IV insertion area guidelines

Hello everyone,

I am looking for some guidelines on acceptable IV insertion spots and the dangers of using subprime areas - such as legs, shoulders, chest. Are their any places that are simply unacceptable to use and why? Finally if someone could point me to some best practice research that would be wonderful.

This case came up this weekend, where a patient had been poked around 7 times before I was called and I simply could not find an IV spot on her arms due to gross edema and cellulitis. Unfortunately she was dependent on levophed and upon arrival it had infiltrated into her wrist. The only spot I could find was the chest which had a great vein (surface) strong blood return, and flushing had the feel of fluid upstream from the insertion with no sign of infiltration. I wish I had someone who could put in a central line but no one was willing to do so.

I know it is not a good spot to place an IV, but the situation to me was a bit desperate and I truly could not see another spot (I tried in two others that both blew due to being spider fragile veins - and those were the only two I could see, which normally I would never have put an IV in except for the situation).

So if I could find some literature, perhaps we could revise our policy to push doctors to place central lines more often in cases where we lose IV's every 6hrs or where the only insertion site is a suboptimal space.

Thanks for any help you can provide

Pat