Peripheral IV Insertion
ProceduresThe steps
- Pick the vein like you'll need it for 3 days: forearm > hand; avoid joints, avoid the antecubital if you can
- Tourniquet 4–6 inches above; palpate for bounce, not just look
- Anchor the vein with skin traction below the site — rolling veins are unanchored veins
- Bevel up, 10–30° angle; watch for flash, then LOWER the angle and advance 1–2 mm more before threading the catheter
- Release tourniquet, occlude above tip, connect and flush — watch and feel the site
- Date/time/gauge label; document site, gauge, attempts
🛡 Never skip
Two attempts max per nurse, then hand off — the patient is not a pincushion and fresh eyes win Avoid the arm with fistulas, lymph node dissection, or restricted extremity Infiltration vs phlebitis: cool + swollen = infiltration; red + warm + cord = phlebitis. Either way the line comes out
Common mistakes
- Threading immediately at first flash — the catheter tip isn't in the vein yet, that's how you blow it
- Going too steep on shallow veins and through the back wall
- Hesitating mid-stick; commit smoothly
Source: Lippincott Nursing Procedures, 9th ed.; Infusion Nurses Society standardsReference only — verify against your facility's policy.
