This document provides guidelines for IV maintenance therapy and insertion. It outlines that IV bags should be changed every 24 hours, tubing every 96 hours, and sites every 96 hours. When choosing sites, start with hand veins and avoid interfering with blood draws. Lidocaine can be used with a doctor's order for difficult insertions or anxious patients. Proper documentation and disposal is also covered. Tips for successful insertion include slowing down, looking for flash instead of pop, and threading carefully after flash.

1. IV Therapy
Maintenance Therapy for Peripheral IV’s
 Verify that the correct solution is hanging
 Verify that the rate is correct
 Assess amount left, availability of solution
 Change the IV bag at least every 24 hours (label)
 Change primary & secondary IV tubing along with caps
every 96 hours (label)
 Mark IV tubing for change using appropriate label
 Change peripheral IV sites every 96 hours
 Mark all peripheral IV sites with start date

2. IV Therapy (continued)
When choosing an IV site:
 Start with the distal veins of the hand and work up
 Avoid the antecubital site because it interferes with blood sampling
 Choose site free of abrasions, inflammation, and lesions
 Be considerate of patient's comfort/mobility (use nondominant arm)
 Longer and larger veins will better dilute infusions
 Start an 18 gauge if possibility of patient going to surgery or
receiving blood

3. IV Therapy (continued)
Lidocaine use for IV starts:
Lidocaine is not routinely used when starting IV’s
It is used however if a patient requests it or if the nurse feels
it will relieve the patient’s anxiety related to the IV start
The registered nurse uses topical EMLA or injects 0.2 ml of
plain 1% Lidocaine (not to exceed 1 ml intradermally) at a
peripheral intravenous site prior to insertion of the
intravenous catheter as directed by the ordering physician
Lidocaine is administered with a doctor’s order when the IV
insertion is expected to be difficult, when the patient is
anxious, and/or when the patient requests anesthesia prior to
IV insertion

4. IV Therapy (Reminders)
Documentation
 Document location, number of attempts, size of cathlon and
confirmation of patency (positive blood return, successful saline
flush)
Do not withdraw needle from catheter hub before pressing the
white button
Needle should be retracted prior to disposal in a puncture-
resistant, leak-proof container
Never reinsert needle into the catheter as this could shear the
catheter
Do not use scissors at or near the insertion site

5. IV Therapy (Tips for Success)
Site Prep – always prep site using the chlorascrub inside the
start kit. If first attempt unsuccessful obtain another single
chlorascrub to prep new site.
 Insertion Success
• slow down the speed of insertion - use less force to penetrate
the skin
• lower the initial insertion angle keeping the elbow low
 Feeling the “pop” (pop causes damage to the vein - flash is a
better indicator)
• slowing the approach allows the flash to catch up
 Seeing the flash
• Trust your instinct and take a pause - look for the flash
behind the spring
• The initial flash may be seen along the cathlon

6. IV Therapy (Tips for Success)
Threading with ease
 After flash, lower the angle and advance 1/8 inch
 Retract the Needle
 Rotating the barrel 360 ensuring cathlon seal is broken
 Release tourniquet before pressing the button
 Do not activation before it’s time (be aware of where your
fingers are)
 Remove needle cover in a straight, outward motion