[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [IV therapy and fluids](https://durgical.com/en/nursing/areas/iv-fluids/) › Inserting a peripheral IV catheter

# Inserting a peripheral IV catheter

- Procedure

You choose an arm vein, clean the skin, insert the catheter with aseptic technique, secure it, label it and document it.

Updated Nov 5, 2026

## Key points

- In adults, use an upper-limb vein; if the catheter was placed in the leg, move it to the arm as soon as possible (CDC 2011).
- Survey from distal to proximal and prefer the non-dominant arm.
- Avoid the arm with an arteriovenous fistula, mastectomy or lymph node dissection, paralysis or a cast.
- Let the antiseptic dry completely before the puncture.
- At most two attempts per clinician; then ask someone more experienced.
- Gauge: a lower number means a wider catheter and more flow.

## What it is

A peripheral IV catheter is a short, flexible tube left inside a superficial vein, almost always in the upper limb. It is used to give fluids, medications and blood components. The technique aims at three things: choosing the right vein, preventing infection and not hurting the patient. The gauge is chosen for the purpose and the size of the vein; hand hygiene and skin antisepsis are the key measures against infection (CDC 2011 guideline).

## Indications

- Giving fluids or medications intravenously.
- Transfusing blood or blood components.
- Having rapid venous access in a patient who may deteriorate.
- Short intermittent infusions, with the catheter locked between doses.

## Contraindications and precautions

- Limbs to avoid: arteriovenous fistula or graft, mastectomy or lymph node dissection, lymphoedema, paralysis or reduced sensation after a stroke, a cast.
- Sites to avoid: areas of flexion, the palmar side of the wrist (risk of nerve injury), veins with valves or branches, hard or cord-like veins.
- Skin to avoid: scars, tattoos, oedema, wounds or infection, and sites below a recent puncture.
- Fragile skin or steroid treatment: the tourniquet may be left off so the vein and skin do not tear.
- Older adult with superficial veins: use a lower angle so you do not go through the vein.
- Never disable the catheter's safety mechanism.

## Equipment

- Single-use tourniquet.
- Antiseptic approved by the institution (70 % alcohol, tincture of iodine or alcoholic chlorhexidine, per the CDC guideline).
- Clean gloves (acceptable if the site is not touched again after antisepsis).
- Catheter of the right gauge; adults usually get 18 or 20, children and frail older adults 22.
- Extension set or needleless connector and a prefilled saline syringe.
- Sterile transparent dressing, securement device or sterile tape, gauze, a label and a sharps container.

## Step by step (and why)

- Check the order, allergies and arm restrictions — so you do not puncture a limb that must be protected.
- Perform hand hygiene, identify with two identifiers and explain — prevents infection and wrong-patient errors.
- Apply the tourniquet, check the radial pulse and choose a straight vein, distal to proximal — saves the proximal veins.
- Release the tourniquet, clean the skin with the antiseptic and let it dry completely — wet antiseptic does not disinfect well.
- Put on gloves, reapply the tourniquet and stretch the skin below the site — keeps the vein from rolling.
- Insert at a low angle (10 to 15°); when flashback appears, lower the angle and advance slightly — the catheter enters the lumen.
- Advance the catheter off the needle, release the tourniquet and activate the safety mechanism — prevents needlestick injury.
- Attach the extension, check blood return and flush with saline while watching the site — swelling means it is not in the vein.
- Secure the catheter, cover it with a transparent dressing and label it with the date — lets you watch the site and its age.
- Dispose of sharps and document gauge, vein, number of attempts and tolerance — leaves a traceable record.

## Complications

- Infiltration: fluid leaks into the tissue, causing swelling, cool tight skin and pain.
- Phlebitis: inflammation of the vein with redness, warmth, pain or a palpable cord.
- Haematoma or bleeding at the site, especially if the catheter is dislodged.
- Local infection: usually appears two or three days after insertion, from lapses in asepsis or a contaminated dressing.
- Nerve injury: shooting pain or tingling during the puncture.

## Next step: when to call for help

- After two failed attempts, ask a more experienced clinician or ask whether another route is possible.
- If the patient feels shooting pain or tingling, remove the catheter at once, report it and document it.
- Call if the patient needs urgent fluids and access cannot be obtained.
- Call if the site keeps bleeding despite pressure, or if swelling appears when you flush.

## Test yourself

Think of the answer, then tap the question to see it.

## In which direction do you survey the arm veins to choose a site?

From distal to proximal: start at the hand and forearm and move up, so the proximal veins are kept for later punctures.

## How many puncture attempts per clinician are recommended at most?

Two. After that, ask a more experienced clinician or consider another route.

## Why do you let the antiseptic dry before the puncture?

Because it has to dry to disinfect the skin properly; puncturing wet skin reduces its effect.

## Which arm do you avoid in a patient with a mastectomy and lymph node dissection?

The arm on the operated side. The arm with an arteriovenous fistula, paralysis or a cast is also avoided.

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## Connections

## Related 2

- [Caring for a peripheral IV line: flushing, dressing and when to remove it](https://durgical.com/en/nursing/caring-for-a-peripheral-iv-line-flushing-dressing-and-when-to-remove-it/)
- [IV complications: phlebitis, infiltration and extravasation](https://durgical.com/en/nursing/iv-complications-phlebitis-infiltration-and-extravasation/)

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Nursing Advanced Skills, 1.3 Peripheral IV Access](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Advanced_Skills_(OpenRN)/01%3A_Initiate_IV_Therapy/1.03%3A_Peripheral_IV_Access) (Open RN (Chippewa Valley Technical College), LibreTexts, 2023); [Nursing Advanced Skills, 1.5 Checklist: Perform IV Insertion and IV Removal](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Advanced_Skills_(OpenRN)/01%3A_Initiate_IV_Therapy/1.05%3A_Checklist-_Perform_IV_Insertion_and_IV_Removal) (Open RN (Chippewa Valley Technical College), LibreTexts, 2023); [Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011): Summary of Recommendations](https://www.cdc.gov/infection-control/hcp/intravascular-catheter-related-infections/summary-recommendations.html) (Centers for Disease Control and Prevention, 2011).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/inserting-a-peripheral-iv-catheter/