Peripheral Vascular Access – Sites, Indications & Contraindications

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.

peripheral vascular access
Retrieved from https://www.nursingtimes.net/clinical-archive/infection-control/vessel-health-and-preservation-2-inserting-a-peripheral-iv-vascular-cannula-01-05-2020/ on 1st June 2021

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.

Retrieved from https://www.jaypeedigital.com/book/9789351524229/chapter/ch18 on 1st June 2021
peripheral vascular access
Retrieved from https://www.quora.com/How-do-you-draw-blood-from-veins-in-the-foot-I-cant-find-any-veins-there on 1st June 2021

Scalp: may be appropriate in neonates or infants. Sites include the frontal, occipital, superficial temporal or posterior auricular veins.

peripheral vascular access
Retrieved from https://www.researchgate.net/figure/Simplified-schematic-of-the-arterial-supply-of-the-skull-lateral-view-Vessels_fig2_328171256 on 1st June 2021

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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