Is the inside of the wrist a safe site to start an IV

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    Hello fellow nurses, I am somewhat of a new RN, almost a year, and work at a SNF/LTC facility. Our patients are challenging for IV starts for a variety of reasons and finding a site is often difficult. I do always see veins in the inside of the wrist (distal anterior wrist) but I never start it there even if it is the only "good looking vein" simply because I never see patients with an IV started in that spot. I know it should be avoided since it is a place the patient will often bend, but are there other contraindications to starting and IV at this site? Is the inside of the wrist a safe site to start an IV ?

    I found an article on the internet that the first 3 inches of the inside of the wrist should not be used because there is a risk of hitting a nerve and causing permanent nerve damage. Dose any one know if this is true?
  2. 5 Comments so far...

  3. 0
    I don't have an intelligent answer, I don't know. Have never tried the area, sounds too painful!! Yikes!
  4. 0
    that is the rationale, as i remember
    Quote from whereisrebecca
    Hello fellow nurses, I am somewhat of a new RN, almost a year, and work at a SNF/LTC facility. Our patients are challenging for IV starts for a variety of reasons and finding a site is often difficult. I do always see veins in the inside of the wrist (distal anterior wrist) but I never start it there even if it is the only "good looking vein" simply because I never see patients with an IV started in that spot. I know it should be avoided since it is a place the patient will often bend, but are there other contraindications to starting and IV at this site? Is the inside of the wrist a safe site to start an IV ?

    I found an article on the internet that the first 3 inches of the inside of the wrist should not be used because there is a risk of hitting a nerve and causing permanent nerve damage. Dose any one know if this is true?
  5. 1
    In 2011 the Infusion Nurses Society changed their recommendation about this area. It is 33IA and states " Avoid the lateral surface of the wrist for approx 4-5 inches b/c of the potential for nerve damage". They are referring to the area and vein jokingly called the" interns vein" b/c on autopsy they have found that the radial nerve crosses over the vein in 3 places so the potential to hit that nerve is fairly high. Nerve damage can cause chronic pain syndromes (regional pain syndromes and such) and many a patient has sued and won due to having to deal with chronic pain.

    The volar wrist is also a very vulnerable area and it it also painful so yes it should be avoided as well. it is also an area of flexion which will increase the rate and severity of phlebitis and leaking at the site.

    If you ever do hit a nerve with the point of your needle...immediately pull it out. The patient will report feeling an electric shock sensation. That usually solves the problem but with IV sites if the nerve sustains prolonged pressure or irritation the pain can become chronic. We have to be extremely careful when placing PICCs especially though the brachial vein as there is a rather large nerve and nerve bundle there. We have even had to remove a PICC on a few occasions b/c we determined the PICC was irritating the nerve there.

    It is tempting to use the wrist sites..but STOP yourself as many of the lawsuits related to IV therapy have been caused by IV statts in that location. better to spend the extra time looking for a better location.
    SeaH20RN likes this.
  6. 0
    So, this precludes using the "snuff pocket" too. oh well, good to know.
    Quote from iluvivt
    In 2011 the Infusion Nurses Society changed their recommendation about this area. It is 33IA and states " Avoid the lateral surface of the wrist for approx 4-5 inches b/c of the potential for nerve damage". They are referring to the area and vein jokingly called the" interns vein" b/c on autopsy they have found that the radial nerve crosses over the vein in 3 places so the potential to hit that nerve is fairly high. Nerve damage can cause chronic pain syndromes (regional pain syndromes and such) and many a patient has sued and won due to having to deal with chronic pain.

    The volar wrist is also a very vulnerable area and it it also painful so yes it should be avoided as well. it is also an area of flexion which will increase the rate and severity of phlebitis and leaking at the site.

    If you ever do hit a nerve with the point of your needle...immediately pull it out. The patient will report feeling an electric shock sensation. That usually solves the problem but with IV sites if the nerve sustains prolonged pressure or irritation the pain can become chronic. We have to be extremely careful when placing PICCs especially though the brachial vein as there is a rather large nerve and nerve bundle there. We have even had to remove a PICC on a few occasions b/c we determined the PICC was irritating the nerve there.

    It is tempting to use the wrist sites..but STOP yourself as many of the lawsuits related to IV therapy have been caused by IV statts in that location. better to spend the extra time looking for a better location.
  7. 0
    LOL, whether its recommended or not, no way in HE.. would I let anyone start an IV for me there, ergo, I would never do that to a patient!


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