Cannulating right or wrong

We need a doctors order before going above the acf

In my experience, you're no more likely to hit an artery above the antecubital space than you are at or below it. And while it's not my first choice, I occasionally go there, especially with long term patients or patients with poor access options.

Out of curiosity, why does it require a physician order to go above the antecubital space?

Just our health authority policy. It's so we ding damage the vessels if a picc ends up being required

For what it's worth, our specially trained RNs who insert PIVs with ultrasound assistance go above the ACF at times. I've never heard of any issues.

This is where it pays to know your anatomy. The cephalic vein is on the lateral half of the bicep and has no artery or nerve near it. The basilic vein on the medial side can, but sometimes it's paired with the brachial branch still if you're not several inches proximal to the AC. No special orders, just good nursing judgement. No more risk of an arterial puncture when poking a palpable basilic vein compared to that same vein in the AC next to the brachial artery.

I work at a LVL 2 Trauma center, we place IVs where we find a vein: Chest wall/"boob veins", upper arm/"Canadian", toes (need Drs order), EJ, abdominal wall, even on the scalp in geriatric pts. Almost always just to get things started and give fluids. If they require multiple meds/drips pt will get US guided PIV, midline or even central line cath; depending on situation.