How to Insert an IV

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An intravenous (IV) line is one of the most common, important tools in modern medicine. IVs allow healthcare professionals to administer fluids, blood products, and medications directly into a patient's bloodstream via a small tube. This allows rapid absorption and precise control over the dosage of the substance administered, which is vital for a variety of medical procedures, including giving fluids to treat dehydration, giving blood to a patient losing it rapidly, or issuing antibiotic treatments. [1] To insert an IV, you should first become a trained medical professional. Prepare to insert the IV, access the vein, and maintain the IV for the best results.

Part 1
Part 1 of 3:

Preparing to Start an IV

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  1. Starting an IV requires the same basic level of preparation and precaution as any medical procedure. Before you begin, you'll want to have all of your tools and equipment handy, and make sure that any materials that will come into contact with the patient's body are fresh and sterile (especially your needles). [2] To start a typical IV line, you will need: [3]
    • Non-sterile disposable gloves
    • “Over-the-needle" IV catheter (typically 14-24 gauge)
    • Bag of IV fluid
    • Tourniquet
    • Sterile bandage or dressing
    • Gauze
    • Alcohol wipes
    • Medical tape
    • Sharps container
    • Sterile pad or paper (to set your tools out on)
  2. An important part of the process of starting an IV is introducing yourself to the patient and explaining the procedure that's about to occur. Talking to patients and sharing this basic information helps put them at ease and ensures that no part of the process surprises or shocks them. [4] It also ensures that you have their full consent to proceed. [5] When you're done, have the patient sit or recline and leave their arm in a dependent position. [6]
    • Verify the patient’s identity with at least 2 identifiers, such as their name and date of birth. [7]
    • When patients are nervous, the muscles around their blood vessels may contract in a process called vasoconstriction. [8] This makes it harder to start an IV, so make sure your patient is as relaxed and comfortable as possible before proceeding.
    • Look at the patient’s medical record or ask them if they’ve had trouble with IV insertion in the past. If so, the patient may be able to tell you which sites are easiest to access, or you can use an ultrasound to help you locate a good vein. [9]
    • Check if your patient has any allergies or sensitivities. If they have a latex allergy, make sure your tourniquet, gloves, and cannula are latex free. [10]
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  3. Prime the IV tubing by suspending the IV bag from an elevated stand, filling the tubing with saline solution, and checking for any bubbles. [11] If necessary, clamp the tubing so that the solution doesn't drip onto the floor. Be sure to remove any bubbles from the tubing by stretching the tubing downward and gently tapping it with your finger. [12] Then, place a dated and signed sticker on both the IV tubing and the IV bag. [13]
    • Injecting air bubbles into a patient's bloodstream can cause a serious condition called an embolism. [14]
    • One easy technique for removing bubbles from the IV tubing is to uncoil the tubing to its full length and run the roller valve all the way up to the drip chamber. Next, puncture the IV bag with the tubing spike and pinch the drip chamber. Open the roller valve and release the line—fluid should flow down the length of the tubing without producing any bubbles. [15]
  4. Typically, IV catheters are mounted over the needle used to puncture the vein. After the vein is accessed, the catheter is left in place for easy access to the vein. Catheters come in different sizes called gauges. The smaller the gauge number, the thicker the catheter and the more rapidly medicine can be administered and blood can be drawn. [16]
    • Generally, you'll choose a catheter that's about 14-24 gauge, depending on the patient’s age and health condition. [17] An 18- or 20-gauge catheter is used for most adults, while a 22-gauge catheter is preferred for children and the elderly. [18]
  5. Inserting an IV pierces the skin and introduces foreign equipment directly into the bloodstream. To avoid the risk of a dangerous infection, it's important to wash your hands and dry them with a clean paper towel before beginning, then put on clean gloves before you handle your equipment and touch the patient. [19] If your gloves' sterility becomes compromised, take them off and put on a new pair—it's better to be safe than sorry. Below are situations that require changing gloves: [20]
    • Before touching the patient
    • Before clean/aseptic procedures (like administering IV medications)
    • After procedures with a risk of body fluid exposure
    • After touching the patient
    • After touching the patient's surroundings
    • Before moving to a different patient
  6. Next, you'll want to find a site on the patient to administer the IV. For adult patients, the most accessible veins are long, straight ones in upper extremities that aren’t near joints and are furthest from the body. [21] For children, the most commonly used veins are the cephalic vein in the proximal forearm, the long saphenous vein at or just proximal to the ankle, or the medical aspect of the upper arm. [22] Look at the patient’s medical record or ask them if they have a history of hard-to-reach veins. [23] Usually, patients with previous difficult IV experiences will know where their veins are most accessible. Note that, regardless of the presence of veins, there are certain places you won’t want to insert an IV. These include: [24]
    • Burns, scars, or sclerosed areas
    • In the same location as another recent IV
    • Places where the IV will interfere with surgery
    • Sites that show signs of infection (redness, swelling, irritation, etc.)
    • In a limb on the same side of the body as a mastectomy, fistula, or vascular graft
  7. To get your chosen veins to swell up for easy insertion, apply a tourniquet about 3 to 4 inches above the intended IV site. [25] For instance, if you're going to insert the IV into the underside of the forearm, you might put the tourniquet part of the way up the upper arm, or about 4-5 finger widths above the venipuncture site. [26]
    • Don't tie the tourniquet too tight—this can prevent the vein from dilating. The tourniquet should be tight enough to block blood flow in the veins but not the arteries. [27]
    • Letting the limb hang limp towards the floor while a tourniquet is in place can help the veins become more prominent by increasing the blood flow to the limb. [28]
  8. If you're having a hard time finding suitable veins, it can be helpful to palpate the patient's skin in the area of the IV site. Align your finger in the direction of the vein, then press down on the skin above it. You should feel the vein "push back". Continue to gently tap the site until the vein becomes visibly larger. [29]
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Part 2
Part 2 of 3:

Accessing the Vein

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  1. Tear open a fresh alcohol wipe (or use a similar sterilizing method like chlorhexidine) and apply it to the skin in the area that the IV will be inserted. [30] Wipe gently but thoroughly, ensuring an even coat of alcohol. This kills bacteria on the skin, minimizing the chance of infection when the skin is punctured. [31]
  2. Remove the catheter from its sterile packaging. Briefly inspect it to ensure that it is intact and working. Press down on the flashback chamber to ensure it is tight. Spin the catheter hub to ensure it sits loosely on the needle. Remove the protective cap and inspect the needle, taking care to ensure the needle doesn't touch anything. If everything looks in order, prepare to insert the needle. [32]
    • Don't allow the catheter or needle to come into contact with anything other than the patient's skin in the IV site. This can compromise their sterility and increase the risk of infection. [33]
  3. Use the non-dominant hand to stabilize the patient's limb with gentle pressure, taking care not to touch the IV site directly. Take the catheter in your dominant hand and insert the needle (bevel facing up) through the skin. [34] Reduce the angle of insertion as you advance the needle into the vein to avoid puncturing the posterior wall of the vein. [35]
    • Look for a flashback of blood at the catheter hub. This is a sign that you've successfully hit the vein. Once you see the flashback, advance the needle an additional 2 to 3 millimeters into the vein. [36]
  4. Inserting an IV is a delicate art and experienced doctors and nurses sometimes miss the vein on their first attempt, especially if the patient has difficult-to-hit veins. If you advance the needle and don't see a flashback of blood, explain to the patient that you've missed and are going to try again. [37] Try to be pleasant to the patient since this process can be painful.
    • You might comfort the patient by explaining why it didn’t work and also saying something like, “Sometimes these things just happen. It’s no one’s fault. We should get it right next time.”
    • If you repeatedly miss the vein, apologize to the patient, remove the needle and catheter, and try again on a different limb with a fresh needle and catheter. Attempting numerous inserts on the same vein can be very painful for the patient and leave lasting scarring. [38]
    • Do not remove the needle from the skin entirely and then reinsert it. This could result in fragmentation of the catheter and embolism in the patient. Instead, throw away the used needle in a sharps container and reattempt using a fresh needle. [39]
  5. Maintaining pressure on the skin, pull the needle (and not the catheter) about 1 centimeter (0.4 in) back out of the vein. Slowly advance the catheter into the vein while maintaining pressure on the vein and skin. [40] When the cannula is seated in the vein, remove the tourniquet and secure the catheter by placing a sterile bandage or dressing (like Tegaderm) over the lower half of the catheter hub. [41]
    • Be sure not to block the IV tubing connection with your dressing.
  6. Hold onto the catheter hub with your thumb and index finger. Keep it securely seated in the vein. Using your other hand, carefully pull the needle (and only the needle) out of the vein. Dispose of the needle in a proper sharps container. Next, remove the protective cover from the end of the primed IV tubing and carefully insert it into the catheter hub. Secure it in the catheter by screwing and locking in place. [42]
  7. Finally, secure the IV against the patient's skin. Place a piece of tape over the catheter hub, then make a loop in the catheter tubing and tape this down with a second piece of tape over the first. [43] Place a clear dressing over the IV site, leaving the catheter hub exposed. Secure the other end of the loop above the site of the IV with a third piece of tape. Putting loops in the tubing reduces the strain on the IV catheter, making it more comfortable for the patient and less likely to accidentally be removed from the vein. [44]
    • Make sure there are no kinks in the loop—this can interfere with the flow of fluids into the bloodstream.
    • Don’t forget to place a label with the date and time of insertion on the IV dressing. [45]
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Part 3
Part 3 of 3:

Maintaining an IV

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  1. Open the IV roller clamp and look for drips forming in the drip chamber. Check that the IV is infusing into the vein by occluding the vein (pressing down on it to block its flow) distal to the site of the IV (away from the torso). The flow of drips should slow and stop, then restart flowing when you stop occluding the vein. [46]
  2. IVs left in for an extended period of time are at a greater risk of infection than IVs used only for a single operation or procedure. [47] To reduce the risk of infection, it's important to carefully remove the dressing, clean the site of the IV, and put a new dressing in place. [48] In general, transparent dressings should be changed every 7 days, while gauze dressings should be changed every 2 days. [49]
    • Don't forget to wash your hands and wear a fresh pair of gloves every time you touch a patient's IV site. [50]
    Overcome insertion difficulties. "When I first started as a nurse, I couldn't hit a vein to save my life. After a few patients with bruises up and down their arms, I decided to buckle down with this guide. Looking at those pictures and steps made it all click — I could see exactly what I was doing wrong. Now, my coworkers ask for tips when they have trouble inserting an IV!" - Breeaunna W.
    Maintain IVs properly to avoid complications. "My dad was diagnosed with heart failure last year. The doctors wanted him on IV medications at home to help manage it. I'll admit, I was nervous about handling his IVs day after day. But this article explained why changing dressings and keeping everything sterile is so important to avoid infection. Thanks to that critical advice, Dad hasn't had any issues or complications from his home IVs after a whole year." - Shivanand R.
    Prepare loved ones for weekly infusions. "As my grandpa's caretaker, I had to learn to handle his weekly treatments when insurance stopped covering home nurses. I'll admit poking IV needles into my 80-year-old grandpa made me nervous at first. But the step-by-step instructions and pictures in this guide made me confident I could learn the proper technique. Now, administering the infusions is like second nature. My grandpa actually finds it comforting when his familiar granddaughter handles everything instead of rotating nurses. This guide made a scary situation so much smoother for both of us." - Lexi B.
    Have a story our readers should hear? Share it with 1 billion+ annual wikiHow users. Tell us your story here .
  3. Close the roller clamp to stop the flow of fluid, then gently remove the tape and dressing to expose the catheter hub and IV site. Place a clean piece of gauze over the IV site and pull the catheter out slowly. [51]
    • Secure the gauze over the puncture site with dressing, like pressure dot, cotton wool and tape, or a bandage. [52]
  4. The needles used to start an IV qualify as medical sharps and need to placed in a well-marked sharps container immediately after use. [53] Needles can transfer infectious agents and blood-borne illnesses from person to person if handled improperly, so it's extremely important to ensure that these needles aren't disposed with ordinary trash. [54]
  5. Though IVs are usually safe procedures, there is always a very small but real chance that complications will result from them. It's important to know the most common signs of IV complications to provide the patient with the best care and, if needed, to know when to get emergency care. Some IV complications (and their symptoms) include: [55]
    • Infiltration: Occurs when fluid is injected outside of the vein into surrounding soft tissue. Will cause swelling and smooth, pale skin in the affected area. Can be a minor or serious issue depending on the medicine being administered.
    • Hematoma: Occurs when blood leaks from the vein into the surrounding tissue, usually after more than one vein wall is accidentally punctured. Often accompanied by pain, bruising, and irritation. Will usually resolve within several weeks light pressure.
    • Embolism: Occurs after injecting air into the vein. Often caused by air bubbles in the IV tubing. Children are especially at risk. In serious cases, it causes trouble breathing, chest pain, blue skin, low blood pressure, and even stroke and heart attack.
    • Thrombosis and endarteritis: Life-threatening conditions that can result from injecting into an artery, rather than a vein. Can lead to severe pain, compartment syndrome (high pressure on a muscle leading to a very painful "tight" or "full" feeling) gangrene, motor dysfunction, and even the eventual loss of the limb.
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Expert Q&A

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  • Question
    What should I do if the fluid in the IV suddenly stops flowing?
    Jennifer Boidy, RN
    Registered Nurse
    Jennifer Boidy is a Registered Nurse based in Baltimore, Maryland. In addition to her nursing career, she also works as a Healthcare Content Strategist & Writer, helping businesses and non-profits market their products and services to healthcare provider organizations, pharmaceutical companies, and other healthcare services vendors. Jennifer’s areas of expertise include pharmaceuticals & life sciences, health technology, medical devices & diagnostics, health insurance & managed care, and healthcare services & facilities. Her certification as a Registered Nurse was issued by the Maryland Board of Nursing. She graduated from the University of Maryland with a BS in Marketing and Finance. She received her Associate of Science in Nursing from Carroll Community College in 2012.
    Jennifer Boidy, RN
    Registered Nurse
    Expert Answer
    If the fluid stops flowing, assess for occlusion, which is indicated by stop in flow, infusion pump alarm indicating occlusion, and/or discomfort at the infusion site. Try to use a mild flush injection, but do not use force. If unsuccessful, you need to remove the IV line and reinsert a new one. Some preventive measures to take: 1) Maintain IV flow rate 2) Flush promptly after intermittent piggy-back administration 3) Have the patient walk with their arm bent at the elbow to reduce risk of blood back flow.
    Thanks! We're glad this was helpful.
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    Not Helpful 5 Helpful 10
  • Question
    Why is the IV tubing spike inserted to the medication port instead of the IV tubing port?
    Jennifer Boidy, RN
    Registered Nurse
    Jennifer Boidy is a Registered Nurse based in Baltimore, Maryland. In addition to her nursing career, she also works as a Healthcare Content Strategist & Writer, helping businesses and non-profits market their products and services to healthcare provider organizations, pharmaceutical companies, and other healthcare services vendors. Jennifer’s areas of expertise include pharmaceuticals & life sciences, health technology, medical devices & diagnostics, health insurance & managed care, and healthcare services & facilities. Her certification as a Registered Nurse was issued by the Maryland Board of Nursing. She graduated from the University of Maryland with a BS in Marketing and Finance. She received her Associate of Science in Nursing from Carroll Community College in 2012.
    Jennifer Boidy, RN
    Registered Nurse
    Expert Answer
    The IV tubing spike is inserted into the bag of IV solution. It can also be inserted into a non-vented bottle of medication.
    Thanks! We're glad this was helpful.
    Thank you for your feedback.
    If wikiHow has helped you, please consider a small contribution to support us in helping more readers like you. We’re committed to providing the world with free how-to resources, and even $1 helps us in our mission. Support wikiHow
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      Warnings

      • Do not attempt to find a vein more than 3 times. If you are unable to locate a vein with the needle after 3 attempts, solicit the help of another technician. [56]
        Thanks
        Helpful 1 Not Helpful 0
      • Always check patient records to make sure there are not specific instructions to follow for the individual before inserting an IV. [57]
        Thanks
        Helpful 1 Not Helpful 1
      • Only insert an IV if you are a trained medical professional. [58]
        Thanks
        Helpful 2 Not Helpful 0
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      Things You'll Need

      • Patient chart
      • IV pole
      • IV bag
      • Tourniquet
      • IV clamp
      • Tape
      • Gloves
      • Needle
      • Syringe
      • Cannula
      • Betadine solution (or a chlorhexidine swab stick like ChloraPrep®)
      • Cotton swab
      • Tap Water (hand hygiene)
      • Antiseptic soap
      • Medical waste bin
      • Sharps disposal bin

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      References

      1. ↑ https://my.clevelandclinic.org/health/treatments/21635-iv-fluids
      2. ↑ https://www.britishjournalofnursing.com/content/back-to-basics/a-guide-to-cannulation-in-adults/
      3. ↑ https://www.ncbi.nlm.nih.gov/books/NBK539795/
      4. ↑ https://my.clevelandclinic.org/health/treatments/24930-peripheral-iv
      5. ↑ https://www.britishjournalofnursing.com/content/back-to-basics/a-guide-to-cannulation-in-adults/
      6. ↑ https://wtcs.pressbooks.pub/nursingadvancedskills/chapter/1-5-checklist-iv-insertion/
      7. ↑ https://wtcs.pressbooks.pub/nursingadvancedskills/chapter/1-5-checklist-iv-insertion/
      8. ↑ https://my.clevelandclinic.org/health/symptoms/21697-vasoconstriction
      9. ↑ https://www.rch.org.au/clinicalguide/guideline_index/Intravenous_access_Peripheral/
      1. ↑ https://www.rch.org.au/clinicalguide/guideline_index/Intravenous_access_Peripheral/
      2. ↑ https://cod.edu/academics/programs/nursing/nursing-simulation-lab/pdf/replacement_of_intravenous_tubing_and_intravenous_solution.pdf
      3. ↑ http://home.nwciowa.edu/videos/nursing/mosby/advanced/assets/procedure/ChangingIntravenousTubingandFluids-procedure.pdf
      4. ↑ https://pressbooks.bccampus.ca/clinicalproceduresforsaferpatientcaretrubscn/chapter/8-7-priming-iv-tubing-changing-iv-bags-changing-iv-tubing/
      5. ↑ https://www.ccjm.org/content/87/12/718
      6. ↑ https://www.researchgate.net/publication/363602184_Air_bubbles_removal_technique_from_intravenous_tubing
      7. ↑ https://www.ncbi.nlm.nih.gov/books/NBK539795/
      8. ↑ https://www.ncbi.nlm.nih.gov/books/NBK539795/
      9. ↑ https://www.ncbi.nlm.nih.gov/books/NBK594499/
      10. ↑ https://velindre.nhs.wales/velindrecc/health-care-professionals-information/iv-picc-and-hick/cannulation/cannulation-docs/cannulation-guideline-01-18/
      11. ↑ https://cdn.who.int/media/docs/default-source/documents/health-topics/hand-hygiene-why-how-and-when-brochure.pdf
      12. ↑ https://www.ncbi.nlm.nih.gov/books/NBK539795/
      13. ↑ https://www.rch.org.au/clinicalguide/guideline_index/Intravenous_access_Peripheral/
      14. ↑ https://www.rch.org.au/clinicalguide/guideline_index/Intravenous_access_Peripheral/
      15. ↑ https://www.akronchildrens.org/lab_test_specimen_procedures/PERFORMING_A_VENIPUNCTURE.html
      16. ↑ https://www.unitekcollege.edu/blog/stick-like-a-pro-tips-for-mastering-the-art-of-venipuncture/
      17. ↑ https://www.ncbi.nlm.nih.gov/books/NBK138665/
      18. ↑ https://harmreductionwa.org/wp-content/uploads/2019/05/PBHRWA-Tourniquets-a-users-guide.pdf
      19. ↑ https://www.wearewithyou.org.uk/advice-and-information/advice-for-you/safer-injecting/how-to-raise-a-vein
      20. ↑ https://wtcs.pressbooks.pub/nursingadvancedskills/chapter/1-5-checklist-iv-insertion/
      21. ↑ https://www.ncbi.nlm.nih.gov/books/NBK539795/
      22. ↑ https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/peripheral_intravenous_iv_device_management/
      23. ↑ https://www.jpaget.nhs.uk/media/406339/intravenous-cannulation-procedure.pdf
      24. ↑ https://opentextbc.ca/clinicalskills/chapter/3-3-care-of-iv-tubing-administration-sets/
      25. ↑ https://pubmed.ncbi.nlm.nih.gov/16280942/
      26. ↑ https://emedicine.medscape.com/article/1998177-technique#c2?form=fpf
      27. ↑ https://emedicine.medscape.com/article/1998177-technique#c2?form=fpf
      28. ↑ https://emedicine.medscape.com/article/1998177-technique#c2?form=fpf
      29. ↑ https://www.saveyourvein.org/
      30. ↑ https://emedicine.medscape.com/article/1998177-technique#c2?form=fpf
      31. ↑ https://wtcs.pressbooks.pub/nursingadvancedskills/chapter/1-5-checklist-iv-insertion/
      32. ↑ https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/peripheral_intravenous_iv_device_management/
      33. ↑ https://wtcs.pressbooks.pub/nursingadvancedskills/chapter/1-5-checklist-iv-insertion/
      34. ↑ https://youtu.be/ue96cuS-lNs?t=384
      35. ↑ https://youtu.be/ue96cuS-lNs?t=401
      36. ↑ https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/peripheral_intravenous_iv_device_management/
      37. ↑ http://home.nwciowa.edu/videos/nursing/mosby/advanced/assets/procedure/ChangingIntravenousTubingandFluids-procedure.pdf
      38. ↑ https://www2.hse.ie/conditions/iv-line-infection/
      39. ↑ https://psnet.ahrq.gov/web-mm/peripheral-iv-too-long
      40. ↑ https://www.saintlukeskc.org/health-library/discharge-instructions-changing-dressing-your-peripherally-inserted-central-catheter
      41. ↑ https://www.saintlukeskc.org/health-library/discharge-instructions-changing-dressing-your-peripherally-inserted-central-catheter
      42. ↑ https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/peripheral_intravenous_iv_device_management/
      43. ↑ https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/peripheral_intravenous_iv_device_management/
      44. ↑ http://www.cetl.org.uk/learning/print/cannulation-venepuncture-print.pdf
      45. ↑ https://www.health.ny.gov/diseases/aids/consumers/prevention/needles_syringes/sharps/
      46. ↑ https://ccnmtl.columbia.edu/projects/aegd/mod01_mec_ivcomp.html
      47. ↑ https://www.ruh.nhs.uk/pathology/phlebotomy/donts.asp?menu_id=2
      48. ↑ https://www.rch.org.au/clinicalguide/guideline_index/Intravenous_access_Peripheral/
      49. ↑ https://www.ncbi.nlm.nih.gov/books/NBK594499/

      About This Article

      Article Summary X

      Before you insert an IV, wash your hands and put on sterile gloves to avoid the risk of infection. Then, find a prominent vein, and apply a tourniquet behind it so it swells and is easier to insert into. Next, disinfect the IV site with an alcohol wipe. When you're ready, stabilize the patient's limb with your non-dominant hand, and insert the needle into the vein. As you press the needle into the vein, reduce the angle between the needle and the skin. Once you're finished, pull the needle about 1 centimeter out of the vein, and slowly press the catheter into the vein. Now, remove the tourniquet, and secure the catheter with a bandage. After you've applied the bandage, carefully pull the needle all the way out of the vein, and insert the primed IV tubing into the catheter hub. Finally, secure the IV to the patient's skin with tape. For more advice from our Medical co-author, like how to maintain an IV after you insert it, scroll down.

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