1.5 Checklist: Perform IV Insertion & IV Removal

*Disclaimer: Always follow agency policy and manufacturer recommendations

Checklist: IV Insertion^[1],[2]

• Verify the provider’s order.
• Review the patient’s medical record for allergies to antiseptic solutions, adhesives, latex, and anesthetic agents. Also, review the medical record for factors that may affect peripheral vasculature.
• Gather the necessary supplies:
  • Clean/nonsterile gloves
  • Single-use tourniquet
  • Appropriate type and size of peripheral IV catheter based on patient status
  • Needless cap/extension tubing set
  • Appropriate antiseptic agent/pad based on client’s allergy status (chlorhexidine-based, povidone-iodine, or 70% alcohol)
  • Prescribed IV solution or medication with attached and primed administration set (Refer to the “Checklist for Primary IV Solution Administration” in Open RN Nursing Skills.)
  • Sterile 10-mL prefilled syringe (or a syringe specifically designed to generate lower injection pressure) containing preservative-free normal saline solution
  • IV pole
  • Securement device (integrated securement device, subcutaneous anchor securement system, tissue adhesive, or adhesive securement device)
  • Transparent semipermeable dressing
  • Label

NOTE: Commercial IV insertion kits come with or without an IV access device. Many facilities keep venipuncture equipment on a tray or cart, enabling increased choice of access devices and easy replacement of contaminated items.

• Perform hand hygiene.
• Confirm the patient’s identity using at least two patient identifiers and ask if they have any allergies.
• Provide privacy.
• Explain the procedure.
• If the patient is in bed in an inpatient setting, raise the patient’s bed to waist level. Place the patient in a comfortable sitting or reclining position, leaving the arm in a dependent position.
• Apply a tourniquet on an upper extremity to dilate the veins and assess for an appropriate insertion site. Verify the radial pulse. If the intended site is visibly soiled, clean it with soap and water. Clip the hair around the insertion site if needed. Administer a local anesthetic, if indicated and prescribed.
• Assess the veins in the upper extremity and identify potential sites that are easily seen or palpated. Choose an insertion site based on the assessment findings.
• Lightly palpate the site of the selected vein without visible valves or bifurcations with the index and middle fingers of the nondominant hand. Stretch the skin to anchor the vein. If it feels hard or ropelike, select another vein. If the vein is easily palpable but not sufficiently dilated, place the extremity in a dependent position for several seconds or lightly stroke the vessel. Apply dry heat, if necessary.
• Release the tourniquet for site preparation.
• Perform hand hygiene and put on gloves.
• Open and prepare the supplies. Flush the needleless cap/extension set with normal saline and keep the syringe attached. Maintain the sterility of the end of the connector.
• Clean the intended insertion site and surrounding skin with a facility-approved antimicrobial, and then allow it to dry completely.
• Reapply the tourniquet. Verify the radial pulse.
• Using the thumb of the nondominant hand, stretch the skin taut below the puncture site to stabilize the vein.
• Tell the patient that the device will be inserted.
• Place the short peripheral catheter on top of the vein at a 10- to 15-degree angle from the skin. Puncture the skin and anterior vein wall, watching for blood to appear in the catheter, flashback chamber, or both. Lower the catheter until almost flush with the skin. Advance the needle slightly into the vein after flashback is observed to ensure the needle tip and cannula are inserted into the vein.
• After inserting the IV catheter into a patient’s vein, do not let go until it has been properly secured to prevent accidental dislodgment.
• While continuing to hold the skin taut, use the device’s push-off tab to separate the catheter from the needle stylet. Advance the catheter into the vein.
• Release the tourniquet.
• Activate the device’s safety mechanism, as applicable, to cover the needle following the manufacturer’s instructions for use.
• Stabilize the catheter hub while attaching the extension set to the catheter hub and tighten the Luer lock, making sure the Luer lock does not come in contact with the patient’s skin and maintaining sterility of the insertion site and Luer lock.
• Slowly aspirate to assess for blood return that is the color and consistency of whole blood. If no blood return occurs, take steps to locate an external cause of obstruction. It may be necessary to slightly withdraw the catheter if the tip is against a valve in the vein.
• If blood return occurs, slowly inject preservative-free normal saline solution into the catheter according to facility policy while ensuring there is no swelling of surrounding tissue.
• Clamp the catheter.
• Remove and discard the syringe.
• Stabilize and secure the catheter using an engineered stabilization device, if available. If an engineered stabilization device is unavailable, secure the catheter with sterile tape.
• Using sterile technique, apply a transparent semipermeable dressing over the insertion site, following the manufacturer’s instructions.
• Curl the extension set to the side and tape it to the inside of the patient’s arm if needed for extra securement.
• Label the dressing with the current date or the date the dressing is due to be changed, as directed by agency policy.
• Discard needle(s) into a sharps container.
• Dispose of used equipment in appropriate receptacles.
• Remove and discard gloves and other personal protective equipment, if worn.
• Perform hand hygiene.
• In an inpatient setting, help the patient into a comfortable position and place personal items, the tray table, and the call light within easy reach. Make sure the patient knows how to use the call light to summon assistance. To ensure the patient’s safety, raise the appropriate number of side rails and lower the bed to the lowest position. Ensure the bed is locked.
• Perform hand hygiene.
• Document the procedure and assessments.

Checklist: IV Removal^[4],[5]

• Gather the appropriate equipment:
  • Disposable gloves
  • Sterile 2” X 2” dressing
  • Antiseptic swab
  • Tape
• Remove the tape and dressing while keeping the cannula secure (pull toward insertion site).
• Clean the site with an alcohol swab if noted by facility policy. Use caution around the open puncture site, which may be sensitive to alcohol.
• Remove the cannula with slow steady motion and then apply light pressure to the site with a 2” X 2” sterile dressing for a minimum of 30 seconds until bleeding has stopped. Note: Apply pressure for at least 5 to 10 minutes if the patient is on anticoagulant therapy or has bleeding tendencies.
• Maintain the folded pressure dressing over the insertion site and secure with tape.
• Inspect the catheter for intactness after removal by noting the integrity and length of the catheter tip.
• If specimen cultures of the catheter tip are ordered, cut the distal tip of the catheter with sterile scissors and place it in a sterile specimen container.
• Monitor for complications such as bleeding, pain, exudate, and swelling.
• Inspect the IV insertion site for signs of complications resulting from infusion therapy and report any concerns.
• Apply a sterile, folded gauze dressing over the insertion site, and secure it with tape.
• Discard the IV catheter in the regular trash or sharps container, based on agency policy.
• Discard the used supplies, remove gloves, and perform hand hygiene.
• If in an inpatient setting, help the patient into a comfortable position and place personal items, the tray table, and the call light within easy reach. Make sure the patient knows how to use the call light to summon assistance. To ensure the patient’s safety, raise the appropriate number of side rails and lower the bed to the lowest position. Ensure the bed is locked.
• Remove other personal protective equipment, if worn.
• Perform hand hygiene.
• Document the procedure and assessments.
• Monitor for complications such as bleeding, pain, exudate, and swelling.

Documentation Cues

• Procedure, location, and IV site assessment prior to removal
• IV catheter tip assessment and intactness
• Type and size of cannula removed
• Type of dressing applied
• Patient’s tolerance of procedure and patient education provided
• Unexpected outcomes and related nursing interventions