A New ASC Nurses's Guide on How to Start a Painless IV

Starting IVs is a crucial part of being an excellent ambulatory care nurse. While painless IV cannulations can be a challenging skill to master, they are vital to your patient’s recovery. Here’s our 5 steps to starting an IV for new nurses (or nurses who need a refresher):

Step #1: Warm up the area

If your patient’s arms are feeling a bit chilly, it will be much harder to find a good vein. Try using a warm washcloth or towel wrapped around the patient’s arm to warm them up. This will also help dilate the veins. Your surgery center may have hot packs that you can use for these exact instances. If not, however, a warm washcloth works just as well.

Step #2: Find the best vein

When it comes to finding the right vein, don’t judge a book by its cover. The best veins are found through feel, not by sight. In fact, the ideal deeper veins for IVs are often not even visible at first glance. Find a viable vein by using two fingers to tap the area and make veins more visible. Always use the same fingers when searching for veins so you can get used to how the right veins feel. Avoid trying to insert an IV in a vein that is too close to the bend of the elbow or too close to the wrist. These areas are typically more painful and susceptible to infiltration.

Step #3: Choose the correct catheter gauge

The correct catheter size will depend on the patient’s situation. Ideally, you will be using a large bore needle for all surgical patients so that any potential emergency medication is easier to administer later on. If your patient is non-emergent, you can probably use a smaller catheter size. Also aim to use a smaller catheter size in patients who have vascular disorders, diabetes, or a history of drug abuse to try to preserve available veins. As much as possible, opt for smaller needles in larger veins to minimize any potential damage.

Step #4: Insert the needle

Make sure the patient is sitting comfortably with their hand below their heart. Use an alcohol wipe to sterilize the area, moving in the direction of the blood flow; this will help further dilate the vein. Have the patient make a fist and, as you insert the needle, tell them to relax the fist to prevent the vein from rolling. Any rolling of the vein can cause discomfort to the patient if the needle touches a non-vascular structure. Always start in lower veins and work upward to avoid compromising any viable sites. Keep in mind that the cannula is shorter than the needle, so once you hit the vein, you will need to insert a little further before retracting.

Step #5: Lacking confidence? Fake it ‘til you make it

Ideally, you will hit the right vein in the right way on the first try, but this isn’t always feasible. If you have to try a second time, kindly and calmly explain why to the patient and avoid getting flustered. Most patients with difficult-to-reach veins have been through this before.

Did we miss anything? What tips do you have about starting painless IVs? Share your thoughts in the comments below!

About the Author: Stephen Punzak, MD is a practicing Anesthesiologist as well as the CEO of One Medical Passport. He founded One Medical Passport because he has always had a vision of how healthcare could run more efficiently using technology.  He frequently writes on medical topics, workflow efficient measures and ASC industry trends. 

Stephen Punzak MD

Written by Stephen Punzak MD

Dr. Stephen Punzak, M.D., Founded One Medical Passport in 2000 and serves as its Chief Executive Officer. For the past 17 years Dr. Punzak has worked as an anesthesiologist for large tertiary hospitals and ambulatory surgery centers.