the following after procedure:
● date and time of IV insertion
● size and gauge of catheter
● client’s untoward reaction to the procedure
● type of fluid infused and prescribed rate additives, i.e. contrast amount and type

Key Considerations:
● During IV insertion on elderly clients, use a 5 to 15 degree angle because their veins are
more superficial.
● It is recommended to change IV site every 3 days to avoid infection and other IV
complications. Refer to the institution’s policy.
● Always insert IV in the direction of venous return (toward the heart) to prevent venous
valve damage.

Why should the IV insertion site be regularly assessed and maintained?

- Assessment and maintenance of an IV insertion site is done to ensure that the client does not
suffer any untoward complications connected to IV therapy.

What indicates a normal IV insertion site?

- Healthy Vein. A healthy vein is round, firm, elastic and engorged without hardened, bumpy or
flattened areas.
-Absence of signs and symptoms of complications. The IV insertion site must be free from
redness, swelling, bleeding, warmth at the IV site, pallor, pain or discharge.

Nursing Safety Guidelines

Patient Education
● Educate client about the procedure in clear and concise terms. Allow client to ask
questions and answer them to clarify any doubts and fears about the procedure.
● Instruct the client about the rationale for initiating IV therapy as well as the medications
and solutions that will be used.
● Tell client what signs to report: inflammation, clotting, leaking or breaking.
● Give client instructions on how to bathe without getting the dressing wet.
● Discuss client’s activities and find out which activities can be continued to ensure safety
during IV therapy.
Nurse Preparation
● Before starting IV therapy, check if you have all the needed information, physician’s
order and equipment.
● Identify client properly using any two identifiers per agency policy: name and birthday
OR name and account number.
 ● Review and report any incompatibilities between prescribed medications and infusion
solutions.
● Assess the appropriate route and rate of infusion. Ideally, use the client’s non-dominant
hand if possible. NOTE: Never shave the chosen venipuncture site to avoid cuts and
nicks.
● Assess for client’s allergies to latex or povidone-iodine.
● Do a mental review of the entire procedure from start to end and consider modifications,
if needed.
● Maintain strict sterile techniques when required to prevent infections.
● If an equipment gets contaminated during the procedure, change it with a new one.
● Use standard precautions when dealing with body fluids and sharp items.

Key Points:
When choosing venipuncture sites, prioritize the veins on the non-dominant hand, if possible.
Give client as much as instruction needed about the procedure to prevent anxiety, clarify doubts
and reduce fears.

SOURCES:
http://nursingtopics.com/intravenous-therapy-iv-insertion/
https://opentextbc.ca/clinicalskills/chapter/8-4-iv-assessment-maintenance-troubleshooting-and-
discontinuation/