One of the most important skills a nurse can master, is the starting of infusions, administering of IV medications and managing IV therapy. These skills are used daily by nurses all over the world, in all kinds of healthcare settings. These infusions can restore the patient's health and save lives.

The most fear evoking experience of a young nurse is the starting of peripheral IV's. Start by assessing the hand, wrist, forearm, and the anti-cubital area. Apply a tourniquet and palpate the vein with your finger. The best way to become more efficient in locating veins for IV's, is to close your eyes and feel for the veins. There are often veins present that you cannot see, but you can feel them.

Apply an anesthetic cream over the injection site. This will help to numb the area and the patient will feel less pain when the IV cannula is inserted into the skin. Attempt to penetrate the layers of the vein in one motion. The more IV's you start, the better you will become in starting them. If time permits, offer to start IV's for other nurses. This will do two things, improve your skills and earn brownie points with your peers.

When starting the IV, use your thumb and gently tighten the skin distal to the site. This helps to anchor the vein and it doesn't tend to roll as much. Placing the needle directly above the vein, with the bevel up helps with the insertion into the vein.

If you have checked the patient and have been unable to see a vein that you feel you can start the IV in, then apply warm packs for the patient's arm for at least 10 minutes and then take another look. You will be surprised at the difference with some people. Some hospitals now have the support of a visualization device to help locate veins in the patients. These are actually becoming more popular. If one of these devices are not available, then use a blood pressure cuff on a low setting.

Don't be too rough on yourself, there is not a nurse alive that starts every IV every time. The best thing for you to do is to start IV's. The more you start the better you will become. Don't shy away from starting them on any patient. The old saying, "Practice make perfect", is true in this circumstance.

The implanted venous ports consist of an injection port, a self-sealing septum, and a radiopaque catheter. This catheter lays just above the superior vena cava. The position of this radiopaque catheter, allows for the faster dilution and a more effective flow of the injected fluid into the circulatory system of the patient. These implanted systems can be used for infusion of medications, blood products, imaging solutions, total parenteral nutritional solutions, and for the withdrawal of blood samples. The port is accessed with the use of the Huber needle.

The Huber needles is special, because it optimizes percutaneous access to the septum of the implanted port. It goes through the skin into the port septum and into the port reservoir, where the fluids are delivered. The access area of the implanted port is usually easily detected. Palpation of the area where the port is located under the skin, will allow you to feel the ring that is around the insertion area. It usually feels raised and solid, approximately the size of a quarter. The Huber needle is inserted into the soft center of the circle.

The size of the needle used to access the port will be determined by the size of the patient. A thinner patient will only require a 1-inch needle, when a heavier patient might require a 1 1/2-inch needle. The shorter needles such as the 3/4-inch needles are usually used for children. Wolf-Pak provides safety Huber needles, to help prevent needle sticks.

Always wash your hands with soap and water and then use surgical gloves when inserting the Huber needle. Apply "scream cream" (this is an anesthetic cream mixture used in some facilities), over the area where the port is located. Apply the cream approximately a half hour before the insertion of the needle. This helps with the comfort of the patient while accessing the site and receiving the medications. Always explain to the patient what procedure you are doing.

Cleanse the skin where you will insert the Huber needle with prep for at least 30 seconds to sterilize the area. Attach the Huber needle to a syringe that is filled with sterile saline. After feeling the patient's skin for the port access area, hold the port in place with the non-dominant hand and push the Huber needle at a 90 degree angle through the skin. When you feel it touch the bottom of the port, stop insertion. Aspirate a little blood into the syringe and then inject the saline. Tape or secure the needle and catheter per protocol of the facility.

Attach the needle to the intravenous line and start the medication slowly, allowing no more than 5 ml a second infusion. If using the line to extract blood, always discard the first 5 ml of blood because it will be diluted with saline. After discarding the first 5 ml, withdraw the necessary amount of blood. After the blood is withdrawn, flush the line with 10 ml of saline or 5 ml of heparin, per facility protocol.

If unable to withdraw a little of the patients' blood, the needle is probably not in the correct place and should be removed and attempted again. All facilities have protocols and procedures in place for the use of the implanted venous ports and the insertion of the Huber needles. The nursing staff receives education as to the procedures and are responsible for the accessing and deaccessing of the implanted ports.