10 IV Insertion Tips for Nurses
IV insertion is a skill almost every nurse needs — used every day to infuse fluids and medications and to draw blood. It can be tough, especially for the new or inexperienced nurse, but with time and these 10 tips you'll sink those IVs like a pro.
1. IV Insertion: Location, Location, Location!
The best spot for your IV depends on your setting and the patient's chief complaint. Each site has clear trade-offs.
Occlusion Alarm Tip
If a patient on continuous infusions keeps setting off the occlusion alarm with an AC line, ask if you can place another IV — preferably in the forearm or hand.
2. Small Veins? Make Them Larger
When the veins you've got are small, a few simple techniques can plump them up before you stick.
3. IV Insertion with Fragile Veins
Some patients — often the elderly — have veins you can see fine, but that blow the instant you stick them, even with a 22g. Two adjustments help.
4. Don't Give Up During the IV Insertion
Some nurses hate "digging," and that's understandable — but it's often minimally painful, and you can thread the catheter within seconds. The trick is to not dig blindly: use your fingers to palpate the accurate direction of the vein.
If you don't get a flash after inserting, pull the needle and catheter back to almost out of the skin, re-palpate, and aim again in the vein's direction. Plenty of IVs miss on the first pass but thread on the 2nd or 3rd advancement — and the patient's pain receptors desensitize, so it's usually less painful than a fresh poke. That said, some patients won't tolerate this and will tell you not to dig.
Never Re-Advance the Needle Alone
It is not recommended to retract only the needle while leaving the catheter in place and then re-advance the needle. This risks fracturing the catheter and leaving a foreign body in the patient.
5. Go Big or Go Home
Smaller is not always easier. Sometimes a 22g and below are too flimsy. When veins are sclerosed, hardened, or scarred, a 20g may thread more reliably — and 20g IVs are more durable and better in an emergency.
6. The Arterial Stick
When inserting an IV, you can accidentally hit an artery. The clues: the IV pulsates, blood fills the catheter very quickly (depending on MAP), and the blood is bright red rather than the darker red of venous blood.
Pulsating IV? Take It Out
"Access is access" doesn't apply here. Peripheral IVs in arteries have much higher complication rates — the worst being thrombophlebitis, and you can literally cause a blood clot in the patient's arm, especially if meds are infused. Remove the catheter and try again in an actual vein.
7. Inserting the IV "Outside the Box"
Think outside the lower arm. Look at the upper arm, where large veins sometimes sit close to the surface. Most facilities prefer an arm, but in a true emergency any access beats none.
8. Angle Danger
Many nurses and students miss purely on technique — they hold the skin taut, stabilize the vein, insert, and go right through it, unable to thread. The usual culprit is too steep an angle.
9. Rollie Pollie Ollie (Rolling Veins)
Some veins like to roll, and the patient will usually warn you. To minimize it:
10. Patient Comfort
This last tip is mostly about comfort. After cleaning the site, place the needle flush with the skin right where you'll poke, bevel up, and press it into the cleansed skin for 3–5 seconds before you poke. The longer you wait, the more the skin receptors desensitize — theoretically decreasing pain.
With less perceived pain, the patient is less likely to tense up, leading to a smoother, more successful placement.
