Peripheral IV placement

Overview

Superficial and deep veins of the upper limb.

• Most common method of obtaining vascular access, may be performed by several members of the healthcare team
• Typically inserted in the arm (median cubital vein, basilic vein, cephalic vein)
  • Alternative sites include forearm, wrist, hand, leg, foot, neck, or scalp

Indications

• IV fluid administration/blood products
• IV medications
• IV contrast for CT, MRI, or nuclear imaging
• IV nutritional support
• Repeated venous blood sampling

Contraindications

• No absolute contraindications
• Avoid infected, injured, or burned extremities if possible

Equipment Needed

• Tourniquet
• Transparent dressing (tegaderm)
• Nonsterile gloves
• Antiseptic solution (alcohol prep pad or chlorhexidine)
• 2X2 gauze
• Venous access device (16 gauge, 18 gauge, 20 gauge, etc.)
• Saline or heparin lock
• Tape (paper tape preferred)

Procedure

1. Prep equipment (open packages for items, prepare tape, prepare saline lock/IV line, identify sharps bin)
2. Apply tourniquet proximal to desired site
3. Cleanse site with antiseptic solution
4. Re-check vein
5. Insert needle, bevel up, at 10-30 degree angle, 1-2 cm distal to the desired target
6. Advance needle until flash of blood is identified in the cannula
7. Push needle forward an additional 2mm, then fix the needle and advance the rest of the catheter.
8. Release the tourniquet, apply pressure above insertion site, then remove needle completely
9. Dispose needle into sharps bin
10. Attach saline lock or IV extension line
11. Secure with tegaderm or tape

Complications

• Failure to access vein
• Extravasation of fluid/medication
• Arterial Puncture
• Thrombophlebitis

See Also

• Central venous catheterization
• Intraosseous access

External Links

• Merk Manual - How To Do Peripheral Vein Cannulation
• Merk Manual - How To Do Peripheral Vein Cannulation (Ultrasound-Guided)
• Alternate IV Access Sites