Clinical Education - Intravenous Therapy Skills

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Veins Used for IV Therapy

Part of the task of initiating IV therapy is choosing a vein suitable for venipuncture. There are four basic things to consider when selecting a vein for venipuncture: location, condition of the vein, purpose of the infusion and duration of the IV therapy. A catheter can be placed in a peripheral vein (peripheral access) or in a central vein (central access). A registered nurse with proper training may initiate peripherally inserted central catheter (PICC) lines.

The Center for Disease Control (CDC) states that in all patients, the upper extremity should be used in preference to the lower extremities for intravenous therapy. This is because peripheral IVs placed in the lower extremities are associated with stagnant blood flow, which increases risk for thrombus, and infection. Additionally, venipuncture of veins in the lower extremity tends to be more difficult due to the condition of the veins. If a lower extremity IV site already exists, it should be changed to an upper extremity site as soon as possible.

Peripheral Veins of the Upper Extremity

Digital veins. Digital veins flow along the lateral portions of the figners and are joinged to each other by communication branches. They are used as a last resort for fluid administration.

Metacarpal veins. Formed by the union of the digital veins. Metacarpal veins lie flat between the joints and metacarpal bones of the dorsal aspect of the hand. These veins tend to be a good place for venipuncture because the metacarpus bones make for a natural splint. Occasionally using this site for venipuncture in the elderly is contraindicated due to inadequate tissue and this skin in this area, which may allow extravasation of blood.

Cephalic vein. Located on the dorsal aspect of the hand and continues upward along the radial border of the forearm. This vein is an excellent vein to use for peripheral IV access. The Accessory Cephalic Vein (usually on the back of the arm - or volar aspect) joins the cephalic vein just below the elbow.

Basilic vein. Originates from metacarpal veins and ascends the arm along the ulnar portion of the upper forearm. This vein is often over-looked because of the location.

Median vein. There are two types of median veins. The median antebrachial vein arises from the venous plexus on the palm and extends upward along the ulnar side of the forearm. The median cephalic/median basilic vein is in the antecubital space. It is most commonly used for blood draw. It is not usually a desirable IV site for routine IV therapy because of the common displacement of the catheter associated with arm movement. However, in emergency situations, it is an ideal location for venipuncture.

Median cephalic vein. Located in the antecubital fossa, it crosses in front of brachial artery, therefore, one must use caution when choosing this site for IV administration.

Median basilic vein. Located on the outside of antecubital fossa on the ulnar curve of the arm and is least desirable for venipuncture; hematoma may occur if patient flexes elbow.

Median antebrachial. Arises from the venous plexus on the palm of the hand and extends along the ulnar side of the front lower forearm.

Young Children and Infants

Sites for children include hand and arms as described above. In newborns, scalp veins and veins of the lower extremity are typically used. Blood flow in scalp veins usually circulates from the crown to the neck. Use of a vein in the lower extremity of a child who is walking is not recommended.

Intravenous Therapy Skills Course

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