IV Initiation


A few years ago when I was doing my EMR course in Calgary, we had the pleasure of watching the EMT students begin their in-class IV practical sessions. This was the day I discovered you can start IVs in a person’s foot. It was also the day I decided I would NEVER let someone put an IV in my foot. Unless I was unconscious. And dying. Severely, severely dying.

IV initiation class is one of those times that you truly question your commitment to your career choice. I mean, the only reason we put ourselves through IV practice is so that we can learn a skill to help our patients. Unless you are a) incapable of feeling pain or b) enjoy pain in a really sick and twisted way- you have to REALLY REALLY want a career in medicine to let your peers practice IV starts on you.

For those of you that know me, I have a budding tattoo collection. This seems to make people think that I should be able to endure IV practice with ease. I also want to punch those people in the trachea. Allow me to clarify. A tattoo is created by injecting ink below the epidermis and into the dermis. After receiving a tattoo you are left with some beautiful art of your choice (hopefully). An IV however is started by slipping a catheter into and up a vein. A catheter is a small hollow tube- kind of like a porcupine quill. Yes, a porcupine quill sliding repeatedly up your veins. Aka: the stuff nightmares are made of. The only thing you are left with after receiving an IV is a sore, ugly, bruised, appendage. (Unless of course you NEED an IV to help keep you alive, then you are left with your life. Duh.). If we want to get real corny- I guess a paramedic learning to initiate IVs is also left with a beautiful skill that better enables us to care for the sick and injured. (Think about that next time you try to throw down with me Granny!)


(My hands the day after IV practice. We also kinda wear them like badges. It’s a weird relationship.)

Sasktatchewan has recently upgraded its PCP skill set to include IV therapy. We can also use this as a drug route for D50W and Narcan. As students we have to attempt a minimum of 10 IV starts in-class (my class has 4 people in it, do the math) with a success rate of 60%. These attempts must include a 20, 18, and 16 gauge catheter (successfully). By the way, the smaller the gauge- the bigger the needle (think of the mess a 22 vrs a 12 gauage shot gun makes…you get the idea). We then get sent off on clinical (in hospital or on the bus) where we must do 25 starts with an 80% success rate. We then get a gold star and can add IV therapy to our field skills.

Most of the youtube how-to videos on this topic are super lame. Honestly, I think you can look forward to me making my own in the future. For now though, you can check this one out.

This next video has a cool trick for finding valves (those thingys inside veins that keep the blood from flowing backwards). It’s neat.

I don’t really feel like explaining much more right now. I mostly wanted to complain about my hands. I wonder when we start learning how to do external jugular vein cannulation…


To all my patients out there,

I endured a substantial amount of pain in order to provide you care.

So be nice.

And you’re welcome.


PS- check out Origins-An Emergent Comedy on Facebook if you want some more dark EMS laughs. 😀 One of my faves.



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