IV Insertion Angle

General Rules
1. Shallower veins require more shallow IV insertion angles
  1. i.e. attempts to the hands should be made at 10-20°
  2. Deeper veins require a steeper approach
2. Always begin the attempt at a 20-30°
  1. Starting a shallow attempt can be painful, can damage the catheter and can cause tissue damage
  2. Starting a very steep attempt can cause going through both sides of the vein
Approach each attempt individually
1. Identify the vein first, then consider the insertion angle.
Hands
1. Hand veins are typically shallow, requiring a shallower insertion angle
2. Identify the appropriate vein
3. Begin at 20-30° insertion to break the skin, then change the angle to 10-20° and continue insertion
Arms and Legs
1. Most arm and leg veins have a more significant covering of tissue to penetrate
2. Identify the appropriate vein
3. Begin at 20-30° and continue that angle during insertion
Deeper Veins
1. Antecubital Fossa
2. Identify the appropriate vein
3. Begin insertion at 20-30°, then change the insertion angle (which might be steeper, depending on the patient – up to 40-45°
Pro-Tips
1. If you miss, don’t fish
  1. This causes shearing and tearing and can be painful.
  2. Retract the catheter almost to the point of removal and attempt the angle again
    1. Don’t remove the catheter completely!
2. These rules aren’t hard and fast
  1. Try steeper angles on typically shallow veins and try more shallow angles on deeper veins
3. Practice, practice, practice
  1. Use peers or other experts to help you in weak areas of insertion, when possible
  2. Watch others, who are far more experienced
  3. Volunteer to place every IV, every time – you will only get better with practice!

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Transcript

All right guys. In this lesson, we’re going to talk about IV insertion angle when you’re doing an IV catheter. So the first thing you want to do is kind of remember this rule, the shallower the vein, the shallower the angle. And what that means is if I have my hand like this and it’s a really shallow vein, I want that angle of the in the angle of insertion to be almost a parallel to it and what, and the reason is is because as you go deeper, so places like the elbow places like the bicep, they can sometimes be deeper, especially like bariatric patients and that means your angle of insertion is going to be more upright. So that’s just kind of a rule of thumb. One other rule of thumb is always to start in the 20 to 30-degree angle range. It’s not a hard and fast rule, but always use that kind of as the guide.

The next thing that you want to do is approach each attempt individually. What you want to do. Look at the IV, where you’re going to start and then say, what insertion angle do I need to start this out? One really important thing that you need to remember is that anytime when you’re starting, one of the really deep veins is to approach it a little bit judiciously. So start at 20 or 30 degrees and then if you need to change that angle, just be careful that you’re not going perpendicular. Alright, and now for a couple of pro tips, if you miss, don’t fish. That always causes tearing and shearing. It’s uncomfortable for the patient. This is not something that comes easily to everybody. And for people that struggle with IVs, the only real way that you can get better is to practice. Always try to volunteer, always learn and look for the opportunity where you can use someone else’s knowledge and experience to help them guide you through the process or even looking at how you can get better.

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Nursing Points

General points for IV insertion angles

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