How to start a peripheral IV
Other platforms explain it with text and video. In VMS you practice it on the patient.
Starting an IV is a core skill in nursing and paramedic programs. Clean technique and a calm plan matter more than speed.
What you need
- IV catheter (often 20 to 22 G for adults, 18 G for fast fluids or blood)
- Tourniquet
- Chlorhexidine-alcohol pad
- Gloves
- Saline flush and extension set
- Transparent dressing
- Sharps container
Step by step
Prepare
Check the order, clean your hands, introduce yourself, confirm the patient with two identifiers, explain and get consent. [1]
Choose the vein
Start low on the arm, non-dominant side, avoid joints, injured or infected skin, and the arm with a dialysis fistula or after breast surgery. [1]
Tourniquet
About 10 to 15 cm above the site, for no more than 2 minutes. [1]
Clean the skin
Gloves on. Scrub with chlorhexidine-alcohol and let it dry completely. Do not touch the site again. [1]
Insert
Hold the skin tight below the site. Needle bevel up at a low angle (about 10 to 30 degrees). When you see blood in the chamber, lower the angle, advance slightly and slide the catheter in off the needle. [1]
Release and secure
Release the tourniquet, press above the tip, remove the needle with the safety on and drop it in the sharps container. Attach the primed extension set. [1]
Flush and check
Flush with saline: no swelling, pain or resistance. [1]
Dress and record
Transparent dressing, label with date and size, and document. [1]
Common errors
- Tourniquet left on too long.
- Touching the site after cleaning.
- Releasing the tourniquet after removing the needle (blood leak).
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
- Open RN, Nursing Skills 2e (Chippewa Valley Technical College) (CC BY 4.0)
- NREMT psychomotor skill sheets (EMT and Paramedic)
Steps adapted from Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. Facts and steps also follow NREMT psychomotor skill sheets (EMT and Paramedic). VMS is not affiliated with these organizations. Updated: 2026-10-11.