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IV Insertion and IV Removal

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IV Insertion and IV Removal

Key Points

  • Confirm order, allergies, and identity before any insertion or removal step.
  • Use strict aseptic technique and securement to reduce dislodgement and infection risk.
  • Limit insertion attempts to two per clinician, then escalate to a higher-skill inserter or specialized access support.
  • Apply life-span technique adjustments (for example pediatric stabilization/distraction and shallower-angle cannulation for fragile superficial geriatric veins).
  • Use safety-engineered catheter devices exactly as designed; do not disable safety-lock mechanisms.
  • Confirm blood return and saline flush patency without tissue swelling before final securement.
  • After removal, verify catheter tip integrity and monitor for bleeding or local complications.

Equipment

  • IV start supplies: gloves, antiseptic product, tourniquet, gauze, tape, transparent dressing, and correctly sized peripheral IV catheter
  • Extension set/needleless or positive-pressure cap, normal saline syringe for patency check, securement device, and site label (for example initials/date/time/gauge per policy)
  • Primary/secondary tubing sets and infusion pump when continuous or intermittent infusions are planned
  • Device variants as available (for example shielded catheter systems, butterfly cannula options, extension tubing, or stopcock/port accessories) selected per policy and therapy needs
  • For removal: sterile gauze, tape, antiseptic swab, and disposal supplies per policy

Procedure Steps

  1. Verify provider order, review allergies and vascular factors, gather supplies, and confirm two patient identifiers.
  2. Assess upper-extremity veins, choose a suitable site, and prepare the skin (clean visible soil first as needed, then antisepsis with full dry time).
  3. Reapply tourniquet, insert catheter at about 10 to 15 degrees, confirm flashback, advance catheter, and release tourniquet.
  4. Attach a primed extension set aseptically, maintain sterile connector handling, and avoid contact of the Luer connection with skin.
  5. Confirm blood return, troubleshoot reversible obstruction when absent (for example slight catheter repositioning), and flush preservative-free normal saline per policy while verifying no surrounding swelling; do not force flush against resistance.
  6. Secure with engineered device and transparent dressing, then label per policy (for example inserter initials, insertion date/time, and catheter gauge).
  7. Dispose sharps safely, reassess patient status, and complete documentation.
  8. For removal, clamp line as applicable, loosen dressing toward the site, withdraw catheter parallel to skin with slow steady motion, hold direct pressure for about 2-3 minutes in routine cases (5-10 minutes if anticoagulated/high bleeding risk or if bleeding persists), confirm catheter tip intactness, redress site, and monitor for bleeding plus local infection signs.
  9. If catheter-tip culture is ordered, cut the distal tip with sterile scissors and place in a sterile specimen container per policy.

Documentation Cues

  • Insertion: site/location, device type/size, securement/dressing type, patency response, and patient tolerance/teaching.
  • Removal: pre-removal site assessment, catheter-tip intactness and cannula details, pressure duration to hemostasis, dressing applied, and tolerance/teaching.
  • If bleeding continues after initial pressure, document extended direct-pressure duration, achieved hemostasis, and any additional escalation/interventions.
  • After bleeding control, document post-removal site status for infection cues (redness, swelling, warmth, tenderness, or purulent drainage).
  • Record any unexpected outcomes, interventions, and provider notification details.

Common Errors

  • Failure to maintain sterile connector/site handling → increased local infection and CR-BSI risk
  • Inadequate pressure or omitted tip inspection during removal → bleeding complications or missed catheter fragment concern
  • Repeated unsuccessful insertion attempts by one clinician → delayed therapy, avoidable pain, and vessel depletion risk
  • Disabling or bypassing catheter safety locks → preventable needlestick injury risk

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