creation date: 2026-04-29 14:53
tags: Interventions
Peripheral IV Access
Background
IV access is used for blood samples, IV medications, and fluids. High volume fluid resuscitation requires a large bore IV catheter (#16).
Contraindications
- Extremities that have massive edema, burns, injury
- Possible injury between extremity and heart (eg. upper extremity is preferred in cases of abdominal injury)
- Areas with cellulitis
- Extremities on side of a mastectomy or indwelling fistula
Complications
- Infection at site
- Development of superficial thrombophlebitis in vein cannulated
Peripheral IV Sites
The site is typically chosen as the most peripheral site that is available and appropriate for the situation. This allows for attempts at more proximal sites if attempt fails (doing otherwise may result in leaking at failed sites).
Generally, the order is as follows:
- Dorsum of hand
- Forearm veins
- Median cubital vein
In cases of trauma, the median cubital may be attempted immediately as it will accommodate a large bore IV easily.
If the upper extremity veins are not accessible:
- Dorsum of the foot
- Saphenous vein of lower leg
Preparation
The potential for contact with patient blood is high. PPE includes:
- Gloves
- Face and eye protection
- Gown
Equipment at bedside should include:
- Gloves
- Non-latex torniquet
- Alcohol swabs
- IV cannula
- 2x2 gauze
- Tegaderm dressing
- Tape
- IV bag with tubing (flushed and ready)
- Sharps container
Procedure
Step 1: Apply tourniquet and prepare skin
- Apply tourniquet to IV arm above the site
- Visualize and palpate the vein
- Cleanse site with alcohol swab
Step 2: Insert Cannula
- Prepare and inspect cannula; ensure the plastic cannula is set back from the tip of the needle
- Stabilize the vein using non-dominant hand and apply and maintain countertension to skin
- Insert the cannula through skin at 30 degree angle with bevel side up; observe for flashback
- Reduce the angle of needle and advance ~5 mm further into the vein (to get plastic cannula is within the lumen as well)
- Slowly advance the catheter over the needle and into the vein, still maintaining countertension; there should be no resistance as that would indicate the tip is hitting a valve or outside the lumen
- Once the plastic cannula is inserted so only the coloured hub is visible, release countertension of the skin and the tourniquet
- Occlude the vein distal to the tip of the cannula by pressing down using non-dominant hand
- Press white button to trigger spring loaded safety mechanism to return needle to plastic chamber; note: still treated as a sharp
- Dispose of sharps
- Reconfirm IV tubing has been flushed and attach to cannula; secure with tegaderm and tape