Starting IVs


Procedure for Starting IVs

Hand veins 


Veins of the arm

Selecting the Site: 
Start at the hand and work up - preserve as much of the vein as possible for future use by starting as low as possible.

Contraindications for using a site:

  • Arm on the side of a mastectomy
  • Edematous areas
  • Hematomas
  • Scarred areas
  • Arms with cannulas, fistulas, or vascular grafts
  • Sites distal to previous IV sites
  • sclerosed veins
  • areas with venous valves or bifurcation

Attach tourniquet or blood pressure cuff to select site:

Apply tourniquet 3-5 inches above the potential venipuncture site.
Tourniquet 1 Tourniquet 2
You should be able to palpate a pulse distal to the tourniquet.

To help distend the vein:

  • Have the patient pump his/her hand a few times
  • Place the patient's arm below the level of the heart to promote venous dilation
  • Apply a hot pack
  • Lightly tap over the vein

Palpate the vein:

  • Select a vein that rebounds (soft, bouncy feeling) when pushed.
  • When possible, select a vein on the nondominant arm that will not interfere with the patient's activities.
  • Select a vein that is large enough for the size of the cannula (especially a concern when blood is going to be administered)

Release the tourniquet, gather and prepare equipment.

Supplies for starting an IV

Prepare equipment, including IV bag, tubing, and pump as needed.

Check agency policy for use of a topical anesthetic for cannula insertion.

Various IV needles/cannulas

Select insertion device depending on the patient situation.

Over-the-needle cannulas (Angiocaths is one brand) are flexible plastic cannulas with a metal stylet for insertion.

Straight steel needles (Butterflies) are used for short term infusions and with pediatric patients (small veins)

An 18-19 gauge is recommended for infusing blood in adults.

Attach injection cap to extension tubing Flush tubing and injection cap


Reapply tourniquet

Locate site

Cleanse according to agency policy (often povidone iodine and/or 70% alcohol) - use a circular motion from the site outward.

Cleanse with alcohol  

Anchor the vein, being careful not to touch the cleansed insertion site.

When using an over-the-needle catheter, insert with bevel up at a 450 angle until through the skin, then immediately lower the angle to 20-300 (You may use a 20-300 insertion angle throughout).

Insert needle
See flashback
Advance cannula
Remove needle
Placing Bioocclusive Dressing
Finished IV site
Flush site with normal saline.