• PIV insertion kits vary by institution - talk to your nursing colleagues to ensure you are familiar with yours.
• In general, necessary supplies include: chuck, IV catheter, IV start kit, saline flush, alcohol wipes, chlorhexidine, extra gauze.
• Place a chuck under the patient’s arm.
• Place your tourniquet proximal to the target vein and sterilize the skin with chlorhexidine.
• Visualize your vessel with ultrasound. The best vessels to target are <1.5cm deep (the deeper the vessel, the more likely your catheter will infiltrate. Consider using a longer IV catheter for deeper vessels).
• Enter the skin with your IV needle at a 45° angle. Visualize your needle tip until it has entered the vessel and you see the flash of blood return.
• Flatten your needle angle, and advance another 1-2mm, visualizing your needle tip throughout. Advance your catheter over your needle.
• Place sterile gauze under your catheter to catch any blood as you prepare to withdraw your needle. Remove the tourniquet, compress the vein proximal to the visible catheter, and safely withdraw your needle.
• Attach your tubing and sterile flush to your catheter. Aspirate blood into your tubing, hold your flush upright to keep air bubbles out of the tubing, and flush your IV catheter.
• You should feel minimal resistance to flow if your catheter is properly positioned. FYI: in some instances, patients may report a “salty” taste in the back of their mouth as saline is flushed into their venous system.

Schoenfeld E, Boniface K, Shokoohi H. ED technicians can successfully place ultrasound-guided intravenous catheters in patients with poor vascular access. Am J Emerg Med. 2011 Jun;29(5):496-501.

Witting MD, Schenkel SM, Lawner BJ, Euerle BD.  Effects of vein width and depth on ultrasound-guided peripheral intravenous success rates. J Emerg Med 2010;39(1):70-5.