The LSUHSC New Orleans
Emergency Medicine Interest Group

Presents

The Student Procedure Manual


Intravenous Catheterization

by Josh Ivker

Indications
Contraindications
Limitations
Equipment
Preparation
Procedure
Complications
Follow Up

Indications

Contraindications
Locations to avoid IV placement

Limitations

Equipment

Preparation

Procedure

  1. Assembly of IV infusion
  2. For Heparin Lock
    Flush tubing with Heparin or saline solution prior to
    attaching to catheter in vein
  3. Place tourniquet 3-4 cm above insertion sight; tourniquet should restrict venous return without impairing arterial circulation; to assure arterial patency check for a distal pulse.
  4. Choose a vein that is straight, large and easily accessible if at all possible. Beware of tortuous areas (how will you thread the catheter?) One tip is to insert just proximal to a branch point; the vein tends to be bigger and rolls less.
  5. The most distal vein accessible should be selected first if several sites are available; this allows the use of more proximal sites if the initial attempt is unsuccessful and avoids fluid leakage from previous puncture sites
  6. If the vein is inapparent, have the patient tense, then relax local muscles repeatedly to increase blood flow to the area, apply a warm compress to the area, or tap sharply over the vein to induce reflexive vasodilatation. Use your sense of touch to feel the vein as well as look at it. Sometimes this will be the only landmark you will have.
  7. Swab insertion site with Iodine swab with a circular motion starting from the center and working outward for 4-5 cm; repeat with alcohol swabs
  8. With your non-dominant hand, pull skin taut to stabilize the vein. Do not contaminate the needle or catheter by touching it.
  9. Puncture the skin rapidly with the catheter needle bevel up at a 30' angle directly over the vein; once in the subcutaneous space, level off the angle of insertion approaching a position nearly parallel with skin surface
  10. Advance needle until blood is seen in the flash chamber of the catheter; a pop may be felt upon entering the vein. Once you feel the pop, advance slightly (1 mm) further to ensure you are completely in the vein.
  11. Advance the catheter over the needle to the hub of the catheter; apply pressure proximally over the catheter tip and remove the needle
  12. Blood samples may be taken at this time, or Hep lock or IV tubing assembly can be attached
  13. Antibiotic ointment can be applied to the insertion site then cover the site with gauze or a clear film dressing
  14. Tape the hub of the catheter and the IV tubing to the skin to secure placement; often a loop of tubing is made and taped down to avoid dislodging the
    catheter if the tubing is accidentally pulled

Complications

Follow Up

 


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