An intravenous or IV line is a soft, flexible tube that is typically inserted into the body via the hand, wrist, or arm. It passes into a Vein in order to deliver medications or fluids to the body in the most direct way possible, and there are many situations in which a patient may require an IV line. This guide will look at how to Insert an IV correctly.

Where to Insert an IV 

There are several possible sites of insertion for IV catheters. The most common sites include the back of the hand, the forearm, or the antecubital fossa, which is the depressed area of the anterior side of the elbow joint. These locations tend to work well for IV insertion due to the presence of large and easy to find veins, allowing for relatively easy and convenient access and insertion. 

In general, it’s best to place IV catheters in the areas where veins are easily accessible and where blood flows freely. Sometimes, the regular sites may not be accessible, and other sites may be selected, like the ankle.

Where Not to Insert an IV 

IV lines should not be inserted anywhere near flexible joints where the catheter risks bending or kinking. A bent catheter can cause lots of problems and could disrupt the flow of medications and fluids into the body. It’s also best to avoid other areas where the catheter could be at risk of bending or causing severe discomfort to the patient, and focus on areas with easily accessible veins.

Who Can Insert an IV? 

Various members of medical personnel are trained in the process of inserting IV lines. This includes doctors, nurses, EMTs, and so on. A lot of hospitals have their own IV line teams of specialized nurses and technicians who have lots of training and experience in this particular procedure.

Can You Insert an IV Yourself? 

It is technically possible for a patient to self-administer their own IV lines. However, this is not recommended by medical professionals as inserting an IV line correctly requires a lot of skill, training, and experience, and it’s not something that the average person can carry out. Those who try inserting their own IV lines will be at greater risk of injuries, infections, vein damages, and other problems.

How Long Does It Take to Insert an IV?

The process of inserting an IV line should not usually take longer than a few minutes, but with preparation time, the procedure may take up to 10 minutes in total.

How to Insert an IV 

IV insertion can be a complex procedure for those who are new to the medical professional, and even experienced nurses and doctors may make mistakes when inserting IV lines. Here are the correct steps to follow to ensure the best chances of a successful and comfortable IV insertion for a patient.

1. Gather Materials – The first step of the process is to prepare all of the necessary materials. This includes the essential IV items like the appropriate IV catheter and an IV bag, as well as other important items, including sterile gloves, a tourniquet, some bandage or dressing, gauze, alcohol wipes, and medical tape.
2. Speak with the Patient – Typically, the next step will be to speak with your patient and explain the procedure ahead. This may not always be possible, depending on the condition of the patient at the time, but it’s considered good practice to speak with a patient, provide some basic information to put them at ease, and ask if they’ve had any history of IV lines or any problems with previous IV insertions.
3. Prime the Line – The next step is to get the IV tubing ready to use. This involves a process known as priming, which basically means filling the IV tube with fluid in order to get rid of any air. You should suspend the IV bag on a stand of some kind and let the solution flow into the tube. Inspect it for any bubbles and tap or squeeze the tube to remove them, as it can be very dangerous to inject air bubbles into a patient’s bloodstream.
4. Choose an Appropriate Catheter – Next, you’ll need to prepare the catheter. It’s important to note that catheters are available in a range of sizes, known as gauges, with some being relatively narrow and others being significantly thicker. Thicker catheters can deliver more medicine into the body at a faster rate, but can be more painful and risky to insert. Typically, IV lines range from 14 to 25 gauge. Higher gauge (thinner) catheters are best-suited for children and elderly patients.
5. Identify a Site – Next, put on a pair of sterile gloves and try to identify an ideal insertion site. Usually, this will be on the back of the hand or somewhere along the forearm, but it can vary depending on the age of the patient, and other factors. The IV should be inserted in a location that is easy to access, with relatively large veins and good blood flow.
6. Prepare the Vein – Once you’ve found a suitable vein to insert the catheter, you’ll need to prepare it. Ideally, a tourniquet should be applied behind the chosen IV site, and this should cause the vein to swell. You may also want to palpate the vein with your fingers for up to 30 seconds to make it larger.
7. Clean the Site – Before inserting the needle in the chosen site, make sure to clean it with the help of an alcohol wipe, or some other sterilizing product. This will get rid of any microbes and dirt from the area, vastly reducing the risk of any infection when the needle enters.
8. Prepare the Catheter – Next, you should remove the catheter from its packaging and carry out a brief visual inspection to check for any damages. Press onto the flashback chamber to make sure it feels tight and remove the cap from the needle to check that it looks fine. Make sure to avoid touching anything with the needle or catheter to avoid any contamination.
9. Insert the Needle – The next step is one of the most important and one of the most difficult. You’ll need to insert the needle into the patient’s body. Hold it in your dominant hand and use your other hand to keep the patient’s limb steady as you approach. Insert the needle with the bevel facing up slowly, and make sure to reduce the angle of insertion as you push the needle further into the vein. Watch the catheter hub for the “flashback” of blood, which shows that you have hit the vein. When this happens, push the needle just one more centimeter, and then stop.
10. Try Again if You Were Unsuccessful – It’s possible that you may miss the vein on the first attempt. This happens to even the most experienced doctors, and if it occurs for you, simply let the patient know that you have missed and then remove the needle before trying the process again with a fresh catheter. This can be unpleasant for the patient, so it’s important to keep them informed and try to maintain a positive attitude.
11. Remove the Needle – Once you successfully enter the vein, pull the needle back out about 1cm. Then push the catheter into the vein while keeping pressure on the vein and the skin. Once the cannula is in position, take off the tourniquet and dispose of the needle. You can then use a dressing or a bandage to seal the catheter hub in place.
12. Insert the Tubing – With the needle disposed of and the cannula in place, you can then take away the protective cover from the end of the tubing and insert it into the catheter hub. It should screw and fix into position. You can then make use of medical tape to secure the IV in place on the patient’s body. Simply make a loop in the tubing and tape it down above the insertion site. This helps to make the catheter more comfortable for your patient. You should also take this time to check for any kinks in the tube and add a label onto the dressing to show when exactly the IV was inserted.

How to Insert an IV on Yourself

In general, it is not wise to attempt insertion of an IV on yourself. IV insertion is quite a complex medical procedure that requires training and medical experience, and it needs to be done with great care and precision to avoid any injury. However, if there is no other option, here are the steps for inserting an IV on yourself.

1. Prepare the Essentials – First, get all of the items together that you’ll need for your IV insertion, including the catheter, the IV bag, some sterile gloves, gauze, tape, and bandage.
2. Choose an Appropriate Needle – Make sure you have selected a needle of the appropriate size. As explained above, IV catheters typically range from 14 gauge (the thickest) to 25 gauge (the thinnest). It’s important to choose a size that is appropriate for your age and body.
3. Clean Your Hands Thoroughly – Wash your hands with great care and dry them with a paper towel to make sure that they are as clean as possible. This will help to reduce the risks of any infection. You should also wear sterile gloves throughout the procedure and change gloves when needed if your existing pair are compromised in any way.
4. Prime the IV – Next, you’ll need to prime the IV and get rid of any air inside the bag or tubing. Typically, this involves letting some fluid into the tube and tapping or squeezing to remove bubbles.
5. Pick a Site – You’ll then select an insertion site. Since you’re carrying out the insertion yourself, it needs to be a site that you can reach with relative ease, which will most likely be on the back of your hand or somewhere on your forearm.
6. Prepare the Site – Apply a tourniquet above the insertion site to make the vein swell and provide easier access. You can also palpate the site with your dominant hand to make the vein appear larger.
7. Disinfect – Clean the insertion site with the aid of an alcohol wipe or some other kind of sterilizing medical wipe. This will clear away any bacteria and reduce the risk of infection.
8. Insert – You can now insert the needle into your skin. Insert at a shallow angle for best results and move slowly. Watch for the flashback of blood to signal that you have entered the vein. You can then retract the needle and insert the catheter into position. Use bandages and tape to secure it, and insert the IV tubing into the catheter hub.

How to Insert an IV on a Child

Inserting an IV line into a child can pose a larger challenge than it would with a typical adult patient. This is because children have smaller veins, so it’s vital to be particularly precise in order to enter the vein without missing it or going too far. Children can also be more prone to moving around or reacting badly to the pain of IV insertion, so distractions, the presence of parents, and positive reinforcement may be needed. Here are the main steps to follow:

1. Prepare the Essentials – First, the nurse or doctor should prepare all of the necessary essentials, including an appropriate catheter needle, an IV bag, sterile gloves, bandage, medical tape, and sterilizing wipes.
2. Speak with the Child or Parent – Next, when it comes to working with pediatric patients, it’s best to take a moment to explain to them the importance of the process and let them know that they need to keep still. If the parents are present, they can also be involved in this discussion. 
3. Prime the IV – Whenever an IV line is being inserted, it’s important to prime it beforehand in order to get rid of any traces of air or bubbles which could cause an embolism if they are not removed.
4. Find a Vein – The next step is to choose and find a vein that you want to insert the IV line into. In children, IV lines are often placed on the back of the hand or inside the elbow, but they may be put in other locations, including the ankle or the upper arm.
5. Apply a Tourniquet – Once a vein has been selected, you can apply a tourniquet and palpate the area to make the vein larger and more visible. This will make it easier to enter.
6. Clean the Site – Next, clean the skin where you plan to insert the needle with the aid of a medical wipe or alcohol wipe. 
7. Insert the Needle – Insert the needle at a shallow angle, slowly and carefully. Watch the catheter hub for the flashback of blood and stop when you see the blood. 
8. Remove the Needle – Next, guide the catheter into position and pull the needle out, before disposing of it. You can then insert the tube into the catheter hub.
9. Tape the Tube in Position – Use dressings, bandages, and medical tape accordingly to secure the IV tubing in the right position against the child’s skin.

How to Insert an Ultrasound Guided IV

Another way to insert an IV line is with the aid of ultrasound scanning technology. This can be an effective method in some situations, as it reduces the risk of injuries by providing a clear picture of the vein as the catheter is inserted. It also makes it easier to access veins that are deeper below the surface. Here’s how to carry out this particular kind of IV insertion.

1. Prepare the Equipment – First, prepare all of the necessary equipment, including the IV line, the IV bag, sterile gloves, the ultrasound machine, medical tape, dressings, and so on. You should also prime the IV to remove any air bubbles so that it’s ready to insert later on.
2. Identify an Insertion Site – Next, you’ll need to pick a site to insert the needle. Usually, when it comes to ultrasound guided IV insertion, a site will be selected somewhere along the forearm.
3. Scan the Site – You can then start using the ultrasound scanner to scan the insertion area and try to find the precise vein you want to insert the line into. Once you’ve found the vein, keep the scanner in place so that you can see the vein clearly on the screen and just tilt it up slightly, providing space for you to enter the needle.
4. Clean the Site – Clean the skin of the insertion site with the aid of a medical wipe.
5. Insert the Needle – Keeping the scanner in position, guide the needle into place using a shallow-angle approach. Keep an eye on the screen to monitor as the needle enters the vein, and when you see it go inside, retract it and feed the catheter tubing into position.
6. Complete the Procedure – To finish the procedure, retract and dispose of the needle, connect the primed IV tubing, and then tape and dress the area appropriately.

Frequently Asked Questions

Is Inserting an IV a Sterile Procedure? 

IV insertion is usually regarded as a sterile procedure. Sterile technique should be used when inserting an IV, and it’s important to make use of sterile gloves and other sterile supplies in order to limit the risk of any infection or contamination.

When Do You Insert an IV? (After Which Steps) 

An IV should only be inserted after the correct preparatory steps have been carried out. This includes preparation of all the necessary materials, priming of the IV tubing, suspension of the IV bag, selection of the appropriate catheter gauge, and identification of the insertion site. A tourniquet will also need to be applied before insertion and the site will need to be disinfected with the aid of an alcohol wipe or sterilizing method.

Where Is the Best Place to Put an IV? 

The most common sites and best sites for IV insertion are the forearm, the back of the hand, or the back of the wrist. This is because the dorsal arch veins pass through these areas and are relatively visible and easier to accurately enter. IVs in these locations are also easily splinted, and it’s easy to spot any infiltration.

At What Angle Should an IV Be Inserted? 

The Needle of an IV line should be inserted at a 15 to 30 degree angle over the skin. It should always be inserted at an angle less than 45 degrees.

Can You Insert an IV Backwards? 

There are certain kinds of IV lines or catheters, known as retrograde catheters or IV lines, which are inserted “backwards”, meaning that the end of the catheter points away from the direction of the blood flow in the vein.

How to Insert an IV Without Blowing a Vein?

Some of the most common reasons why veins blow during IV insertion include a needle that is too large, advancing the catheter too early, or advancing the needle through the vein. To combat these problems, make sure to use a shallow-angle approach, pause when you see the flash, and always choose an appropriate size of catheter.

Which Age Groups Are Most Challenging When Inserting an IV? 

Children are a particularly difficult group of patients to insert IV lines in due to the fact that they have smaller and narrower blood vessels, making it hard to enter without blowing a vein. Older patients are also a challenge due to thinner skin and weaker vein walls, leading to a higher risk of blown veins and other problems.

Other problem groups include drug abusers as their veins may be particularly weak and patients undergoing chemotherapy or treatment for diabetes, as they may also have delicate veins and pose problems of access.

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