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 insertion site. ^[1][2]
  • Common sites in adults and children
    • Antecubital fossae: preferred for fluids and medications used in resuscitation (e.g., adenosine)
    • Hand (commonly used): easily identifiable veins; distal location allows for subsequent proximal attempts.
  • Additional options for children include scalp veins and lower limb veins.
  • Avoid veins that are:
    • Hard (can be thrombosed)
    • Positioned over joints (can easily dislodge)
    • Too small for the desired catheter size (can lead to IV infiltration or IV extravasation)
    • Distal to open wounds and limb deformities
• Select the appropriate catheter size. ^[1]
  • Infants and young children: 22–24 gauge usually sufficient
  • Medication and maintenance fluids: 22 gauge usually sufficient
  • Blood products: 20 gauge or larger typically required
  • Large-volume fluid resuscitation: 16 gauge or larger preferred
• 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).

• Gloves
• Tourniquet
• Antiseptic solution
• IV catheters of appropriate length and gauge
• 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.

• IV infiltration
• IV extravasation
• 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