- IV access is usually needed for anesthesia care, laboring patients, trauma patients, hospital inpatients, and patient care requiring any of the following:
- Emergency administration of medications
- Fluid resuscitation
- Administration of blood products
- Elective administration of intravenous antibiotics, chemotherapeutic agents, or other treatments
- Administration of diagnostic substances, such as methylene blue, indocyanine green, indigo carmine, or intravenous contrast agents
- Patients donating blood products
Absolute Contraindications
Relative Contraindications
- Avoid extremities that have massive edema, burns, or injury; in these cases other IV sites need to be accessed.
- Avoid going through an area of cellulitis; the area of infection should not be punctured with a needle because of the risk of inoculating deeper tissue or the bloodstream with bacteria.
- Avoid extremities with an indwelling fistula; it is preferable to place the IV in another extremity because of changes in vascular flow secondary to the fistula.
- An upper extremity on the same side of a mastectomy should be avoided, particularly if an axillary node dissection was carried out, because of concerns of previous lymphatic system damage and adequate lymphatic flow.
- Very short procedures performed on pediatric patients, like placement of ear tubes
- Bleeding diathesis
- Medication administration that will take longer than 6 days (preference is then for a peripherally inserted central catheter)
- Type of fluid to be administered through peripheral IV is too caustic; hypertonic solutions and some therapeutic agents should not be infused in a peripheral IV.
- Gloves
- Appropriate catheter of case-appropriate size, commonly 18 gauge for adults, smaller for infants/neonates, and larger if large blood loss or rapid fluid resuscitation is predicted for the procedure
- IV set of tubing and bags
- Alcohol swabs
- Adhesive tape only or tape and clear adhesive dressing
- Gauze
- Tourniquet
The relevant anatomy depends upon placement of the IV catheter. Common sites of IV catheterization are as follows:
- Veins of the hand
- Veins in the forearm and arm
- Cephalic vein of the forearm and arm
- Basilic vein of the forearm and arm
- Median cubital vein in the antecubital fossa
- Veins in the dorsal foot
- Saphenous vein
- External jugular vein
- Veins of the scalp (usually in neonates)
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Figure 1
:
Supplies for placing the IV catheter.
Figure 2
:
IV sizes are identified by the colors of the hub. From left to right in decreasing size, 14 gauge (orange), 16 gauge (gray), 18 gauge (green), 20 gauge (pink), 22 gauge (blue), and (not pictured) 24 gauge (yellow).
Figure 3
:
The venous system. From Drake L, Vogl AW, Mitchell AWM, Tibbitts RM, Richardson PE: Gray’s Atlas of Anatomy. Philadelphia, Churchill Livingstone Elsevier, 2008, p 11.
Figure 4
:
Veins of the upper extremity, showing the dorsal venous network of the hand as well as the palmar venous network, including the basilic and cephalic veins of the forearm. From Drake L, Vogl AW, Mitchell AWM, Tibbitts RM, Richardson PE: Gray’s Atlas of Anatomy. Philadelphia, Churchill Livingstone Elsevier, 2008, p 423.
Figure 5
:
Veins of the arm: the basilic and cephalic veins. From Drake L, Vogl AW, Mitchell AWM, Tibbitts RM, Richardson PE: Gray’s Atlas of Anatomy. Philadelphia, Churchill Livingstone Elsevier, 2008, p 377.
Figure 6
:
Veins of the lower limb, demonstrating the veins of the dorsal venous arch of the foot and the great saphenous vein. From Drake L, Vogl AW, Mitchell AWM, Tibbitts RM, Richardson PE: Gray’s Atlas of Anatomy. Philadelphia, Churchill Livingstone Elsevier, 2008, p 344.
Figure 7
:
Anatomy of the head and neck, showing the external jugular vein. From Drake L, Vogl AW, Mitchell AWM, Tibbitts RM, Richardson PE: Gray’s Atlas of Anatomy. Philadelphia, Churchill Livingstone Elsevier, 2008, p 502.
Figure 8
:
Veins of the scalp as well as the vasculature, facial nerve, and lymphatics of the face. From Drake L, Vogl AW, Mitchell AWM, Tibbitts RM, Richardson PE: Gray’s Atlas of Anatomy. Philadelphia, Churchill Livingstone Elsevier, 2008, p 458.
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