Peripheral venous access

Peripheral venous access refers to a vascular catheter that terminates in a peripheral vein in an extremity, the scalp, or trunk. Indications may include IV fluid therapy, blood sampling, and medication administration. Contraindications include infection, tissue compromise, and thrombosis. It is important to determine the best site for insertion, select the right catheter size, and ensure all necessary equipment is at the bedside before performing the procedure. IV infiltration and IV extravasation are common complications.

• IV fluid therapy
• Blood product administration
• Medication administration
• Blood sampling
• Contrast administration for imaging studies

Contraindications to this procedure in the limb or intended insertion site include: ^[1]

• Infection or tissue compromise
• Previous lymph node dissection or proximal IV infiltration
• Thrombosis, fistula, or recent surgery

We list the most important contraindications. The selection is not exhaustive.

• Determine the best site for insertion. ^[1][2]
• Select the appropriate catheter size. ^[1]
  • Medication administration and maintenance fluids: 22 gauge catheter usually sufficient
  • Blood product administration: 20 gauge or larger catheter typically required
  • Large-volume fluid resuscitation: 16 gauge or larger catheter preferred
• Consider local anesthesia for the insertion site. ^[3]
• Ensure all necessary equipment is at the bedside.

Select proximal insertion sites (e.g., antecubital fossae) to administer resuscitative fluids and medication (e.g., adenosine).

• Gloves
• Tourniquet
• Antiseptic solution
• Intravenous catheters
• Sterile dressing
• Absorbent gauze
• Adhesive tape
• Saline lock or primed IV tubing
• Saline flush

1. Place a tourniquet 5–10 cm above the site of insertion.
2. Prepare the site with an antiseptic solution.
3. Apply traction to the skin with the nondominant hand.
4. Direct the needle into the vein at a 10–30° angle with the bevel facing upward.
5. Advance until blood flashback is seen.
6. Depress the angle of the needle and advance another 1–2 mm.
7. Slide the catheter off the needle.
8. Flush with saline or aspirate blood.
9. Apply a sterile dressing.

• Infiltration or extravasation: leakage or unintentional administration of solution or medication into the tissue surrounding a PIV catheter
  • IV infiltration: involves a nonvesicant substance (e.g., saline)
  • IV extravasation: involves a vesicant substance
• Inadvertent intraarterial placement
• Infection and/or thrombophlebitis
• Patient discomfort
• Thrombosis

We list the most important complications. The selection is not exhaustive.

• Tourniquet removed
• Sharps properly disposed of
• Sterile dressing applied
• Catheter placement verified
• IV function confirmed
• IV infiltration or IV extravasation ruled out