Peripheral venous access

Last updated: April 6, 2023

Summarytoggle arrow icon

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.

Indicationstoggle arrow icon

Contraindicationstoggle arrow icon

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

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

Preparationtoggle arrow icon

  • Determine the best insertion site. [1][2]
  • Select the appropriate catheter size. [1]
  • Other steps
    • Consider topical anesthesia for the insertion site in children. [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).

Equipment checklisttoggle arrow icon

Procedure/applicationtoggle arrow icon

  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.

Complicationstoggle arrow icon

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

Postprocedure checklisttoggle arrow icon

Pitfalls and troubleshootingtoggle arrow icon

Common pitfalls in peripheral intravenous line placement [1][4][5]
Challenge Interventions to consider
No visible vein
Needle does not enter vein
  • Increase counter traction on the skin.
  • Change insertion site or position of the patient's arm.
  • Increase the angle of insertion.
  • Assess the vein for possible occlusion using ultrasound.
Catheter does not advance
  • Needle has not been removed: Advance the needle-catheter unit forward 1–2 mm.
  • Needle removed: Gently flush the catheter and attempt to float the catheter forward.
Fluid does not run
  • Ensure the tourniquet has been removed.
  • Withdraw the catheter 1–2 mm and reassess.
Patient discomfort

Referencestoggle arrow icon

  1. Roberts JR. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. Elsevier ; 2018
  2. Pérez Fidalgo JA, García Fabregat L, Cervantes A, Margulies A, Vidall C, Roila F. Management of chemotherapy extravasation: ESMO–EONS Clinical Practice Guidelines. Ann Oncol. 2012; 23: p.vii167-vii173.doi: 10.1093/annonc/mds294 . | Open in Read by QxMD
  3. Bond M, Crathorne L, Peters J, et al. First do no harm: pain relief for the peripheral venous cannulation of adults, a systematic review and network meta-analysis. BMC Anesthesiol. 2015; 16 (1).doi: 10.1186/s12871-016-0252-8 . | Open in Read by QxMD
  4. Mbamalu D, Banerjee A. Classic techniques in medicine: Methods of obtaining peripheral venous access in difficult situations. Postgrad Med J. 1999; 75 (886): p.459-462.doi: 10.1136/pgmj.75.886.459 . | Open in Read by QxMD
  5. Eren H. Difficult Intravenous Access and Its Management. IntechOpen ; 2022

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