Nurses Are Masters at the Fine Art of Caring

How to Start a Painless IV

nurse holding IV bag and tubing
Your shift is just getting started and the first patient you encounter needs an IV STAT. You check the order, obtain the IV med and supplies. As you enter the patient's room, you glance at her arms to get a quick overview and panic sets in just a bit. You must remain calm and confident, but what you see is initially not promising. Breathe and smile! Your patient is already scared to death and wishing she had stayed home instead of seeking help. Now you’re coming in with scary items and talking about poking with needles!

Wash your hands. Using a calm voice and warm smile, put her hand in yours. Introduce yourself and explain that you’re the BEST IV nurse in the whole state! You’re not going to lie, it’s going to be a bit uncomfortable for a moment, but you have a lot of tricks up your sleeve to make it as painless as possible. You’ll explain every step along the way and ask if she has any questions. Has she had IVs before and what was the experience? By holding her hand, you’ll assess her strength, her level of fear, the temperature of her skin and whether your soft, kind, confident words are hopefully working some magic.

Inflate a sphygmomanometer (BP cuff) to check her veins and dangle her non-dominant arm off the gurney or bed. If it’s not good, check her dominant arm, but remember that’s not the best scenario. Keep talking to keep her calm and build rapport and confidence. Explain why she needs the IV and reassure her the goal is to improve her status as soon as possible. Reiterate you’re going to go slowly and take every opportunity to make it successful and as painless as possible.

First, warm her arm with some heated washcloths wrapped in a blanket or towel. This will take about 10 minutes to help her veins really plump up to make this painless. Have her close her eyes and take deep breaths. Relax! Meanwhile, gather any other supplies you’ll need and set up your mini sterile workstation using the bedside table. Use a chair or stool to be comfortable accessing the best veins. Position the bed so you don’t have to bend over.

Remove the blanket or towel and warm cloths. Using a sphygmomanometer provides better and more steady dilation without blocking blood flow. It’s more comfortable for the patient. Place it on the arm with the tubing facing upwards and out of your field. Feel for the best vein. Deflate the cuff until you’re ready to insert the catheter.

After you don your gloves, cleanse the area with alcohol. Inflate the cuff again while the alcohol dries completely. Alcohol on the needle is very painful. Explain the process as you go and have her take more deep breaths. Keep her distracted by asking her questions about topics like her job, her family, her bucket list.

Using a two-step process, have her take another deep breath and
as she exhales, insert the needle bevel up into the skin, and then puncture the vein. Advance the catheter when you have a flash and hook up the line. Slowly start the flow to ensure the vein doesn’t blow. Secure the catheter per your facility policy. For very thin or fragile skin use paper tape. Per your facility policy, date and initial the site on the dressing.

Smile and remind the patient you’re the BEST IV nurse in the state. Right? Provide a reassuring touch. Instruct in what to expect from the IV, how to function with it in place, and signs or symptoms of problems to report to the nurse. Document your procedure. Fist pump!! You made a difference today.


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