Peripheral vascular access is commonly sought through the non-dominant upper extremity due to a reduced risk of dislodgement, thrombosis and thrombophlebitis. However, peripheral venous line cannulation can be done successfully through various sites in the body.
Peripheral Vascular Access Sites
Upper Extremity: The metacarpal veins on the dorsum of the hand drain proximally through the dorsal venous arch into the cephalic and basilic veins in the forearm. These connect by the median cubital and median antebrachial veins in the antecubital fossa region, prior to continuing up the arm.
Lower Extremity: lines may be placed from the dorsal venous plexus of the foot which become the great and small saphenous veins in the leg.
Scalp: may be appropriate in neonates or infants. Sites include the frontal, occipital, superficial temporal or posterior auricular veins.
Preferred veins for cannulation are straight, distal and non-branched (since venous valves are usually located close to branching points). When accessing a vein, a tourniquet is to be placed proximally to the site to create engorgement in the vein. Vein should feel spongy and should not pulsate on palpation (indication of an artery rather than a vein). Avoid veins that are hard to the touch due to possible thrombosis.
Indications for Peripheral Vascular Access
- administration of IV medications
- administration of IV fluids
- phlebotomy (prior to medication and/or fluids to avoid dilution or contamination of blood samples)
Contraindications for Peripheral Vascular Access
While there are no absolute contraindications for cannulation, there are relative contraindications for which clinical judgement on benefits and risks of procedure is warranted. These include:
- coagulopathy
- local infection
- burns
- compromised skin at planned insertion site
- previous lymphatic nodal clearance
- arteriovenous fistula formation
- deep vein thrombosis
In the case of extended treatment, it is best to opt for a central venous catheter rather than peripheral vascular access, as this offers lower failure rates in relation to long-term use.
Optimum PVA Outcome
- prompt placement of peripheral vascular access when required
- regular monitoring of line function
- consideration regarding need for venous access
- removal of lines when no longer indicated
- early intervention in the case of complications
Below you can find a collection of videos that can help provide a more visual approach to peripheral vascular access.
IV Cannulation OSCE
BD Venflon I IV Cannula
IV Insertion Common Mistakes
Special thanks to the creators of the featured videos on this post, specifically Youtube Channels Geeky Medics, BD and Practical Anesthesia Techniques.
Reference:
Beecham, G.B. & Tackling, G. (2020). Peripheral Line Placement. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK539795/ on 2nd June 2021
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Claire is keen about public education on health-related subjects as well as holistic patient-centered care. She is also passionate about spreading awareness on the negative effects that domestic abuse leaves on its victims’ mental, emotional, social and physical wellbeing.
Claire aspires to continue studying following completion of her Nursing Degree, because she truly believes in lifelong education.
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