IV's!

Today I inserted my first IV. Ever. Also, I was injected with my first "IV" (I have had my blood drawn once before...but that doesn't really count). It was awesome! I loved it :) I was so nervous, but luckily I got to be poked first and that took away my nervousness. Brittany consented (again) to by my partner. She was great! I wanted to be able to post pictures of this monumental occasion, but, alas and alack, taking a picture is the last thing I think about when Brittany's blood is squirting all over my gloves.

To help me remember all the things we learned in lab today, I wanted to summarize it on here. It may be quite boring, so don't read on unless it interests you :) Here we go:

IV stands for intravenous. Intravenous therapy is so important as it is the fastest way to get electrolytes, fluids, antibiotics, and other medications into the body. Because of that, it is also very dangerous--once it's in, there is no correcting things, so don't make a mistake! IV's are so important in surgery (being able to replace fluid as blood is being lost), in emergency situations (dehydration, fluid excess, etc.), and having a better way to regulate medications or fluids in the hospital or clinical setting.


When you insert an IV you need to pick a vein that is elastic and healthy. You always see IV's in the forearm, but apparently you're supposed to start as distal (furthest down the limb) as possible. So you start on the hand if they have a healthy vein there. You do this so that if a vein bursts or becomes occluded and you need to move to another you still have options. If you started more proximal (further up on the limb) all the veins below the injection site couldn't be used because the blood flow would already be messed up. SO...today we started on the hand. Here are the steps we learned (I gave them my own numbering and grouped them in that way that made sense to me):

Step 1: Wash hands
Step 2: Introduce yourself to the patient, identify the patient (you know when nurses ask you about a million times to tell them your name and date of birth?), ask about previous IV experience, and explain the procedure.
Step 3: Gather supplies

Step 4: Put tourniquet on the patient to back up blood to find a good spot to stick-once found, mark the spot with either your fingernail or a sterile pen.
Step 5: Remove the tourniquet to allow blood flow again to the limb
Step 6: Clean the area with Chlorhexidine liquid application to kill the bacteria and allow to dry
Step 7: Prep your saline flush, open dressing and gauze
Step 8: Put the tourniquet back on-making sure you don't touch the area you just cleaned
Step 9: Put on gloves
Step 10: remove cap from needle, place thumb to pull skin taut, position your body directly in line with the place you're inserting the needle, put the needle directly on top of the vein, warn the poor soul you're poking, and PUSH.

Here is a depiction of pushing the needle into the vein.

This is the catheter-it shows all the parts that I'm talking about. The cannula is the "hub," the knob is the "safety" to retract the needle, and the blood chamber is where, obviously, you'll see the blood flash.

Screw on the Saline Flush

Once you're in the vein you should see a flash back of blood. When you see that, insert the needle a tiny, tiny bit farther. Then, while still holding everything stable but without touching the skin you've cleaned, advance just the catheter up to the hub. Then, using your non-dominant hand (making sure you still hold on to the catheter with your dominant hand!) remove the tourniquet, apply pressure with your middle finger on the vein just above the catheter (to stop the blood from squirting out all over), stabilize the catheter with your first finger from your same hand--it's kinda a loooong stretch (remember, no touching the skin or it becomes contaminated-only the hub of the catheter), let go with your dominant hand and push the safety to retract the needle, dispose of that in the "sharps" container, grab the saline flush, remove cap with just one hand (make sure you keep it sterile), and screw on to the catheter.

Whew! Can you tell that it's kind of a stressful process? You then flush it with saline to make sure the vein is not occluded, secure it with the dressing, and date, time, and initial on top of the dressing (you have to change the IV every 72 hrs) and from there you can attach whatever it is you need to be putting in the vein.


And there you have an inserted IV! You have to watch the site carefully to make sure the vein or the skin around the insertion site has not been irritated and to make sure the fluid is actually going in to the vein. Watch for redness and swelling to make sure there isn't any clotting or emboli.

And, because we've learned it so SO many times (to make sure we know how critical it is), know that you never NEVER never never  allow anyone to push potassium chloride. It is fatal.

Anyway, I hope that someone learned something about veins and IV's and that this information is better cemented in my brain.

And in case you're wondering-the veins in my hand refused to cooperate, so Brittany had to move up my arm to the AC (antecubital fossa aka the spot right where your arm bends :). Brittany had much better veins in her hand, I just accidentally forgot to put pressure on the vein before I pulled the needle out...and blood went everywhere! I still need to practice a lot, but, surprisingly, it was fun (is that sick?), and I really want to get good at it. You're only allowed 2 tries in the hospital you know.

ttfn, ta ta for now!