OSCE: Intravenous Access (IV Access)

Intravenous injection

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This guide outlines the steps for safe and effective intravenous (IV) access, adhering to proper technique and addressing potential complications. This preparation ensures compliance with OSCE standards for medical examinations.

Key Objectives:

• Demonstrate the correct technique for IV access.

• Ensure patient safety by following the "Rights of Medication Administration."

• Recognize and address potential complications associated with IV access.
  

Steps for Intravenous Access:

Preparation and Patient Safety:

1. Verify the Rights of Medication Administration:

   • Right Client: Introduce yourself and verify the patient’s identity (name and date of birth).

   • Right Drug: Confirm the drug name.

   • Right Dose: Verify the prescribed dose.

   • Right Route: Confirm the route as intravenous.

   • Right Time: Ensure administration at the correct time.

   • Right to Refuse: Respect the patient’s decision and explain potential consequences of refusal.

   • Right Documentation: Record the procedure and observations accurately.

2. Indications for IV Access:

   • Venous blood sampling.

   • Intravenous fluid infusion.

   • Intravenous medication administration.

   • Blood transfusion.

   • Intravenous contrast infusion.

3. Contraindications:

   • Significant edema, burns, sclerosis, or thrombosis at the intended site.

   • Active infection or cellulitis.

   • Presence of a fistula.

4. Complications:

   • Bruising or hematoma formation.

   • Air embolism.

   • Phlebitis or vein irritation.

   • Infection at the site.

   • Nerve damage.

   • Thrombosis.
     

Procedure for IV Access:

1. Select the Injection Site:

   • Hand: Metacarpal and dorsal veins.

   • Forearm: Basilic vein (ulnar side), cephalic vein (radial side), median vein.

   • Antecubital Fossa: Median cubital vein, basilic vein, cephalic vein.

   • Lower Extremity (if necessary): Dorsal digital vein, dorsal metatarsal vein, great saphenous vein.

2. Position the Patient:

   • Position the patient comfortably with the selected limb adequately supported.

3. Apply the Tourniquet:

   • Apply the tourniquet proximally to distend the veins.

4. Skin Preparation:

   • Clean the site with an alcohol swab, using a circular motion from the center outward.

5. Insert the IV Catheter:

   • Position the bevel of the needle facing upward.

   • Insert the needle at an angle of 15-30°, depending on the depth of the vein.

   • Advance the needle until blood return is observed (flashback).

6. Advance the Catheter:

   • Stop advancing the needle and slide the catheter fully into the vein.

   • Hold the catheter in place while carefully removing the needle.

7. Secure the Catheter:

   • Apply pressure at the vein entry point to prevent blood leakage.

   • Attach the IV administration set or cap the catheter.

   • Secure the catheter with Tegaderm or appropriate dressing.

8. Administer Medication or Fluids:

   • Connect IV fluids or administer medications as prescribed.

   • Check for signs of infiltration, such as swelling or pain.

9. Post-Procedure Care:

   • Remove the tourniquet.

   • Observe for immediate adverse reactions.
     

Evaluation Criteria:

Step	Correct	Partially Correct	Not Performed
Patient Identification	✅	⚠️	❌
Site Preparation	✅	⚠️	❌
Catheter Insertion Technique	✅	⚠️	❌
Securing and Dressing the Site	✅	⚠️	❌
Documentation	✅	⚠️	❌