How To Get An Intravenous Line Painlessly

Intravenous, in-the-vein (IV) lines are a fact of life for the majority of hospital patients. If you are admitted into the medical ward of just about any hospital in the United States, chances are you will have one or more IV portals inserted into your veins even if you are not receiving fluids or medications through them. They're the fastest way to get life-saving meds to you, and are therefore routinely inserted in case of unexpected complications.

How Is an IV Inserted?

Most of the time, an IV is placed in a vein (a blood vessel that carries blood back to the heart) in the arms, or less often in the legs or (for infants) scalp.

The IV assembly consists of a needle inside a catheter, which is like a little pipe, inserted about 1 inch (20-25 mm) into a vein. Part of the catheter remains outside the skin, and it can be connected to a syringe, or an infusion line (connected to an "IV bag"), or capped with a haplock for potential future use.

Do I Really Have to Have an IV?

Hospital rules usually require patients to have IV lines from the moment they are admitted until the moment they leave, just in case emergency medications are needed, even if intravenous infusion is not needed when the catheter is put in. If you are that rare patient who “codes” and needs epinephrine and atropine to restart your heart, or if you are unable to drink water and you need intravenous fluids to prevent your skin and veins from collapsing, then you will appreciate the value of having an IV line any time you are hospitalized. Many medications have to be delivered by IV, and sometimes the only way a hospital patient can get nutrients is by IV.

IV lines are usually absolutely necessary. But nobody likes getting them.

What Makes Getting an IV (Sometimes but Not Always) Unpleasant?

Inexperienced (and out-of-practice) nurses sometimes need more than one poke to get a line started. Veins can roll and "hide" at the exact moment the nurse inserts the needle. Veins may be crooked, and they may have valves that stop the needle before it can be properly inserted. If the catheter won't go far enough into a vein, it has to be taken out and reinserted elsewhere.

Sometimes inserting a needle into a vein to set up an IV line can make a bloody mess, especially if you are on an anti-coagulant (blood thinning) medication, as you almost certainly would be in you are in the hospital for heart issues or after-care of almost any kind of surgery. And sometimes the skin is simply unusually dried out and tough. A needle that should slip through the skin easily does not, because the skin fights back.

Skilled nurses and paramedics often can deal with all of these issues and still manage to insert an IV line fairly expertly, but you can make the experience easier as a patient, too. It is a good idea to know the following five ways to make an getting an IV line more comfortable before you go to the hospital, and to review them before taking a child to hospital treatment.

Five Ways To Make The Experience Of Getting An IV More Comfortable

In the course of thirteen hospital stays in a single year, Robert (the author of this article) had to be given over 150 fresh IV ports for various kinds of intravenous therapy to be delivered.

Robert commented that his favorite nurse for giving IV lines, which he regularly had to have changed at 3 in the morning, was a usually male nurse who generally came into his room looking just a little disheveled, like he was running late for work (which he in fact had been).

Robert and his nurse would always find something to chat about for a few minutes, whether it was the nurse's experience as a Marine combat medic in Iraq or Robert's experience dodging bullets reporting from elsewhere in the Middle East, or the weather, or football, or the women in their lives. And during the course of the conversation, the nurse would insert the IV when Robert wasn't paying attention, always with a single painless stick. The whole thing was over before Robert knew it.

Of course, if you are trying to make the experience of getting an IV less traumatic for a child, talking with an ex-Marine combat medic about women isn't the best way to go, but these ten general rules apply to pain-free IV lines for hospital patients of all ages.

1. Let the nurse make small talk.

Skilled nurses know how to use conversation to distract their patients from the fact they are getting an intravenous line placed in a vein. Relaxed muscles make it easier and less painful to penetrate the skin and easier to place the catheter in the vein. If you are a parent, you may have to make a judgment as to where it is better for you or the nurse to talk to your child. If you are the patient, you'll know they're probably only talking to you to distract you. Don't try to outsmart them. Be grateful.

2. Let the nurse look for the best vein.

Nurses will usually take a minute or two to look for the best site to insert the IV. They need good light to see your veins. Don't make a fuss about turning the overhead lights on, and definitely don't complain that it's all taking too long. And let the nurse look at sites on both arms to find the placement that will cause you little or no pain.

3. Don't look at the IV going in.

Most people find the process of getting an IV much less traumatic if they close their eyes or at least look away. Robert, the writer mentioned above, observed several IV insertions just to be able to describe the experience better. When one insertion Robert was watching required six sticks with a needle, however, he decided he knew enough about the process and all the later IV's went in much more smoothly. 

4. Hold still.

Your nurse has to guide an 18- to 24-gauge needle, an object that is just about 3/100 of an inch or 8/10 of a millimeter in diameter, into about an inch (25 mm) of a vein without encountering any valves in the vein, or any twists or turns in the vein. If you move, the needle will miss. The good news is, if you hold still, the insertion may not even hurt.

5. Ask about anesthetic, especially for a child.

Numbing the skin can make getting an IV easier, especially for a child. The problem with anesthetics for IV sites has always been that getting the anesthetic to make the insertion of the IV needle painless required the insertion of a hypodermic needle to give the medication. A relatively new system known as the J-tip, however, squirts lidocaine through the skin without a needle with a "push" from a small cannister of carbon dioxide. Topical coolants, however, usually are not helpful.

And if receiving fluids and medications intravenously is a chronic problem for either adults or children, seek out a hospital with high-tech capacities. Some hospitals are equipped with ultrasound devices that can be used by nurses to place intravenous therapy lines painlessly with a single stick. This is particularly helpful for people who receive chemotherapy or parenteral nutrition.

If you embrace these tips, you still won't love IV lines — but you'll probably be able to stop dreading their insertion.