16+ Essential Steps for IV Insertion in the Antecubital Fossa

What is the Antecubital Fossa?

The antecubital fossa is one of the primary locations on the body where doctors and nurses insert an IV. The antecubital fossa is a small triangular space where the arm and forearm meet. This is also the area on the opposite side of the elbow joint.

At the antecubital fossa there is a major intersection of major veins and arteries.

Veins that pass through  or just under the antecubital fossa include:

• Basilic vein
• Cephalic vein
• Median Basilic vein
• Median cubital vein
• Median antebrachial vein
• Median antebrachial cephalic vein
• Antebrachial basilic vein
• Median antebrachial basilic vein

Maor arteries that pass through or just under the antecubital fossa include:

• Brachial artery
• Ulnar artery
• Radial artery

Why use the Antecubital Fossa?

The antecubital fossa or the area where your forearm and arm meet is often the preferred location for running IVs. You might be wondering why this is?

The antecubital fossa is the desired location for three primary reasons:

1. The veins are easily accessible
2. The veins are close to the surface of the skin, making them easier to find.
3. The veins in this area have a wide lumen. The lumen refers to the channel within the vein where blood flows.

What Do you Need to Start an IV Insertion?

IV insertions are one of the most fundamental duties of being a nurse and doctor. To properly and effectively insert an IV you will need to medial supplies which include:

1.IV start kit: The IV starter kit is a packaged kit that includes most of the necessary tools required to start an IV insertion. Inside an IV start kit you will find:

• Gloves

• Tourniquet

• Antiseptic

• Gauzes 

• Tape 

• Tegaderm or transparent medical dressing 

• Syringes 

• IV gauge needle

2.Extension tubing or Cap - The extension tube is used to connect the IV bag.

3.Saline Flush - The saline flush is used to determine if the IV is working properly.

How To Start An IV Insertion? Step by Step walkthrough.

If you never have inserter IV or you are looking to refresh your memory, then you’re in luck.

1. Before you begin touching or using any supplies, you should prepare all the supplies you need and keep them close by.
2. Prepare your IV start kit.
3. Remember to always communicate with your patient or the person you will be applying an IV too. Many people are afraid of IV’s so it’s important that you explain each step and let them know they may feel some pain.
4. Put on your gloves and apply the tourniquet just above the antecubital fossa or the bend of the arm.
5. Place your patient’s hand pointing downwards or towards the floor and have them open and close their hand. With the hand pointing downwards, gravity will draw blood into your patient’s limbs. Opening and closing the hand will make the veins more visible.
6. Prime your saline flush by removing the air bubble inside. Attach your saline flush to your tubing, flush the tubing to remove any air, and ensure that the tubing is working properly.
7. Prepare your tape. Tear off about 3-5 inches of table. Tear the tape down the middle. This is the tape you will use to secure the IV.
   
8. Using the antiseptic wipes or any other alcohol to clean the site or antecubital fossa. Wipe the area for around 10 - 15 seconds and avoid drying it or blowing on it. This will spread bacteria over the site.
9. Prepare your needle gauge. Remember to use the proper needle gauge depending on the type of testing.
   
10. Locate the vein. You can do this by feeling around. Insert the needle into the vein.
11. When inserting the needle, use the chamber on the needle to confirm you have punctured the vein. Once you are inside the vein, you will see blood coming up the chamber.
12. After seeing the blood, slide the cannula slightly into the vein. After sliding the cannula into the vein, hit the safety button on the needle. This will retract the needle into the chamber, keeping you and others safe.
13. Remember to keep the IV pointing upwards to reduce the likelihood that blood squirts out.
14. Attach the extension tubing into the IV and test with the saline solution. When injecting the saline solution, avoids any puffing around the injection site. This is a sign that your IV is not inside the vein, and the saline solution is entering the tissues. Patients may experience a burning or painful sensation if this does happen.
15. After testing, you can use the tape you prepared earlier to tape the extension tube down. Using the Tegaderm to secure the
16. Remove the tourniquet and make sure that you use a label to date and time your IV to make tracking and monitoring easier.